We propose to conduct a comparative effectiveness study of screening and diagnostic breast imaging modalities and breast biopsies in accurately diagnosing breast cancer. Results will aid clinicians and policymakers in selecting among breast cancer detection methods while minimizing over-diagnoses and unnecessary biopsies. Several knowledge gaps in the area of breast cancer diagnosis require further study. Specifically, the evidence regarding whether digital mammography is more accurate than conventional film- screen mammography for screening certain patient subgroups is insufficient. Use of computer-aided detection to assist in interpreting images is gaining widespread use, but the evidence for improved accuracy with this technology is incomplete. There are also knowledge gaps in effectiveness for diagnostic ultrasound and magnetic resonance imaging. We propose a natural experiment to examine the comparative effectiveness of different imaging modalities and breast biopsy procedures in diagnosing breast cancer. We are partnering with Advocate Health Care (AHC), the largest integrated not-for-profit health care delivery system in the metropolitan Chicago region and one of the top 10 of its kind in the nation. Advocate patients are urban and suburban and have diverse racial/ethnic and socioeconomic backgrounds, and they reflect variation in breast cancer risk in the general population. The Illinois State Cancer Registry (ISCR) is one of the most highly recognized population-based cancer registries in the nation. After linking data from the AHC radiology database for years 2001 through 2011 with incident breast cancer cases from ISCR through 2012, we will model accuracy measures for different imaging and biopsy procedures stratified by important clinical characteristics. We will also evaluate the accuracy of imaging and biopsy procedures in detecting more aggressive breast cancer subtypes and more difficult to detect histologies. All models will adjust finely for measured facility, radiologist and patient characteristics, and calendar time. We will also examine how changes over time in clinical practices and introduction of new technologies may have affected imaging and biopsy accuracy. The sample size for this proposed study would far exceed any prior study on the topic of screening and diagnostic imaging accuracy in breast cancer. This is a highly innovative natural experiment that proposes to examine relations across the continuum of breast cancer screening, diagnostic imaging, and breast biopsy as practiced in a real-world setting. Given the large sample size and the proposed collection of detailed information on potential confounders, we believe that our study will make a substantial contribution to the literature and to future clinical, administrative, and policy decision-making.

Public Health Relevance

The goal of this study is to examine the comparative effectiveness of breast imaging and biopsy procedures in ruling in or ruling out a breast cancer diagnosis. This study will create generalizeable knowledge that can be used by clinicians and policymakers to maximize breast cancer detection while minimizing over-diagnoses and unnecessary biopsies. Results of this study will allow clinicians (including primary care physicians, radiologists, and breast health specialists), managed care organizations, health insurance companies, and government payers (including CMS and state Medicaid agencies) to make more informed decisions regarding the use of diagnostic imaging and biopsy procedures for specific patient subgroups.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS018366-03
Application #
8326993
Study Section
Health Care Technology and Decision Science (HTDS)
Program Officer
Lawrence, William
Project Start
2010-09-01
Project End
2015-08-31
Budget Start
2012-09-30
Budget End
2013-08-31
Support Year
3
Fiscal Year
2012
Total Cost
Indirect Cost
Name
University of Illinois at Chicago
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
098987217
City
Chicago
State
IL
Country
United States
Zip Code
60612
Allgood, Kristi L; Rauscher, Garth H; Whitman, Steven et al. (2014) Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 23:1649-58
Rauscher, Garth H; Murphy, Anne Marie; Orsi, Jennifer M et al. (2014) Beyond the mammography quality standards act: measuring the quality of breast cancer screening programs. AJR Am J Roentgenol 202:145-51
Rauscher, Garth H; Conant, Emily F; Khan, Jenna A et al. (2013) Mammogram image quality as a potential contributor to disparities in breast cancer stage at diagnosis: an observational study. BMC Cancer 13:208