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Kaye AJ, Atkin S, Ziobro A, Donnelly J, Ahlawat S. Analysis of the economic burden of docusate sodium at a United States tertiary care center. Hosp Pract (1995) 2023; 51:168-173. [PMID: 37334679 DOI: 10.1080/21548331.2023.2225964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES The primary objective was to determine the financial resources allocated to docusate at a representative U.S. tertiary care center. Secondary objectives included comparing docusate utilization between two tertiary care centers, and exploring alternative uses for the funds spent on docusate. METHODS The study population included all patients 18 years and older admitted to University Hospital in Newark, New Jersey. Every scheduled docusate prescription for the study population between January 1st, 2015 and December 31st, 2019 was collected. The annual total cost associated with docusate use per year was calculated. The 2015 data from this study and a 2015 McGill University Health Centre study were compared. Also, alternative uses for the money utilized on docusate were assessed. RESULTS Over the study period, 37,034 docusate prescriptions and 265,123 docusate doses were recorded. The average cost of prescribing docusate was $25,624.14 per year and $49.37 per hospital bed per year. A comparison between the 2015 data of University Hospital and McGill showed that McGill prescribed 107 doses and spent $10.09 more per hospital bed than University Hospital. Finally, alternative uses for the average yearly spending on docusate equated to 0.35 the salary of a nurse, 0.51 the salary of a secretary, 20.66 colonoscopies, 27.00 upper endoscopies, 186.71 mammograms, 1,399.37 doses of polyethylene glycol 3350, 3,826.57 doses of lactulose, or 4,583.80 doses of psyllium. CONCLUSION A single average size tertiary care hospital spent about $25,000 yearly on docusate despite its lack of clinical effectiveness. While this amount is small compared to an overall hospital budget, when considering likely comparable docusate use at the U.S's 6,090 hospitals, the economic burden of docusate becomes significant. The funds currently being used on docusate could be redirected to alternative, more cost-effective purposes.
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Affiliation(s)
- Alexander J Kaye
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Suzanne Atkin
- Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aidan Ziobro
- Pharmacy Department, University Hospital, Newark, NJ, USA
| | - Jason Donnelly
- Pharmacy Department, University Hospital, Newark, NJ, USA
| | - Sushil Ahlawat
- Division of Gastroenterology and Hepatology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Badal K, Lee CM, Esserman LJ. Guiding principles for the responsible development of artificial intelligence tools for healthcare. COMMUNICATIONS MEDICINE 2023; 3:47. [PMID: 37005467 PMCID: PMC10066953 DOI: 10.1038/s43856-023-00279-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
Several principles have been proposed to improve use of artificial intelligence (AI) in healthcare, but the need for AI to improve longstanding healthcare challenges has not been sufficiently emphasized. We propose that AI should be designed to alleviate health disparities, report clinically meaningful outcomes, reduce overdiagnosis and overtreatment, have high healthcare value, consider biographical drivers of health, be easily tailored to the local population, promote a learning healthcare system, and facilitate shared decision-making. These principles are illustrated by examples from breast cancer research and we provide questions that can be used by AI developers when applying each principle to their work.
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Affiliation(s)
- Kimberly Badal
- Department of Surgery, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
| | - Carmen M Lee
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Alameda, CA, USA
| | - Laura J Esserman
- Department of Surgery, Helen Diller Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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Guan Y, Haardörfer R, McBride CM, Lipscomb J, Escoffery C. Factors Associated with Mammography Screening Choices by Women Aged 40-49 at Average Risk. J Womens Health (Larchmt) 2022; 31:1120-1126. [PMID: 35171027 DOI: 10.1089/jwh.2021.0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The U.S. Preventive Services Task Force (USPSTF) does not recommend routine mammogram screening for women aged 40-49 years at average risk for breast cancer. We aimed to assess the extent to which women were following guideline recommendations and to examine whether guideline awareness and other individual-level factors were associated with adherence. Materials and Methods: We surveyed a nationally representative panel of 383 U.S. women aged 40-49 years at low risk for hereditary breast cancer in October 2019. Results: Only 29% of women reported not having initiated screening mammography. Most women (80%) were unaware of the USPSTF screening guideline related to age of initiation and frequency of mammography. Being aware of the recommendation to initiate screening at age 50 increased the odds of not initiating screening (odds ratio [OR] = 6.70, p < 0.001), whereas being older than 45 years (OR = 0.22, p < 0.001) and having a primary care doctor decreased the odds of not initiating screening (OR = 0.25, p < 0.001). Conclusions: Mammogram screening in excess of USPSTF recommendations is prevalent among U.S. women aged 40-49 years. Efforts are needed to increase women's awareness of the rationale for guidelines and the opportunities to discuss with providers whether delaying mammograms is appropriate.
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Affiliation(s)
- Yue Guan
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Colleen M McBride
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Martinez KA, Deshpande A, Lipold L, Rothberg MB. Change in individual physicians' screening mammography completion rates following the updated USPSTF guideline supporting shared decision making: An observational cohort study. PATIENT EDUCATION AND COUNSELING 2022; 105:166-172. [PMID: 33992485 DOI: 10.1016/j.pec.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To understand changes in physician screening practices in response to the 2009 U.S. Preventive Services Task Force recommendation supporting shared decision making (SDM) for mammography in women aged 40-49 years. METHODS We assessed screening completion rates for physicians in the Cleveland Clinic Health System pre-2009 (2006-2008) and post-2009 (2010-2015), and rates for physicians new to the system post-2009. We used mixed effects logistic regression to estimate the odds of a woman receiving screening post-2009. If physicians practiced SDM, we hypothesized their screening rates would change after 2009. To test this, we included each physician's pre-2009 screening rate as a predictor in the model. RESULTS Among 125 physicians, the screening rate increased from 40% to 45% from pre-2009 to post-2009. For physicians new to the health system post-2009 the rate was 32%. In the mixed effects model (N = 17,007), the strongest predictor of mammography receipt among patients post-2009 was their physician's pre-2009 screening rate (aOR:3.57 per 10% increase in pre-2009 rate; 95%CI:1.69-7.50). CONCLUSIONS Whether a woman received a mammogram post-2009 was highly associated with her physicians' pre-2009 screening rate, suggesting physicians are not individualizing screening decisions via SDM. PRACTICE IMPLICATIONS Physicians may need support to effectively practice SDM.
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Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid Ave, G10, Cleveland, OH 44195, USA.
| | - Abhishek Deshpande
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid Ave, G10, Cleveland, OH 44195, USA
| | - Laura Lipold
- Cleveland Clinic, Family Medicine, 26900 Cedar Rd, Beachwood, OH 44122, USA
| | - Michael B Rothberg
- Cleveland Clinic Center for Value-Based Care Research, 9500 Euclid Ave, G10, Cleveland, OH 44195, USA
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Smetherman D, Biggs K, Fayanju OM, Grosskreutz S, Khan Z, Malak S, Moseley T, Smith-Graziani D, Valero V, Lightfoote J. Racial and Ethnic Disparities in Breast Cancer: A Collaboration Between the American College of Radiology Commissions on Women and Diversity and Breast Imaging. JOURNAL OF BREAST IMAGING 2021; 3:712-720. [PMID: 38424936 DOI: 10.1093/jbi/wbab081] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 03/02/2024]
Abstract
Since the 1980s, the mortality rate from breast cancer in the United States has dropped almost 40%. The quality of life and survival gains from early detection and improved treatment have not been shared equally by all ethnic groups, however. Many factors, including social determinants of health, unequal access to screening and oncologic care, and differences in incidence, tumor biology, and risk factors, have contributed to these unequal breast cancer outcomes. As breast radiologists approach their own patients, they must be aware that minority women are disproportionately affected by breast cancer at earlier ages and that non-Hispanic Black and Hispanic women are impacted by greater severity of disease than non-Hispanic White women. Guidelines that do not include women younger than 50 and/or have longer intervals between examinations could have a disproportionately negative impact on minority women. In addition, the COVID-19 pandemic could worsen existing disparities in breast cancer mortality. Increased awareness and targeted efforts to identify and mitigate all of the underlying causes of breast cancer disparities will be necessary to realize the maximum benefit of screening, diagnosis, and treatment and to optimize quality of life and mortality gains for all women. Breast radiologists, as leaders in breast cancer care, have the opportunity to address and reduce some of these disparities for their patients and communities.
