almost 20% of breast cancer diagnoses, and neariy 30% of screen-detected breast cancers, are DCIS. Since limitations in our understanding ofthe natural history of DCIS prevent identification ofwhich DCIS tumors will progress into invasive cancers, the management of DCIS requires treatment similar to therapies for Invasive breast cancer even though relative survival after DCIS approaches 100%. Researchers are actively searching for methods to optimize the screening process by identifying prognostic markers to identify DCIS with malignant potential.
We aim to (1) compare current screening processes with a comprehensive, personalized breast cancer screening process that considers DCIS prognostic markers such as those under investigation in Projects 1 and 2. We further aim to (2) perform subgroup analyses to determine how the use of new DCIS prognostic markers affects the benefits and harms of screening for women with varying rates of DCIS (e.g., by age and race), and to (3) evaluate the impact of increasing digital mammography and MRI use on DCIS incidence, overtreatment, and the comparative effectiveness of new DCIS prognostic markers. To address these aims, we will use the University of Wisconsin Breast Cancer Simulation (UWBCS) model to examine comparative effecfiveness at the population level. The UWBCS model, developed as part of the Cancer Inten/ention and Surveillance Modeling Network (CISNET), Is a discrete-event, stochastic simulation model designed to replicate breast cancer incidence and mortality rates in the U.S. population. Data from the Vermont Breast Cancer Surveillance System and other sources, including the Wisconsin In Situ Cohort, will provide essential new inputs to the UWBCS model for this project. Multiple measures of the benefits and harms associated with breast cancer screening will be evaluated. Simulation modeling is ideally suited for comparative effectiveness since numerous screening process variables can be considered simultaneously, data sources can be combined to address gaps, and long term outcomes can be evaluated in a timely manner. Our comparative effectiveness analysis will provide a framework by which new prognostic markers can be evaluated for their potential impacts on the benefits and harms of screening, with a focus on those breast cancer diagnoses with excellent prognosis that are primarily only found through screening. This project will address a critical need to assess whether novel new personalized treatment decision-making approaches tied to emerging screening tests can maximize quality of life by avoiding overtreatment in all populations.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Specialized Center--Cooperative Agreements (U54)
Project #
5U54CA163303-03
Application #
8567666
Study Section
Special Emphasis Panel (ZCA1-SRLB-R)
Project Start
Project End
Budget Start
2013-06-01
Budget End
2014-05-31
Support Year
3
Fiscal Year
2013
Total Cost
$225,547
Indirect Cost
$68,229
Name
University of Vermont & St Agric College
Department
Type
DUNS #
066811191
City
Burlington
State
VT
Country
United States
Zip Code
05405
Onega, Tracy; Lee, Christoph I; Benkeser, David et al. (2016) Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related? J Am Coll Radiol 13:611-9
Carney, Patricia A; Allison, Kimberly H; Oster, Natalia V et al. (2016) Identifying and processing the gap between perceived and actual agreement in breast pathology interpretation. Mod Pathol 29:717-26
Corley, Douglas A; Haas, Jennifer S; Kobrin, Sarah (2016) Reducing Variation in the "Standard of Care" for Cancer Screening: Recommendations From the PROSPR Consortium. JAMA 315:2067-8
Hubbard, Rebecca A; Ripping, Theodora M; Chubak, Jessica et al. (2016) Statistical Methods for Estimating the Cumulative Risk of Screening Mammography Outcomes. Cancer Epidemiol Biomarkers Prev 25:513-20
Mandelblatt, Jeanne S; Stout, Natasha K; Schechter, Clyde B et al. (2016) Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies. Ann Intern Med 164:215-25
Schapira, Marilyn M; Sprague, Brian L; Klabunde, Carrie N et al. (2016) Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice. J Gen Intern Med 31:1148-55
Sprague, Brian L; Conant, Emily F; Onega, Tracy et al. (2016) Variation in Mammographic Breast Density Assessments Among Radiologists in Clinical Practice: A Multicenter Observational Study. Ann Intern Med 165:457-464
Hubbard, Rebecca A; O'Meara, Ellen S; Henderson, Louise M et al. (2016) Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S. Prev Med 89:169-77
Klabunde, Carrie N; Zheng, Yingye; Quinn, Virginia P et al. (2016) Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly. Am J Prev Med 51:e67-75
Valeri, Linda; Chen, Jarvis T; Garcia-Albeniz, Xabier et al. (2016) The Role of Stage at Diagnosis in Colorectal Cancer Black-White Survival Disparities: A Counterfactual Causal Inference Approach. Cancer Epidemiol Biomarkers Prev 25:83-9

Showing the most recent 10 out of 55 publications