Role of Advanced Screening Technologies in Early Detection of Breast Cancer

描述(由申请人提供)：先进筛查技术在乳腺癌早期检测中的作用项目摘要/摘要本申请涉及广泛的挑战领域(05)：比较有效性研究和特定挑战主题，05-CA-105 CISNET(癌症干预和监测建模网络)。这项研究的目标是评估先进筛查技术对乳腺癌筛查的益处。它计划应用Lee和Zelen(2008)开发的随机模型来解决先进筛查技术在乳腺癌早期检测中的有效性。Lee-Zelen模型(2008)是作为CISNet乳房组的一部分开发的。该模型预测乳腺癌死亡率作为疾病自然病史和检测过程的函数。该模型的主要假设是：i)乳腺癌是一种进展性疾病，ii)筛查带来的死亡率得益于诊断的阶段转变。在迅速崛起的先进筛查技术中，数字乳房摄影(DM)和磁共振成像(MRI)被报道在诊断乳腺癌方面更敏感。然而，与这些筛查方式相关的死亡率效益尚未得到评估。这笔赠款将重点评估糖尿病和核磁共振筛查对死亡率的好处。数字乳房X光成像筛查试验表明，在筛查50岁以下的妇女或任何年龄的乳房致密的妇女方面，DM明显比胶片乳房X光检查更敏感(Pisano等人，2005年)。在检测具有乳腺癌遗传易感性的女性中，MRI已被证明比乳房X光检查更敏感(Kreige等人，2004年；Leach等人，2005年)。将研究的一个重要问题涉及使用DM和MRI的最佳筛查策略。筛查计划的特征是：i)开始筛查计划的年龄，ii)检查之间的时间和3)可能结束筛查的年龄。这些变量的潜在排列如此之多，以至于临床试验不可能检查所有可能的排列。此外，随机试验是不可行的。调查这一问题的唯一方法是建立一个筛查过程的分析模型，该模型结合了疾病的主要特征和筛查过程。基于风险的筛查计划的潜在节省是巨大的。具体地说，它计划：评估50岁以下妇女和任何年龄的乳房致密的妇女中糖尿病的死亡率益处。估计糖尿病如果在美国人口中传播可能带来的死亡率好处。评估MRI对罹患乳腺癌风险较高的女性的死亡率益处。找到取决于乳房密度的最佳筛查检查时间表。根据DM和MRI筛查方式的风险状况，研究最佳筛查策略。先进筛查技术在乳腺癌早期发现中的作用 公共卫生相关性：磁共振成像(MRI)可用于高危人群的乳腺癌筛查，数字乳房X光检查可能有利于筛查乳房致密的女性。该项目将使用Lee-Zelen(2008)的数学模型来评估死亡率收益，并为这些先进的筛查模式找到最佳的筛查策略。由于很难使用随机临床试验来研究这些问题，数学模型可以在理解这些筛查模式的潜在收益方面做出重大贡献。

DESCRIPTION (provided by applicant): Role of Advanced Screening Technologies for Early Detection of Breast Cancer Project Summary/Abstract This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic, 05-CA-105 CISNET (The Cancer Intervention and Surveillance Modeling Network). The goals of this research are targeted at evaluating the benefits associated with advanced screening technologies for breast cancer screening. It is planned to apply the stochastic model developed by Lee and Zelen (2008) to address the effectiveness of advanced screening technologies in the early detection of breast cancer. The Lee-Zelen model (2008) has been developed as part of the CISNET breast group. The model predicts breast cancer mortality as a function of the disease natural history and detection process. The principal assumptions of the model are that: i) breast cancer is a progressive disease and ii) mortality benefit from screening is due to a stage shift in diagnosis. Among the rapidly emerging advanced screening technologies, digital mammography (DM) and magnetic resonance imaging (MRI) have been reported to be more sensitive in diagnosing breast cancer. However the mortality benefit associated with these screening modalities has not been evaluated. This grant will focus on evaluating the mortality benefit from DM and MRI screening. The digital mammographic imaging screening trial showed that DM was significantly more sensitive than film mammography in screening women under age 50 or women of any age with very dense breasts (Pisano et al., 2005). MRI has been shown to be more sensitive than mammography in detecting breast cancer in women with inherited susceptibility to breast cancer (Kreige et al., 2004; Leach et al., 2005). An important issue which will be investigated deals with optimal screening strategies using DM and MRI. A screening program is characterized by: i) the age to begin a screening program, ii) the times between examinations and 3) possibly the age to end screening. There are so many potential permutations of these variables that clinical trials cannot possibly examine all of the possible permutations. Furthermore randomized trials are not feasible. The only way to investigate the problem is to have an analytical model of the screening process which incorporates the main features of the disease and the screening process. The potential savings of having screening programs based on risk are enormous. Specifically it is planned to: Estimate the mortality benefit of DM in women under age 50 and women of any age with dense breasts. Estimate the potential mortality benefit of DM if disseminated in the U.S. population. Estimate the mortality benefit of MRI in women with elevated risk of developing breast cancer. Find optimal screening exam schedules which depend on breast density. Investigate optimal screening strategies by risk status for DM and MRI screening modalities. Role of Advanced Screening Technologies for Early Detection of Breast Cancer PUBLIC HEALTH RELEVANCE: Magnetic resonance imaging (MRI) may be utilized for breast cancer screening in high risk populations and digital mammography may be advantageous for screening women with dense breasts. This project will use the Lee-Zelen's (2008) mathematical model to evaluate mortality benefit as well as to find optimal screening strategies for these advanced screening modalities. As it is difficult to investigate these problems using randomized clinical trials, mathematical models can make a significant contribution in understanding the potential gain from these screening modalities.