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Affiliation(s)
- Dana Smetherman
- Ochsner Health, Department of Radiology, New Orleans, LA, USA
| | - Kelly Biggs
- James E. Van Zandt, VA Medical Center, Department of Radiology, Altoona, PA, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Department of Surgery, Philadelphia, PA, USA
| | | | - Zahra Khan
- Medina Global, Strategic Planning and Health Policy, Cambridge, MA, USA
| | - Sharp Malak
- St. Bernard's Healthcare, Department of Radiology, Jonesboro, AR, USA
| | - Tanya Moseley
- The University of Texas MD Anderson Cancer Center, Departments of Breast Surgical Oncology and Breast Imaging, Houston, TX, USA
| | | | - Vicente Valero
- The University of Texas MD Anderson Cancer Center, Breast Medical Oncology Department, Houston, TX, USA
| | - Johnson Lightfoote
- Pomona Valley Hospital Medical Center, Department of Radiology, Pomona, CA, USA
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6
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Kejela S. Cost-effectiveness of screening mammography in a low income country: a Markov simulation analysis. BMC Med Imaging 2021; 21:162. [PMID: 34727883 PMCID: PMC8564986 DOI: 10.1186/s12880-021-00696-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Background Breast cancer is the most common cancer diagnosed in women. Screening mammography is the only imaging screening study for breast cancer with a proven. mortality benefit. This study aims to analyze the cost-effectiveness of screening mammography in Ethiopia. Methods Multistate Markov model was used for computer simulation to estimate cost and health benefits of screening mammography interventions for age-group of 40–49 years and 50–59 years. The cost-effectiveness analysis was made for 4 policies based on where the screening mammography procedures were conducted: government institution only, the private institution only, 50% ratio for each, and 10% private institution policy. Outputs were expressed in total cost, life-years gained (LYG) incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB). Results All 4 policies of annual screening mammography failed to achieve acceptable ICER and lead to a net loss in INMB. The lowest ICER value was for government institution-only policy with 3510.3 USD/LYG and 3224.9 USD/LYG both above the cost-effectiveness threshold of 2808.5 USD. The cost per single death averted for each group was 110,206.7 USD and 77,088.2 USD for age-group 40–49 years and 50–59 years respectively. Conclusion Screening mammography could not be shown to be cost-effective in Ethiopia with the current low cost-effectiveness threshold. Alternative screening approach like annual clinical breast examination may need to be investigated.
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Affiliation(s)
- Segni Kejela
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Guo Y, Szurek SM, Bian J, Braithwaite D, Licht JD, Shenkman EA. The role of sex and rurality in cancer fatalistic beliefs and cancer screening utilization in Florida. Cancer Med 2021; 10:6048-6057. [PMID: 34254469 PMCID: PMC8419763 DOI: 10.1002/cam4.4122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People's fatalistic beliefs about cancer can influence their cancer prevention behaviors. We examined the association between fatalistic beliefs and breast and colorectal cancer screening among residents of north-central Florida and tested whether there exists any sex or rural-non-rural disparities in the association. METHODS We conducted a cross-sectional, random digit dialing telephone survey of 895 adults residing in north-central Florida in 2017. Using weighted logistic models, we examined the association between (1) respondents' sociodemographic characteristics and cancer fatalistic beliefs and (2) cancer fatalistic beliefs and cancer screening utilization among screening eligible populations. We tested a series of sex and rurality by fatalistic belief interactions. RESULTS Controlling for sociodemographics, we found the agreement with "It seems like everything causes cancer" was associated with a higher likelihood of having a mammogram (odds ratio [OR]: 3.34; 95% confidence interval [CI]: 1.17-9.51), while the agreement with "Cancer is most often caused by a person's behavior or lifestyle" was associated with a higher likelihood of having a blood stool test (OR: 1.85; 95% CI: 1.12-3.05) or a sigmoidoscopy or colonoscopy among women (OR: 2.65; 95% CI: 1.09-6.44). We did not observe any rural-non-rural disparity in the association between fatalistic beliefs and cancer screening utilization. CONCLUSIONS Some, but not all, cancer fatalistic beliefs are associated with getting breast and colorectal cancer screening in north-central Florida. Our study highlights the need for more research to better understand the social and cultural factors associated with cancer screening utilization.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
| | - Sarah M. Szurek
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
| | - Dejana Braithwaite
- University of Florida Health Cancer CenterGainesvilleFLUSA
- Department of Aging and Geriatric ResearchCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- Department of EpidemiologyCollege of Public Health and Health Professions and College of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Jonathan D. Licht
- University of Florida Health Cancer CenterGainesvilleFLUSA
- Division of Hematology and OncologyDepartment of MedicineCollege of MedicineUniversity of FloridaGainesvilleFLUSA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFLUSA
- University of Florida Health Cancer CenterGainesvilleFLUSA
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8
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Morgan MB, Mates JL. Applications of Artificial Intelligence in Breast Imaging. Radiol Clin North Am 2021; 59:139-148. [DOI: 10.1016/j.rcl.2020.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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9
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Tadavarthi Y, Vey B, Krupinski E, Prater A, Gichoya J, Safdar N, Trivedi H. The State of Radiology AI: Considerations for Purchase Decisions and Current Market Offerings. Radiol Artif Intell 2020; 2:e200004. [PMID: 33937846 DOI: 10.1148/ryai.2020200004] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 01/02/2023]
Abstract
Purpose To provide an overview of important factors to consider when purchasing radiology artificial intelligence (AI) software and current software offerings by type, subspecialty, and modality. Materials and Methods Important factors for consideration when purchasing AI software, including key decision makers, data ownership and privacy, cost structures, performance indicators, and potential return on investment are described. For the market overview, a list of radiology AI companies was aggregated from the Radiological Society of North America and the Society for Imaging Informatics in Medicine conferences (November 2016-June 2019), then narrowed to companies using deep learning for imaging analysis and diagnosis. Software created for image enhancement, reporting, or workflow management was excluded. Software was categorized by task (repetitive, quantitative, explorative, and diagnostic), modality, and subspecialty. Results A total of 119 software offerings from 55 companies were identified. There were 46 algorithms that currently have Food and Drug Administration and/or Conformité Européenne approval (as of November 2019). Of the 119 offerings, distribution of software targets was 34 of 70 (49%), 21 of 70 (30%), 14 of 70 (20%), and one of 70 (1%) for diagnostic, quantitative, repetitive, and explorative tasks, respectively. A plurality of companies are focused on nodule detection at chest CT and two-dimensional mammography. There is very little activity in certain subspecialties, including pediatrics and nuclear medicine. A comprehensive table is available on the website hitilab.org/pages/ai-companies. Conclusion The radiology AI marketplace is rapidly maturing, with an increase in product offerings. Radiologists and practice administrators should educate themselves on current product offerings and important factors to consider before purchase and implementation.© RSNA, 2020See also the invited commentary by Sala and Ursprung in this issue.
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Affiliation(s)
- Yasasvi Tadavarthi
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Brianna Vey
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Elizabeth Krupinski
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Adam Prater
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Judy Gichoya
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Nabile Safdar
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
| | - Hari Trivedi
- Department of Radiology, Medical College of Georgia at Augusta University, 1120 15th St, Augusta, GA 30912 (Y.T.); and Department of Radiology, Emory University, Atlanta, Ga (B.V., E.K., A.P., J.G., N.S., H.T.)
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10
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Kunst N, Gross CP. Breast Cancer Screening and Health Care Costs-Reply. JAMA Intern Med 2020; 180:1553-1554. [PMID: 32777026 DOI: 10.1001/jamainternmed.2020.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Natalia Kunst
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.,Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,Link Medical Research, Oslo, Norway.,Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine and Yale Cancer Center, New Haven, Connecticut.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Chang Sen LQ, Mayo RC, Leung JW. Concerns about the economics of mammography and how radiologists can respond. Clin Imaging 2020; 66:84-86. [DOI: 10.1016/j.clinimag.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
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12
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Nachtigal E, LoConte NK, Kerch S, Zhang X, Parkes A. Variation in Breast Cancer Screening Recommendations by Primary Care Providers Surveyed in Wisconsin. J Gen Intern Med 2020; 35:2553-2559. [PMID: 32495085 PMCID: PMC7459047 DOI: 10.1007/s11606-020-05922-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cancer screening is chiefly performed by primary care providers (PCPs) who rely on organizational screening guidelines. These guidelines provide evidence-based recommendations; however, they are often without unanimity leading to divergent screening recommendations. OBJECTIVE Due to the high incidence of breast cancer, the availability of screening methods, and the presence of multiple incongruent guideline recommendations, we sought to understand breast cancer screening practices in Wisconsin to identify patterns that would allow us to improve evidence-based screening adherence. METHODS A 46-question survey on breast cancer screening beliefs and practices for average-risk women was sent to healthcare providers in Wisconsin in 2018, who provided cancer screening services to women. Providers included physicians, nurse practitioners (NPs), physician assistants (PAs), and midwives. RESULTS A total of 295 people responded to the survey, for a response rate of 28.6%. Most respondents were physicians (64.1%), followed by NPs (25.7%), PAs (5.3%), and midwives (1.5%). Of physicians, most practiced family medicine (65.3%), followed by internal medicine (25.3%) and gynecology (9.4%). The United States Preventive Services Task Force (USPSTF) was reported as being "very influential" for 60.5% of providers, followed by the American Cancer Society at 46.8%. For patients 40-49 years old, 75.6% of providers performed clinical breast exams and 58.5% recommended self-breast exams; these numbers increased for women 50+ years old to 78.7% and 61.2%, respectively. Mammography was more likely to be recommended annually for women aged 40-49 rather than biennially by non-physician clinicians compared to physicians (p < .001). CONCLUSIONS PCPs in Wisconsin continue to overestimate the efficacy of clinical and self-breast exams as well as overuse these in clinical practice. Providers find multiple screening guidelines influential but favor the USPSTF; however, these guidelines are frequently not being followed. Further research needs to be done to investigate the lack of national guideline adherence by providers to improve compliance with evidence-based screening recommendations.
