Breast Cancer Screening Strategies in the Era of New Technologies

项目摘要-项目2数字乳房断层成像在乳腺癌筛查中的应用迅速增加，超过了社区环境中对整个妇女和特定人群有效的证据。新出现的证据表明，断层合成可能会降低召回率，同时提高癌症检测能力。然而，关键的问题仍然存在：关于筛查结果改善的早期报告是否超出了最初的筛查周期，并在社区中可持续；断层合成的结果是否因妇女的特征而异；断层合成是否等于或优于补充的MRI筛查；以及额外发现的癌症是否有可能导致乳腺癌发病率和死亡率的降低。随着以断层合成作为主要筛查方式的迅速转变，需要彻底了解其在跨妇女亚群的社区环境中的有效性。在我们目前的P01中，利用乳腺癌监测联盟(BCSC)丰富的数据资源，我们已经证明了女性水平特征对数字化乳房X光检查结果的重要性。鉴于断层合成在BCSC中的快速吸收，现在可以检查与女性水平因素相关的断层合成筛查结果，并量化利弊平衡。我们的总体项目目标是确定最有效的筛查战略，将新的筛查技术纳入基于妇女风险因素的社区实践中。我们假设，对于某些(但不是所有)女性来说，断层合成将比数字乳房X光检查表现得更好，有些女性可能会从多模式筛查中受益。我们还将评估断层合成是否可以减少数字乳房X光检查漏诊癌症风险较高的女性对补充磁共振成像(MRI)的需求。我们的具体目标是： 目的1)根据妇女的特征，确定与数字乳房X光摄影相比，筛查体层摄影的好处和坏处 目的2)确定补充MRI的多模式筛查与单纯断层合成筛查的益处和危害；以及 目的3)通过模拟建模(结合比较有效性核心)，评估在风险组中进行补充MRI的多模式筛查与单独进行断层合成筛查的长期益处和危害。 这个项目将填补关于断层合成和多模式筛查有效性的关键知识空白，我们相信这将直接转化为可操作的筛查指南

PROJECT SUMMARY – Project 2 Digital breast tomosynthesis use has rapidly increased for breast cancer screening, outpacing evidence of effectiveness in community settings for women overall and for specific populations. Emerging evidence suggests tomosynthesis may lower recall rates while simultaneously improving cancer detection. However, critical questions remain: whether early reports of improved screening outcomes remain beyond initial screening rounds and are sustainable in community settings; whether tomosynthesis outcomes vary based on women’s characteristics; whether tomosynthesis is equal to or outperforms supplemental MRI screening; and whether additional cancers detected are likely to lead to reduced morbidity and mortality from breast cancer. With the rapid shift to tomosynthesis as the dominant screening modality, a thorough understanding of its effectiveness in community settings across subgroups of women is needed. In our current P01, using the rich data resource of the Breast Cancer Surveillance Consortium (BCSC), we have demonstrated the importance of woman-level characteristics on digital mammography screening outcomes. Given the quick uptake of tomosynthesis in the BCSC, it is now possible to examine outcomes of tomosynthesis screening in relation to woman-level factors and to quantify the benefit-harm balance. Our overall project objective is to identify the most effective screening strategies that incorporate new screening technologies in community practice based on women's risk factors. We hypothesize that tomosynthesis will perform better than digital mammography for some, but not all, women and that there are some women who may benefit from multi-modal screening. We will also evaluate whether tomosynthesis can reduce the need for supplemental magnetic resonance imaging (MRI) in women at high risk of a missed cancer on digital mammography. We specifically aim to: Aim 1) determine the benefits and harms of screening tomosynthesis compared to digital mammography based on women's characteristics Aim 2) determine the observed benefits and harms of multi-modality screening with supplemental MRI versus tomosynthesis alone; and Aim 3) evaluate the long- term benefits and harms from multi-modality screening with supplemental MRI versus tomosynthesis screening alone across risk groups through simulation modeling (in conjunction with the Comparative Effectiveness Core). This project will fill critical knowledge gaps regarding the effectiveness of tomosynthesis and multi-modality screening, which we believe will have direct translation into actionable screening guidelines