Decades of breast cancer screening research demonstrating a 20-30% reduction in breast cancer mortality, has led to one of the most successful public health efforts in the U.S. with over 33 million women a year in this country undergo screening mammography. In spite of the tremendous research and health care delivery efforts that have gone into breast cancer screening, optimization remains hampered by the key issues including: a) continued excess mortality and advanced stage of breast cancer;b) demonstrated harms associated with breast cancer screening;c) ambiguity over specific guidelines;d) emergence of new technologies. These issues have been, and continue to be addressed through randomized controlled trials (RCTs) and observational studies of individuals. However, breast cancer screening occurs within complex systems of health care delivery, encompassing individuals, providers, facilities, organizations, and communities. The goal of screening 'the right women with the right test at the right time'is likely to only be achieved by studying breast cancer screening processes within a framework that encompasses individual, provider, and practice-level factors. A shortcoming of prior work has been a relative lack of examining system factors that determine processes of care and ultimately screening outcomes. Recent health care reform initiatives emphasize preventive care, a medical home model, accountability, and use of information systems ? all of which operate at a systems-level. After at least two decades of breast cancer screening research, a shift to examining the screening process as it plays out within systems is necessary to further improve the effectiveness of screening, and to optimize it for individual women and for populations. This project will provide a systems approach to the entire screening process and will integrate health information technology (IT) into improvement strategies to advance quality, and ultimately women's outcomes. Our main objective is to improve breast cancer screening systems through measurement and feedback through the following specific aims: (1) use a microsystems approach, map the entire breast screening process within heterogeneous health care delivery systems, develop generalizable metrics of process indicators for providers and practices, and assess process change in a health information technology environment;(2) characterize process and screening outcomes in relation to woman-, provider-, and practice-level correlates;and (3) develop and implement a provider and practice-level dashboard tool to measure and report metrics for breast cancer screening processes. This research will provide critical evidence of how breast cancer screening systems work overall, which system factors are salient, and for which subgroups of women, and will begin to contribute tools for improving delivery processes in order to achieve the greatest benefit with the least harm for women individually and from a population level.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center--Cooperative Agreements (U54)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-R)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Dartmouth College
United States
Zip Code
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
McCarthy, Anne Marie; Kim, Jane J; Beaber, Elisabeth F et al. (2016) Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity. Am J Prev Med 51:507-12
Conant, Emily F; Beaber, Elisabeth F; Sprague, Brian L et al. (2016) Breast cancer screening using tomosynthesis in combination with digital mammography compared to digital mammography alone: a cohort study within the PROSPR consortium. Breast Cancer Res Treat 156:109-16
Weiss, Julie E; Goodrich, Martha; Harris, Kimberly A et al. (2016) Challenges With Identifying Indication for Examination in Breast Imaging as a Key Clinical Attribute in Practice, Research, and Policy. J Am Coll Radiol :
Kim, Jane J; Tosteson, Anna Na; Zauber, Ann G et al. (2016) Cancer Models and Real-world Data: Better Together. J Natl Cancer Inst 108:
Tosteson, Anna N A; Beaber, Elisabeth F; Tiro, Jasmin et al. (2016) Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium. J Gen Intern Med 31:372-9
Haas, Jennifer S; Sprague, Brian L; Klabunde, Carrie N et al. (2016) Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines. J Gen Intern Med 31:52-9
Chen, Jane S; Sprague, Brian L; Klabunde, Carrie N et al. (2016) Take the money and run? Redemption of a gift card incentive in a clinician survey. BMC Med Res Methodol 16:25
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
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

Showing the most recent 10 out of 22 publications