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Affiliation(s)
- Emily Nachtigal
- Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
| | - Noelle K LoConte
- Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Sarah Kerch
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Xiao Zhang
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Amanda Parkes
- Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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Salim M, Dembrower K, Eklund M, Lindholm P, Strand F. Range of Radiologist Performance in a Population-based Screening Cohort of 1 Million Digital Mammography Examinations. Radiology 2020; 297:33-39. [PMID: 32720866 DOI: 10.1148/radiol.2020192212] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is great interest in developing artificial intelligence (AI)-based computer-aided detection (CAD) systems for use in screening mammography. Comparative performance benchmarks from true screening cohorts are needed. Purpose To determine the range of human first-reader performance measures within a population-based screening cohort of 1 million screening mammograms to gauge the performance of emerging AI CAD systems. Materials and Methods This retrospective study consisted of all screening mammograms in women aged 40-74 years in Stockholm County, Sweden, who underwent screening with full-field digital mammography between 2008 and 2015. There were 110 interpreting radiologists, of whom 24 were defined as high-volume readers (ie, those who interpreted more than 5000 annual screening mammograms). A true-positive finding was defined as the presence of a pathology-confirmed cancer within 12 months. Performance benchmarks included sensitivity and specificity, examined per quartile of radiologists' performance. First-reader sensitivity was determined for each tumor subgroup, overall and by quartile of high-volume reader sensitivity. Screening outcomes were examined based on the first reader's sensitivity quartile with 10 000 screening mammograms per quartile. Linear regression models were fitted to test for a linear trend across quartiles of performance. Results A total of 418 041 women (mean age, 54 years ± 10 [standard deviation]) were included, and 1 186 045 digital mammograms were evaluated, with 972 899 assessed by high-volume readers. Overall sensitivity was 73% (95% confidence interval [CI]: 69%, 77%), and overall specificity was 96% (95% CI: 95%, 97%). The mean values per quartile of high-volume reader performance ranged from 63% to 84% for sensitivity and from 95% to 98% for specificity. The sensitivity difference was very large for basal cancers, with the least sensitive and most sensitive high-volume readers detecting 53% and 89% of cancers, respectively (P < .001). Conclusion Benchmarks showed a wide range of performance differences between high-volume readers. Sensitivity varied by tumor characteristics. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Mattie Salim
- From the Departments of Pathology and Oncology (M.S., F.S.), Physiology and Pharmacology (K.D., P.L.), and Medical Epidemiology and Biostatistics (M.E.), Karolinska Institute, Stockholm, Sweden; Department of Radiology (M.S.) and Breast Radiology (F.S.), Karolinska University Hospital, Dalagatan 90, 113 43 Stockholm, Sweden; and the Department of Radiology, Capio Sankt Görans Hospital, Stockholm, Sweden (K.D.)
| | - Karin Dembrower
- From the Departments of Pathology and Oncology (M.S., F.S.), Physiology and Pharmacology (K.D., P.L.), and Medical Epidemiology and Biostatistics (M.E.), Karolinska Institute, Stockholm, Sweden; Department of Radiology (M.S.) and Breast Radiology (F.S.), Karolinska University Hospital, Dalagatan 90, 113 43 Stockholm, Sweden; and the Department of Radiology, Capio Sankt Görans Hospital, Stockholm, Sweden (K.D.)
| | - Martin Eklund
- From the Departments of Pathology and Oncology (M.S., F.S.), Physiology and Pharmacology (K.D., P.L.), and Medical Epidemiology and Biostatistics (M.E.), Karolinska Institute, Stockholm, Sweden; Department of Radiology (M.S.) and Breast Radiology (F.S.), Karolinska University Hospital, Dalagatan 90, 113 43 Stockholm, Sweden; and the Department of Radiology, Capio Sankt Görans Hospital, Stockholm, Sweden (K.D.)
| | - Peter Lindholm
- From the Departments of Pathology and Oncology (M.S., F.S.), Physiology and Pharmacology (K.D., P.L.), and Medical Epidemiology and Biostatistics (M.E.), Karolinska Institute, Stockholm, Sweden; Department of Radiology (M.S.) and Breast Radiology (F.S.), Karolinska University Hospital, Dalagatan 90, 113 43 Stockholm, Sweden; and the Department of Radiology, Capio Sankt Görans Hospital, Stockholm, Sweden (K.D.)
| | - Fredrik Strand
- From the Departments of Pathology and Oncology (M.S., F.S.), Physiology and Pharmacology (K.D., P.L.), and Medical Epidemiology and Biostatistics (M.E.), Karolinska Institute, Stockholm, Sweden; Department of Radiology (M.S.) and Breast Radiology (F.S.), Karolinska University Hospital, Dalagatan 90, 113 43 Stockholm, Sweden; and the Department of Radiology, Capio Sankt Görans Hospital, Stockholm, Sweden (K.D.)
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14
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Kunst N, Long JB, Xu X, Busch SH, Kyanko KA, Richman IB, Gross CP. Use and Costs of Breast Cancer Screening for Women in Their 40s in a US Population With Private Insurance. JAMA Intern Med 2020; 180:799-801. [PMID: 32202606 PMCID: PMC7147248 DOI: 10.1001/jamainternmed.2020.0262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses Blue Cross Blue Shield Axis data to examine the total annual cost of breast cancer screening for women aged 40 through 49 years in the United States.
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Affiliation(s)
- Natalia Kunst
- Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, the Netherlands.,Link Medical Research, Oslo, Norway.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jessica B Long
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Xiao Xu
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Susan H Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Kelly A Kyanko
- Department of Population Health, New York University School of Medicine, New York
| | - Ilana B Richman
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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15
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Liu Z, Li R, Liang K, Chen J, Chen X, Li X, Li R, Zhang X, Yi L, Long W. Value of digital mammography in predicting lymphovascular invasion of breast cancer. BMC Cancer 2020; 20:274. [PMID: 32245448 PMCID: PMC7119272 DOI: 10.1186/s12885-020-6712-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Lymphovascular invasion (LVI) has never been revealed by preoperative scans. It is necessary to use digital mammography in predicting LVI in patients with breast cancer preoperatively. Methods Overall 122 cases of invasive ductal carcinoma diagnosed between May 2017 and September 2018 were enrolled and assigned into the LVI positive group (n = 42) and the LVI negative group (n = 80). Independent t-test and χ2 test were performed. Results Difference in Ki-67 between the two groups was statistically significant (P = 0.012). Differences in interstitial edema (P = 0.013) and skin thickening (P = 0.000) were statistically significant between the two groups. Multiple factor analysis showed that there were three independent risk factors for LVI: interstitial edema (odds ratio [OR] = 12.610; 95% confidence interval [CI]: 1.061–149.922; P = 0.045), blurring of subcutaneous fat (OR = 0.081; 95% CI: 0.012–0.645; P = 0.017) and skin thickening (OR = 9.041; 95% CI: 2.553–32.022; P = 0.001). Conclusions Interstitial edema, blurring of subcutaneous fat, and skin thickening are independent risk factors for LVI. The specificity of LVI prediction is as high as 98.8% when the three are used together.
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Affiliation(s)
- Zhuangsheng Liu
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Ruqiong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Keming Liang
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Junhao Chen
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Xiaoping Li
- Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Xin Zhang
- Department of Clinical Experimental Center, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Lilei Yi
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China.
