Risk-based Imaging Strategies to Improve Breast Cancer Surveillance Outcomes

项目摘要-项目3目前，美国有280万有乳腺癌个人病史(PHBC)的妇女面临多年的成像监测。乳房影像监测的目的是及早发现第二次乳癌事件，无论是局部复发还是另一乳房的新癌，目的是降低乳腺癌死亡率。原发性乳腺癌的治疗策略通常会考虑妇女的临床和肿瘤特征。然而，与治疗指南不同的是，目前的监测指南建议对所有患有PHBC的妇女进行年度乳房X光检查，而不考虑风险。有了关于肿瘤生物学的新信息和新兴的成像技术(数字乳房断层合成和乳房核磁共振)，我们可以转向女性及其医生基于风险的监测决策。尽管新的成像方法在筛查方面显示出了希望，但它们改善早期第二乳腺癌检测和长期结果的能力尚未确立。该项目的总体目标是促进从所有妇女的年度乳房X光检查的单一战略转变为个性化的、基于风险的战略，纳入所有可用的成像模式和对妇女监测结果风险的可靠估计。我们建议结合女性的风险因素和肿瘤特征，为重要的监督乳房X光检查结果产生风险估计：好处(早期发现第二次浸润性乳腺癌)和失败(在阴性乳房X光检查后发现第二次乳腺癌的间隔时间)。早期证据表明，妇女的风险因素、原发乳腺癌的特征、确诊时的年龄、检测模式和治疗选择可以用来确定那些可能从其他监测策略(单独进行断层合成或乳房X光检查和核磁共振)中受益的高危妇女。此外，监测失败风险较低的女性可以通过单独接受乳房X光检查或断层合成，将错误警报的风险降至最低。我们的科学前提是，与指南推荐的年度乳房X光检查相比，量身定做的战略将通过减少监测失败和错误警报来改善监测结果。我们的具体目标是： 目的1：在患有PHBC的女性中，确定监视断层摄影与数字乳腺摄影的利弊。 目的2：开发新的风险预测模型，以识别和直接比较女性监测乳房X光检查结果的累积绝对风险。 该项目将结合临床和成像风险因素，评估重要的监测好处、失败和错误警报的风险，支持从“一刀切”的年度监测战略转向针对患有PHBC的妇女的个性化、基于风险的战略。

PROJECT SUMMARY – Project 3 Currently, 2.8 million women in the United States with a personal history of breast cancer (PHBC) face years of imaging surveillance. Breast imaging surveillance is aimed at the early detection of second breast cancer events, either local recurrence or new cancers in the other breast, with the goal of decreasing breast cancer mortality. Treatment strategies for primary breast cancers routinely take into account women's clinical and tumor characteristics. However, unlike treatment guidelines, current surveillance guidelines recommend annual mammography for all women with a PHBC regardless of risk. With new information about tumor biology and emerging imaging technologies (digital breast tomosynthesis and breast MRI), we can move toward risk-based surveillance decision making by women and their physicians. Although new imaging methods show promise for screening, their ability to improve early second breast cancer detection and longer-term outcomes is not yet established. The overall goal of this project is to facilitate a shift from a single strategy of annual mammography for all women to individualized, risk-based strategies, incorporating the full range of available imaging modalities and reliable estimates of a woman's risk of surveillance outcomes. We propose to integrate women's risk factors and tumor characteristics to produce risk estimates for important surveillance mammography outcomes: benefits (early detection of second invasive breast cancer), and failures (interval detection of second breast cancer after negative mammography). Early evidence suggests that women's risk factors, primary breast cancer characteristics, age at diagnosis, mode of detection, and treatment choices can be used to identify women at high risk of surveillance mammography failure who might benefit from alternative surveillance strategies (tomosynthesis alone or mammography and MRI). In addition, women at low risk of surveillance failure could minimize their risk of false alarms by receiving mammography or tomosynthesis alone. Our scientific premise is that tailored strategies will improve surveillance outcomes by reducing both surveillance failures and false alarms compared with guideline-recommended annual mammography alone. Our specific aims are: Aim 1: Determine the benefits and harms of surveillance tomosynthesis compared with digital mammography among women with a PHBC. Aim 2: Develop novel risk prediction models to identify and directly compare a woman's cumulative absolute risk of surveillance mammography outcomes. This project will combine clinical and imaging risk factors to estimate risks of important surveillance benefits, failures, and false alarms, supporting a shift away from a "one size fits all" annual surveillance strategy, toward individualized, risk-based strategies for women with a PHBC.