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16
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Schaffter T, Buist DSM, Lee CI, Nikulin Y, Ribli D, Guan Y, Lotter W, Jie Z, Du H, Wang S, Feng J, Feng M, Kim HE, Albiol F, Albiol A, Morrell S, Wojna Z, Ahsen ME, Asif U, Jimeno Yepes A, Yohanandan S, Rabinovici-Cohen S, Yi D, Hoff B, Yu T, Chaibub Neto E, Rubin DL, Lindholm P, Margolies LR, McBride RB, Rothstein JH, Sieh W, Ben-Ari R, Harrer S, Trister A, Friend S, Norman T, Sahiner B, Strand F, Guinney J, Stolovitzky G. Evaluation of Combined Artificial Intelligence and Radiologist Assessment to Interpret Screening Mammograms. JAMA Netw Open 2020; 3:e200265. [PMID: 32119094 PMCID: PMC7052735 DOI: 10.1001/jamanetworkopen.2020.0265] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/26/2019] [Indexed: 12/18/2022] Open
Abstract
Importance Mammography screening currently relies on subjective human interpretation. Artificial intelligence (AI) advances could be used to increase mammography screening accuracy by reducing missed cancers and false positives. Objective To evaluate whether AI can overcome human mammography interpretation limitations with a rigorous, unbiased evaluation of machine learning algorithms. Design, Setting, and Participants In this diagnostic accuracy study conducted between September 2016 and November 2017, an international, crowdsourced challenge was hosted to foster AI algorithm development focused on interpreting screening mammography. More than 1100 participants comprising 126 teams from 44 countries participated. Analysis began November 18, 2016. Main Outcomes and Measurements Algorithms used images alone (challenge 1) or combined images, previous examinations (if available), and clinical and demographic risk factor data (challenge 2) and output a score that translated to cancer yes/no within 12 months. Algorithm accuracy for breast cancer detection was evaluated using area under the curve and algorithm specificity compared with radiologists' specificity with radiologists' sensitivity set at 85.9% (United States) and 83.9% (Sweden). An ensemble method aggregating top-performing AI algorithms and radiologists' recall assessment was developed and evaluated. Results Overall, 144 231 screening mammograms from 85 580 US women (952 cancer positive ≤12 months from screening) were used for algorithm training and validation. A second independent validation cohort included 166 578 examinations from 68 008 Swedish women (780 cancer positive). The top-performing algorithm achieved an area under the curve of 0.858 (United States) and 0.903 (Sweden) and 66.2% (United States) and 81.2% (Sweden) specificity at the radiologists' sensitivity, lower than community-practice radiologists' specificity of 90.5% (United States) and 98.5% (Sweden). Combining top-performing algorithms and US radiologist assessments resulted in a higher area under the curve of 0.942 and achieved a significantly improved specificity (92.0%) at the same sensitivity. Conclusions and Relevance While no single AI algorithm outperformed radiologists, an ensemble of AI algorithms combined with radiologist assessment in a single-reader screening environment improved overall accuracy. This study underscores the potential of using machine learning methods for enhancing mammography screening interpretation.
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Affiliation(s)
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | | | - Dezső Ribli
- Department of Physics of Complex Systems, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Yuanfang Guan
- Department of Computational Medicine and Bioinformatics, Michigan Medicine, University of Michigan, Ann Arbor
| | | | | | - Hao Du
- National University of Singapore, Singapore
| | - Sijia Wang
- Integrated Health Information Systems Pte Ltd, Singapore
| | - Jiashi Feng
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
| | | | | | - Francisco Albiol
- Instituto de Física Corpuscular (IFIC), CSIC–Universitat de València, Valencia, Spain
| | - Alberto Albiol
- Universitat Politecnica de Valencia, Valencia, Valenciana, Spain
| | - Stephen Morrell
- Centre for Medical Image Computing, University College London, Bloomsbury, London, United Kingdom
| | | | | | - Umar Asif
- IBM Research Australia, Melbourne, Australia
| | | | | | | | - Darvin Yi
- Stanford University, Stanford, California
| | - Bruce Hoff
- Computational Oncology, Sage Bionetworks, Seattle, Washington
| | - Thomas Yu
- Computational Oncology, Sage Bionetworks, Seattle, Washington
| | | | - Daniel L. Rubin
- Department of Biomedical Data Science, Radiology, and Medicine (Biomedical Informatics), Stanford University, Stanford, California
| | - Peter Lindholm
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Laurie R. Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Russell Bailey McBride
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph H. Rothstein
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Weiva Sieh
- Department of Population Health Science and Policy, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rami Ben-Ari
- IBM Research Haifa, Haifa University Campus, Mount Carmel, Haifa, Israel
| | | | - Andrew Trister
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephen Friend
- Computational Oncology, Sage Bionetworks, Seattle, Washington
| | - Thea Norman
- Bill and Melinda Gates Foundation, Seattle, Washington
| | - Berkman Sahiner
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland
| | - Fredrik Strand
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Justin Guinney
- Computational Oncology, Sage Bionetworks, Seattle, Washington
| | - Gustavo Stolovitzky
- IBM Research, Translational Systems Biology and Nanobiotechnology, Thomas J. Watson Research Center, Yorktown Heights, New York
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17
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Ratushnyak S, Hoogendoorn M, van Baal PHM. Cost-Effectiveness of Cancer Screening: Health and Costs in Life Years Gained. Am J Prev Med 2019; 57:792-799. [PMID: 31753260 DOI: 10.1016/j.amepre.2019.07.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Studies reporting on the cost-effectiveness of cancer screening usually account for quality of life losses and healthcare costs owing to cancer but do not account for future costs and quality of life losses related to competing risks. This study aims to demonstrate the impact of medical costs and quality of life losses of other diseases in the life years gained on the cost-effectiveness of U.S. cancer screening. METHODS Cost-effectiveness studies of breast, cervical, and colorectal cancer screening in the U.S. were identified using a systematic literature review. Incremental cost-effectiveness ratios of the eligible articles were updated by adding lifetime expenditures and health losses per quality-adjusted life year gained because of competing risks. This was accomplished using data on medical spending and quality of life by age and disease from the Medical Expenditure Panel Survey (2011-2015) combined with cause-deleted life tables. The study was conducted in 2018. RESULTS The impact of quality of life losses and healthcare expenditures of competing risks in life years gained incurred owing to screening were the highest for breast cancer and the lowest for cervical cancer. The updates suggest that incremental cost-effectiveness ratios are underestimated by $10,300-$13,700 per quality-adjusted life year gained if quality of life losses and healthcare expenditures of competing risks are omitted in economic evaluations. Furthermore, cancer screening programs that were considered cost saving, were found not to be so following the inclusion of medical expenditures of competing risks. CONCLUSIONS Practical difficulties in quantifying quality of life losses and healthcare expenditures owing to competing risks in life years gained can be overcome. Their inclusion can have a substantial impact on the cost-effectiveness of cancer screening programs.
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Affiliation(s)
- Svetlana Ratushnyak
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Center of Healthcare Quality Assessment and Control, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter H M van Baal
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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18
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Khushalani JS, Ekwueme DU, Richards TB, Sabatino SA, Guy GP, Zhang Y, Tangka F. Utilization and Cost of Mammography Screening Among Commercially Insured Women 50 to 64 Years of Age in the United States, 2012-2016. J Womens Health (Larchmt) 2019; 29:327-337. [PMID: 31613693 DOI: 10.1089/jwh.2018.7543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In recent years, most insurance plans eliminated cost-sharing for breast cancer screening and recommended screening intervals changed, and newer modalities-digital mammography and breast tomosynthesis-became more widely available. The objectives of this study are to examine how these changes affected utilization, frequency, and costs of breast cancer screening among commercially insured women, and to understand factors associated with utilization and frequency of screening. Materials and Methods: This study used commercial insurance claims data for women 50 to 64 years of age, continuously enrolled in commercial insurance plans during 2012-2016. Results: Of the 685,737 eligible women, 20% were not screened, 40% received annual screening, 24% received biennial screening, and 16% were screened less frequently than recommended during the time period examined. Sociodemographic factors such as age <60 years, rurality, and fee-for-service insurance were associated with low screening utilization. Patients who received annual screening incurred ∼1.78 times higher costs compared to those who received biennial screening during the study period. Digital mammography was the most costly and commonly used modality along with computer-aided detection. Conclusions: Evidence-based interventions to promote screening among women who are screened less frequently are needed along with interventions to move toward biennial screening rather than annual screening. Increasing provider awareness regarding breast cancer screening rates and frequency among various sociodemographic groups is essential to guide provider recommendations and shared decision making. The results of this study can guide targeted public health interventions to reduce barriers to screening, and can also serve as inputs for economic analyses of screening interventions and programs.
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Affiliation(s)
- Jaya S Khushalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Thomas B Richards
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuanhui Zhang
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Florence Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Yang Y, Li F, Luo X, Jia B, Zhao X, Liu B, Gao R, Yang L, Wei W, He J. Identification of LCN1 as a Potential Biomarker for Breast Cancer by Bioinformatic Analysis. DNA Cell Biol 2019; 38:1088-1099. [PMID: 31424267 DOI: 10.1089/dna.2019.4843] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The biological functions of lipocalin-1 (LCN1) are involved in innate immune responses and act as a physiological scavenger of potentially harmful lipophilic molecules. However, the relevance of LCN1 with cancer is rarely concerned currently. The aim of this study is to address the relevance of LCN1 with BRCA by bioinformatics. In this study, we found that the expressions of LCN1 increased significantly in various cancerous tissues, including BRCA, compared with their adjacent normal tissues through the TIMER database. Furthermore, UALCAN database analysis showed that the expression of LCN1 increased gradually from stage 1 to stage 4 and was upregulated in BRCA patients with different races and subtypes compared with that in the normal. In addition, those patients with perimenopause and postmenopause status displayed higher LCN1 expression. Importantly, LCN1 genetic alterations, including copy number amplification, deep deletion, and missense mutation, could be found, and the alteration frequency showed difference in various invasive BRCA through cBioPortal database. Moreover, a positive correlation between LCN1 somatic copy number alterations and immune cell enrichments was revealed in basal like BRCA by GISTIC 2.0. Finally, analysis on prognostic value of LCN1 by Kaplan-Meier plotter showed that low LCN1 expression correlated with poor prognosis for relapse-free survival in all types of BRCA, overall survival in luminal B BRCA, distant metastasis free survival in human epithelial growth factor receptor-2 (HER2) positive BRCA, and postprogression survival (PPS) in luminal A BRCA. But high LCN1 expression also displayed poor prognosis for PPS in HER2 positive BRCA. The results together verified the significance of LCN1 in BRCA, suggesting that it may be a potential biomarker for BRCA diagnosis.
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Affiliation(s)
- Yuemei Yang
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China.,Department of R&D Technology Center, Beijing Zhicheng Biomedical Technology Co. Ltd., Beijing, P.R. China
| | - Feng Li
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Xueying Luo
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Binghan Jia
- Department of R&D Technology Center, Beijing Zhicheng Biomedical Technology Co. Ltd., Beijing, P.R. China
| | - Xiaoling Zhao
- Department of R&D Technology Center, Beijing Zhicheng Biomedical Technology Co. Ltd., Beijing, P.R. China
| | - Baoer Liu
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Rui Gao
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Liping Yang
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Wei Wei
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Jinsong He
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
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20
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Toy M, Hutton DW, So S. Population Health And Economic Impacts Of Reaching Chronic Hepatitis B Diagnosis And Treatment Targets In The US. Health Aff (Millwood) 2019; 37:1033-1040. [PMID: 29985701 DOI: 10.1377/hlthaff.2018.0035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The National Academies of Sciences, Engineering, and Medicine have concluded that eliminating the public health problem of chronic hepatitis B is feasible. We examined the economic and public health impact of reaching the World Health Organization targets of having 90 percent of chronic hepatitis B cases diagnosed and 80 percent being treated by 2030 in the United States with an annual incremental increase in screening and treatment rates. To reach the targets by 2030 would require screening approximately 14.5 million adults in at-risk populations to diagnose an estimated 870,000 undiagnosed cases and would result in substantial health gains: an increase of 16.5 million quality-adjusted life-years (QALYs), and reductions in liver-related deaths of 37 percent and in cases of compensated cirrhosis of 24 percent, decompensated liver cirrhosis of 51 percent, and liver cancer of 35 percent. Achieving the targets by 2030 would be highly cost-effective at $103 per QALY and would be cost-saving if the antiviral drug price were no more than $114 per month. Achieving them by 2025 would be cost-saving and would reduce liver-related deaths by 47 percent.
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Affiliation(s)
- Mehlika Toy
- Mehlika Toy ( ) is a research scientist at the Stanford University School of Medicine, in California
| | - David W Hutton
- David W. Hutton is an associate professor of health management and policy at the University of Michigan, in Ann Arbor
| | - Samuel So
- Samuel So is a professor of surgery at the Stanford University School of Medicine
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21
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Willingness to decrease mammogram frequency among women at low risk for hereditary breast cancer. Sci Rep 2019; 9:9599. [PMID: 31270367 PMCID: PMC6610104 DOI: 10.1038/s41598-019-45967-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/20/2019] [Indexed: 01/02/2023] Open
Abstract
This study aimed to assess women's willingness to alter mammogram frequency based on their low risk for HBOC, and to examine if cognitive and emotional factors are associated with women's inclination to decrease mammogram frequency. We conducted an online survey with women (N = 124) who were unlikely to have a BRCA mutation and at average population risk for breast cancer based on family history. Most women were either white (50%) or African American (38%) and were 50 years or older (74%). One-third of women (32%) were willing to decrease mammogram frequency (as consistent with the USPSTF guideline), 42% reported being unwilling and 26% were unsure. Multivariate logistic regression showed that feeling worried about breast cancer (Adjust OR = 0.33, p = 0.01), greater genetic risk knowledge (Adjust OR = 0.74, p = 0.047), and more frequent past mammogram screening (Adjust OR = 0.13, p = 0.001) were associated with being less willing to decrease screening frequency. Findings suggest that emerging genomics-informed medical guidelines may not be accepted by many patients when the recommendations go against what is considered standard practice. Further study of the interplay between emotion- and cognition-based processing of the HBOC screen result will be important for strategizing communication interventions aimed at realizing the potential of precision public health.
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22
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Oakes AH, Chang HY, Segal JB. Systemic overuse of health care in a commercially insured US population, 2010-2015. BMC Health Serv Res 2019; 19:280. [PMID: 31046746 PMCID: PMC6498548 DOI: 10.1186/s12913-019-4079-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Overuse is a leading contributor to the high cost of health care in the United States. Overuse harms patients and is a definitive waste of resources. The Johns Hopkins Overuse Index (JHOI) is a normalized measure of systemic health care services overuse, generated from claims data, that has been used to describe overuse in Medicare beneficiaries and to understand drivers of overuse. We aimed to adapt the JHOI for application to a commercially insured US population, to examine geographic variation in systemic overuse in this population, and to analyze trends over time to inform whether systemic overuse is an enduring problem. METHODS We analyzed commercial insurance claims from 18 to 64 year old beneficiaries. We calculated a semiannual JHOI for each of the 375 Metropolitan Statistical Areas and 47 rural regions of the US. We generated maps to examine geographic variation and then analyzed each region's change in their JHOI quintile from January 2011 to June 2015. RESULTS The JHOI varied markedly across the US. Across the country, rural regions tended to have less systemic overuse than their MSA counterparts (p < 0.01). Regional systemic overuse is positively correlated from one time period to the next (p < 0.001). Between 2011 and 2015, 53.7% (N = 226) of regions remained in the same quintile of the JHOI. Eighty of these regions had a persistently high or persistently low JHOI throughout study duration. CONCLUSIONS The systemic overuse of health care resources is an enduring, regional problem. Areas identified as having a persistently high rate of systemic overuse merit further investigation to understand drivers and potential points of intervention.
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Affiliation(s)
- Allison H Oakes
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hsien-Yen Chang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jodi B Segal
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
- Center for Health Services and Outcomes Research of the Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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23
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Use of Mastectomy for Overdiagnosed Breast Cancer in the United States: Analysis of the SEER 9 Cancer Registries. J Cancer Epidemiol 2019; 2019:5072506. [PMID: 30804999 PMCID: PMC6362466 DOI: 10.1155/2019/5072506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/24/2018] [Accepted: 12/23/2018] [Indexed: 12/28/2022] Open
Abstract
Aim We investigated use of mastectomy as treatment for early breast cancer in the US and applied the resulting information to estimate the minimum and maximum rates at which mastectomy could plausibly be undergone by patients with overdiagnosed breast cancer. Little is currently known about overtreatments undergone by overdiagnosed patients. Methods In the US, screening is often recommended at ages ≥40. The study population was women age ≥40 diagnosed with breast cancer in the US SEER 9 cancer registries during 2013 (n=26,017). We evaluated first-course surgical treatments and their associations with case characteristics. Additionally, a model was developed to estimate probability of mastectomy conditional on observed case characteristics. The model was then applied to evaluate possible rates of mastectomy in overdiagnosed patients. To obtain minimum and maximum plausible rates of this overtreatment, we respectively assumed the cases that were least and most likely to be treated by mastectomy had been overdiagnosed. Results Of women diagnosed with breast cancer at age ≥40 in 2013, 33.8% received mastectomy. Mastectomy was common for most investigated breast cancer types, including for the early breast cancers among which overdiagnosis is thought to be most widespread: mastectomy was undergone in 26.4% of in situ and 28.0% of AJCC stage-I cases. These rates are substantively higher than in many European nations. The probability-based model indicated that between >0% and <18% of the study population could plausibly have undergone mastectomy for overdiagnosed cancer. This range reduced depending on the overdiagnosis rate, shrinking to >0% and <7% if 10% of breast cancers were overdiagnosed and >3% and <15% if 30% were overdiagnosed. Conclusions Screening-associated overtreatment by mastectomy is considerably less common than overdiagnosis itself but should not be assumed to be negligible. Screening can prompt or prevent mastectomy, and the balance of this harm-benefit tradeoff is currently unclear.
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Mango VL, Goel A, Mema E, Kwak E, Ha R. Breast MRI screening for average-risk women: A monte carlo simulation cost-benefit analysis. J Magn Reson Imaging 2019; 49:e216-e221. [PMID: 30632645 DOI: 10.1002/jmri.26334] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Screening high-risk women for breast cancer with MRI is cost-effective, with increasing cost-effectiveness paralleling increasing risk. However, for average-risk women cost is considered a major limitation to mass screening with MRI. PURPOSE To perform a cost-benefit analysis of a simulated breast cancer screening program for average-risk women comparing MRI with mammography. STUDY TYPE Population simulation study. POPULATION/SUBJECTS Five million (M) hypothetical women undergoing breast cancer screening. FIELD STRENGTH/SEQUENCE Simulation based primarily on Kuhl et al8 study utilizing 1.5T MRI with an axial bilateral 2D multisection gradient-echo dynamic series (repetition time / echo time 250/4.6 msec; flip angle, 90°) with a full 512 × 512 acquisition matrix and a sensitivity encoding factor of two, performed prior to and four times after bolus injection of 0.1 mmol of gadobutrol per kg of body weight (Gadovist; Bayer, Germany). An axial T2 -weighted fast spin-echo sequence with identical anatomic parameters was also included. ASSESSMENT A Monte Carlo simulation utilizing Medicare reimbursement rates to calculate input variable costs was developed to compare 5M women undergoing breast cancer screening with either triennial MRI or annual mammography, 2.5M in each group, over 30 years. STATISTICAL TESTS Expected recall rates, BI-RADS 3, BI-RADS 4/5 cases and cancer detection rates were determined from published literature with calculated aggregate costs including resultant diagnostic/follow-up imaging and biopsies. RESULTS Baseline screening of 2.5M women with breast MRI cost $1.6 billion (B), 3× higher than baseline mammography screening ($0.54B). With subsequent screening, MRI screening is more cost-effective than mammography screening in 24 years ($13.02B vs. $13.03B). MRI screening program costs are largely driven by cost per MRI exam ($549.71). A second simulation model was performed based on MRI Medicare reimbursement trends using a lower MRI cost ($400). This yielded a cost-effective benefit compared to mammography screening in less than 6 years ($3.41B vs. $3.65B), with over a 22% cost reduction relative to mammography screening in 12 years and reaching a 38% reduction in 30 years. DATA CONCLUSION Despite higher initial cost of a breast MRI screening program for average-risk women, there is ultimately a cost savings over time compared with mammography. This estimate is conservative given cost-benefit of additional/earlier breast cancers detected by breast MRI were not accounted for. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
- Victoria L Mango
- Department of Radiology, Breast and Imaging Center, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Akshay Goel
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Eralda Mema
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Ellie Kwak
- Department of Radiology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Richard Ha
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
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Abstract
Cass R. Sunstein's 2016 book The Ethics of Influence: Government in the Age of Behavioral Science provides an extremely informative introduction to the science and ethics of the exercise of "influence" over others. As a longtime physician employed in both the public and private sectors, I now recognize that most of my formal training has been in the hard sciences, with little, if any, training in the appropriate influence of the decision-making processes of my patients and/or other health care professionals in institutional settings. Breast cancer screening is an excellent example of the conflicts of modern medicine, highlighting our collective inability to effectively "nudge" others in the pursuit of health and/or organizational effectiveness and efficiency. Using the framework of Sunstein's ethical values of welfare, autonomy, dignity, and self-government, I discuss many of the conflicting issues in a nationwide breast cancer screening program and the effects of these issues on client nudging to determine whether mammography screening is ethical.
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Shaffer VA, Scherer LD. Too Much Medicine: Behavioral Science Insights on Overutilization, Overdiagnosis, and Overtreatment in Health Care. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2372732218786042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Overutilization—defined as the use of health care services for which the benefits do not outweigh the harms—has been identified as one of the leading contributors to the rising cost of health care in the United States. Although informational interventions designed to address overutilization have had a significant, but modest, impact on the rate of overutilization, they have not been sufficient to solve the problem. Also, various psychological mechanisms contribute to the desire for more medical tests and treatments. To effectively address overutilization, we need to better understand the psychological underpinnings of overuse in medicine. The article reviews recent findings from the behavioral science literature—including reliance on anecdotal evidence, test-related affect, the use of diagnostic labels, and medical maximizing tendencies—that lend insight into why patients sometimes seek, demand, or expect medical tests and treatments that are considered by experts to be low value.
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Bleyer A, Keen JD. Continued Avoidance of USPSTF Guidelines for Screening Mammography. J Womens Health (Larchmt) 2018; 27:850-853. [DOI: 10.1089/jwh.2018.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas
| | - John D. Keen
- Department of Radiology, John H. Stroger, Jr., Hospital of Cook County, Cook County Health and Hospital System, Veterans Administration Hospital, Chicago, Illinois
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Wang Y, Zhang Y, Huang Q, Li C. Integrated bioinformatics analysis reveals key candidate genes and pathways in breast cancer. Mol Med Rep 2018; 17:8091-8100. [PMID: 29693125 PMCID: PMC5983982 DOI: 10.3892/mmr.2018.8895] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
Breast cancer (BC) is the leading malignancy in women worldwide, yet relatively little is known about the genes and signaling pathways involved in BC tumorigenesis and progression. The present study aimed to elucidate potential key candidate genes and pathways in BC. Five gene expression profile data sets (GSE22035, GSE3744, GSE5764, GSE21422 and GSE26910) were downloaded from the Gene Expression Omnibus (GEO) database, which included data from 113 tumorous and 38 adjacent non-tumorous tissue samples. Differentially expressed genes (DEGs) were identified using t-tests in the limma R package. These DEGs were subsequently investigated by pathway enrichment analysis and a protein-protein interaction (PPI) network was constructed. The most significant module from the PPI network was selected for pathway enrichment analysis. In total, 227 DEGs were identified, of which 82 were upregulated and 145 were downregulated. Pathway enrichment analysis results revealed that the upregulated DEGs were mainly enriched in ‘cell division’, the ‘proteinaceous extracellular matrix (ECM)’, ‘ECM structural constituents’ and ‘ECM-receptor interaction’, whereas downregulated genes were mainly enriched in ‘response to drugs’, ‘extracellular space’, ‘transcriptional activator activity’ and the ‘peroxisome proliferator-activated receptor signaling pathway’. The PPI network contained 174 nodes and 1,257 edges. DNA topoisomerase 2-a, baculoviral inhibitor of apoptosis repeat-containing protein 5, cyclin-dependent kinase 1, G2/mitotic-specific cyclin-B1 and kinetochore protein NDC80 homolog were identified as the top 5 hub genes. Furthermore, the genes in the most significant module were predominantly involved in ‘mitotic nuclear division’, ‘mid-body’, ‘protein binding’ and ‘cell cycle’. In conclusion, the DEGs, relative pathways and hub genes identified in the present study may aid in understanding of the molecular mechanisms underlying BC progression and provide potential molecular targets and biomarkers for BC.
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Affiliation(s)
- Yuzhi Wang
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yi Zhang
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Qian Huang
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Chengwen Li
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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29
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Keen JD. Opportunity cost of annual screening mammography. Cancer 2018; 124:1297-1298. [PMID: 29266218 DOI: 10.1002/cncr.31197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 11/06/2022]
Affiliation(s)
- John D Keen
- Department of Radiology/Imaging, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
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30
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Mullen LA, Panigrahi B, Hollada J, Panigrahi B, Falomo ET, Harvey SC. Strategies for Decreasing Screening Mammography Recall Rates While Maintaining Performance Metrics. Acad Radiol 2017; 24:1556-1560. [PMID: 28760363 DOI: 10.1016/j.acra.2017.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/14/2017] [Accepted: 06/08/2017] [Indexed: 01/09/2023]
Abstract
RATIONALE AND OBJECTIVE This study aimed to determine the impact of interventions designed to reduce screening mammography recall rates on screening performance metrics. MATERIALS AND METHODS We assessed baseline performance for full-field digital mammography (FFDM) and digital breast tomosynthesis mammography (DBT) for a 3-year period before intervention. The first intervention sought to increase awareness of recalls from screening mammography. Breast imagers discussed their perceptions regarding screening recalls and were required to review their own recalled cases, including outcomes of diagnostic evaluation and biopsy. The second intervention implemented consensus double reading of all recalls, requiring two radiologists to agree if recall was necessary. Recall rates, cancer detection rates, and positive predictive value 1 (PPV1) were compared before and after each intervention. RESULTS The baseline recall rate, cancer detection rate, and PPV1 were 11.1%, 3.8/1000, and 3.4%, respectively, for FFDM, and 7.6%, 4.8/1000, and 6.0%, respectively, for DBT. Recall rates decreased significantly to 9.2% for FFDM and to 6.6% for DBT after the first intervention promoting awareness, as well as to 9.9% for FFDM after the second intervention implementing group consensus. PPV1 increased significantly to 5.7% for FFDM and to 9.0% for DBT after the second intervention. Cancer detection rate did not significantly change with the implementation of these interventions. An average of 2.3 minutes was spent consulting for each recall. CONCLUSION Reduction in recall rates is desirable, provided performance metrics remain favorable. Our interventions improved performance and could be implemented in other breast imaging settings.
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Affiliation(s)
- Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287
| | - Babita Panigrahi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287
| | - Jacqueline Hollada
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Eniola T Falomo
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287
| | - Susan C Harvey
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline St Suite 4120 E, Baltimore, MD 21287.
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Abstract
Where does cancer come from? Although the cell-of-origin is difficult to pinpoint, cancer clones harbor information about their clonal ancestries. In an effort to find cells before they evolve into a life-threatening cancer, physicians currently diagnose premalignant diseases at frequencies that substantially exceed those of clinical cancers. Cancer risk prediction relies on our ability to distinguish between which premalignant features will lead to cancer mortality and which are characteristic of inconsequential disease. Here, we review the evolution of cancer from premalignant disease, and discuss the concept that even phenotypically normal cell progenies inherently gain more malignant potential with age. We describe the hurdles of prognosticating cancer risk in premalignant disease by making reference to the underlying continuous and multivariate natures of genotypes and phenotypes and the particular challenge inherent in defining a cell lineage as "cancerized."
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Affiliation(s)
- Kit Curtius
- Centre for Tumor Biology, Barts Cancer Institute, EC1M 6BQ London, United Kingdom
| | - Nicholas A Wright
- Centre for Tumor Biology, Barts Cancer Institute, EC1M 6BQ London, United Kingdom
| | - Trevor A Graham
- Centre for Tumor Biology, Barts Cancer Institute, EC1M 6BQ London, United Kingdom
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32
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Martinez KA, Rothberg MB. Divergent Responses to Mammography and Prostate-Specific Antigen Recommendations. Am J Prev Med 2017; 53:533-536. [PMID: 28318901 DOI: 10.1016/j.amepre.2017.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Kathryn A Martinez
- Cleveland Clinic, Center for Value-Based Care Research, Cleveland, Ohio.
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Kopans DB. The Breast Cancer Screening "Arcade" and the "Whack-A-Mole" Efforts to Reduce Access to Screening. Semin Ultrasound CT MR 2017; 39:2-15. [PMID: 29317036 DOI: 10.1053/j.sult.2017.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The effort to reduce access to breast cancer screening has been going on for decades. As each piece of misinformation has been published, scientific responses have exposed the fallacies, but then new "alternative facts" are generated. The effort has been compared to the arcade game "Whack-a-Mole" in which one false argument is addressed only to have a new one "pop up" to replace it. This has ranged from the false claim that early detection would have no effect on breast cancer, to the fallacious idea that early detection was leading to early deaths among young women, to the more recent false suggestion that tens of thousands of breast cancers found by mammography would disappear if left undetected. The following is a short review of a number of nonscientifically derived "Moles" that have been "Whacked" by science.
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Affiliation(s)
- Daniel B Kopans
- Emeritus at the Harvard Medical School, 20 Manitoba Road, Waban, Massachusetts 02468, MA.
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35
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Ray KM, Price ER, Joe BN. Evidence to Support Screening Women in Their 40s. Radiol Clin North Am 2017; 55:429-439. [DOI: 10.1016/j.rcl.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Katz A. Family doctors should engage with patients about mammography. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy (MCHP); Departments of Community Health Sciences and Family Medicine; Max Rady College of Medicine; Rady Faculty of Health Sciences; University of Manitoba; Winnipeg Canada
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38
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Haas JS. The Complexity of Achieving the Promise of Precision Breast Cancer Screening. J Natl Cancer Inst 2017; 109:2938663. [PMID: 28130476 DOI: 10.1093/jnci/djw301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jennifer S Haas
- Affiliation of author: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
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39
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Primary Care Providers' Barriers and Adherence to the U.S. Preventive Services Task Force Mammography Screening Guidelines. J Dr Nurs Pract 2017; 10:38-44. [PMID: 32751040 DOI: 10.1891/2380-9418.10.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Earlier detection through mammography screening, increased awareness, and improved treatment modalities has resulted in a decline in breast cancer incidence. Despite the availability of the clinical guidelines by the U.S. Preventive Services Task Force (USPSTF), adherence to these methods is only 42% (Meissener, Klabunde, Breen, & Zapka, 2011). The purpose of this scholarly project was to identify and improve provider's adherence to the USPSTF mammography screening clinical guidelines in three primary care clinics located in Southeastern North Carolina. The project included development of an educational program to increase awareness of the guidelines followed by measures to increase screening. A posteducation intervention chart review was completed to determine if there was an increase in adherence and use to the guidelines. Sample size included 90 retrospective chart reviews of the patients meeting the criteria for mammography screening. Based on the results, further recommendations were provided to the providers to improve adherence. Data analysis was conducted using descriptive statistics. The findings of this project identified barriers to the adherence to the USPSTF mammography screening guidelines among primary care providers in the three clinics selected. The educational intervention increased the adherence to the USPSTF mammography screening guideline from 15% to 16%.
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40
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Degeling K, Koffijberg H, IJzerman MJ. A systematic review and checklist presenting the main challenges for health economic modeling in personalized medicine: towards implementing patient-level models. Expert Rev Pharmacoecon Outcomes Res 2016; 17:17-25. [PMID: 27978765 DOI: 10.1080/14737167.2017.1273110] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The ongoing development of genomic medicine and the use of molecular and imaging markers in personalized medicine (PM) has arguably challenged the field of health economic modeling (HEM). This study aims to provide detailed insights into the current status of HEM in PM, in order to identify if and how modeling methods are used to address the challenges described in literature. Areas covered: A review was performed on studies that simulate health economic outcomes for personalized clinical pathways. Decision tree modeling and Markov modeling were the most observed methods. Not all identified challenges were frequently found, challenges regarding companion diagnostics, diagnostic performance, and evidence gaps were most often found. However, the extent to which challenges were addressed varied considerably between studies. Expert commentary: Challenges for HEM in PM are not yet routinely addressed which may indicate that either (1) their impact is less severe than expected, (2) they are hard to address and therefore not managed appropriately, or (3) HEM in PM is still in an early stage. As evidence on the impact of these challenges is still lacking, we believe that more concrete examples are needed to illustrate the identified challenges and to demonstrate methods to handle them.
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Affiliation(s)
- Koen Degeling
- a Health Technology and Services Research Department, MIRA institute for Biomedical Technology and Technical Medicine , University of Twente , Enschede , The Netherlands
| | - Hendrik Koffijberg
- a Health Technology and Services Research Department, MIRA institute for Biomedical Technology and Technical Medicine , University of Twente , Enschede , The Netherlands
| | - Maarten J IJzerman
- a Health Technology and Services Research Department, MIRA institute for Biomedical Technology and Technical Medicine , University of Twente , Enschede , The Netherlands
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Ong MS, Mandl KD. National expenditure for false-positive mammograms and breast cancer overdiagnoses estimated at $4 billion a year. Health Aff (Millwood) 2016; 34:576-83. [PMID: 25847639 DOI: 10.1377/hlthaff.2014.1087] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Populationwide mammography screening has been associated with a substantial rise in false-positive mammography findings and breast cancer overdiagnosis. However, there is a lack of current data on the associated costs in the United States. We present costs due to false-positive mammograms and breast cancer overdiagnoses among women ages 40-59, based on expenditure data from a major US health care insurance plan for 702,154 women in the years 2011-13. The average expenditures for each false-positive mammogram, invasive breast cancer, and ductal carcinoma in situ in the twelve months following diagnosis were $852, $51,837 and $12,369, respectively. This translates to a national cost of $4 billion each year. The costs associated with false-positive mammograms and breast cancer overdiagnoses appear to be much higher than previously documented. Screening has the potential to save lives. However, the economic impact of false-positive mammography results and breast cancer overdiagnoses must be considered in the debate about the appropriate populations for screening.
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Affiliation(s)
- Mei-Sing Ong
- Mei-Sing Ong is a research fellow at Boston Children's Hospital, in Massachusetts, and a research fellow at the Australian Institute of Health Innovation, Macquarie University, in Sydney, Australia
| | - Kenneth D Mandl
- Kenneth D. Mandl is a professor at Harvard Medical School and director of the Children's Hospital Informatics Program at Boston Children's Hospital
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42
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Chang CH, Bynum JPW, Onega T, Colla CH, Lurie JD, Tosteson ANA. Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations. J Womens Health (Larchmt) 2016; 25:1030-1037. [PMID: 27427790 DOI: 10.1089/jwh.2015.5701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is uncertain how changes in the U.S. Preventive Services Task Force breast cancer screening recommendations (from annual to biennial mammography screening in women aged 50-74 and grading the evidence as insufficient for screening in women aged 75 and older) have affected mammography use among Medicare beneficiaries. MATERIALS AND METHODS Cohort study of 12 million Medicare fee-for-service women aged 65-74 and 75 and older to measure changes in 3-year screening use, 2007-2009 (before) and 2010-2012 (after), defined by two measures-proportion screened and frequency of screening by age, race/ethnicity, and hospital referral region. RESULTS Fewer women were screened, but with similar frequency after 2009 for both age groups (after vs. before: age 65-74: 60.1% vs. 60.8% screened, 2.1 vs. 2.1 mammograms per screened woman; age 75 and older: 31.7% vs. 33.6% screened, 1.9 vs. 1.9 mammograms per screened woman; all p < 0.05). Black women were the only subgroup with an increase in screening use, and for both age groups (after vs. before: age 65-74: 55.4% vs. 54.0% screened and 2.0 vs. 1.9 mammograms per screened woman; age 75 and older: 28.5% vs. 27.9% screened and 1.8 vs. 1.8 mammograms per screened woman; all p < 0.05). Regional change patterns in screening were more similar between age groups (Pearson correlation r = 0.781 for proportion screened; r = 0.840 for frequency of screening) than between black versus nonblack women (Pearson correlation r = 0.221 for proportion screened; r = 0.212 for frequency of screening). CONCLUSIONS Changes in screening mammography use for Medicare women are not fully aligned with the 2009 recommendations.
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Affiliation(s)
- Chiang-Hua Chang
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire
| | - Julie P W Bynum
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Tracy Onega
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Carrie H Colla
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Jon D Lurie
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
| | - Anna N A Tosteson
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Geisel School of Medicine, Lebanon , New Hampshire.,2 Department of Medicine, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire.,3 Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center , Lebanon , New Hampshire
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43
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Abstract
When screening for cancer in older adults, it is important to consider the risks of screening, how long it takes to benefit from screening, and the patient's comorbidities and life expectancy. Delivering high-value care requires the consideration of evidence-based screening guidelines and careful selection of patients. This article considers the impact of cancer. It explores perspectives on the costs of common cancer screening tests, illustrates how using life expectancy can help clinicians determine who will benefit most from screening, and provides tools to help clinicians discuss with their older patients when it may be appropriate to stop screening for cancer.
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Affiliation(s)
- Ashley H Snyder
- Division of General Internal Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Mail Code H034, Hershey, PA 17033, USA
| | - Allison Magnuson
- Division of Hematology/Oncology, Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA
| | - Amy M Westcott
- Department of Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Mail Code H106, Hershey, PA 17033, USA.
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Harvey S, Gallagher AM, Nolan M, Hughes CM. Listening to Women: Expectations and Experiences in Breast Imaging. J Womens Health (Larchmt) 2016; 24:777-83. [PMID: 26390380 DOI: 10.1089/jwh.2015.29001.swh] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Susan Harvey
- 1 Director of Breast Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions , Baltimore, Maryland
| | | | - Martha Nolan
- 2 Society for Women's Health Research , Washington, DC
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Miglioretti DL, Zhu W, Kerlikowske K, Sprague BL, Onega T, Buist DSM, Henderson LM, Smith RA. Breast Tumor Prognostic Characteristics and Biennial vs Annual Mammography, Age, and Menopausal Status. JAMA Oncol 2016; 1:1069-77. [PMID: 26501844 DOI: 10.1001/jamaoncol.2015.3084] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Screening mammography intervals remain under debate in the United States. OBJECTIVE To compare the proportion of breast cancers with less vs more favorable prognostic characteristics in women screening annually vs biennially by age, menopausal status, and postmenopausal hormone therapy (HT) use. DESIGN, SETTING, AND PARTICIPANTS This was a study of a prospective cohort from 1996 to 2012 at Breast Cancer Surveillance Consortium facilities. A total of 15,440 women ages 40 to 85 years with breast cancer diagnosed within 1 year of an annual or within 2 years of a biennial screening mammogram. EXPOSURES We updated previous analyses by using narrower intervals for defining annual (11-14 months) and biennial (23-26 months) screening. MAIN OUTCOMES AND MEASURES We defined less favorable prognostic characteristics as tumors that were stage IIB or higher, size greater than 15 mm, positive nodes, and any 1 or more of these characteristics. We used log-binomial regression to model the proportion of breast cancers with less favorable characteristics following a biennial vs annual screen by 10-year age groups and by menopausal status and current postmenopausal HT use. RESULTS Among 15,440 women with breast cancer, most were 50 years or older (13,182 [85.4%]), white (12,063 [78.1%]), and postmenopausal (9823 [63.6%]). Among 2027 premenopausal women (13.1%), biennial screeners had higher proportions of tumors that were stage IIB or higher (relative risk [RR], 1.28 [95% CI, 1.01-1.63]; P=.04), size greater than 15 mm (RR, 1.21 [95% CI, 1.07-1.37]; P=.002), and with any less favorable prognostic characteristic (RR, 1.11 [95% CI, 1.00-1.22]; P=.047) compared with annual screeners. Among women currently taking postmenopausal HT, biennial screeners tended to have tumors with less favorable prognostic characteristics compared with annual screeners; however, 95% CIs were wide, and differences were not statistically significant (for stage 2B+, RR, 1.14 [95% CI, 0.89-1.47], P=.29; size>15 mm, RR, 1.13 [95% CI, 0.98-1.31], P=.09; node positive, RR, 1.18 [95% CI, 0.98-1.42], P=.09; any less favorable characteristic, RR, 1.12 [95% CI, 1.00-1.25], P=.053). The proportions of tumors with less favorable prognostic characteristics were not significantly larger for biennial vs annual screeners among postmenopausal women not taking HT (eg, any characteristic: RR, 1.03 [95% CI, 0.95-1.12]; P=.45), postmenopausal HT users after subdividing by type of hormone use (eg, any characteristic: estrogen+progestogen users, RR, 1.16 [95% CI, 0.91-1.47]; P=.22; estrogen-only users, RR, 1.14 [95% CI, 0.94-1.37]; P=.18), or any 10-year age group (eg, any characteristic: ages 40-49 years, RR, .1.04 [95% CI, 0.94-1.14]; P=.48; ages 50-59 years, RR, 1.03 [95% CI, 0.94-1.12]; P=.58; ages 60-69 years, RR, 1.07 [95% CI, 0.97-1.19]; P=.18; ages 70-85 years, RR, 1.05 [95% CI, 0.94-1.18]; P=.35). CONCLUSIONS AND RELEVANCE Premenopausal women diagnosed as having breast cancer following biennial vs annual screening mammography are more likely to have tumors with less favorable prognostic characteristics. Postmenopausal women not using HT who are diagnosed as having breast cancer following a biennial or annual screen have similar proportions of tumors with less favorable prognostic characteristics.
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Affiliation(s)
- Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis2Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Weiwei Zhu
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco,4General Internal Medicine Section, Department of Veterans Affairs, University of California-San Francisco, San Francisco
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, University of Vermont College of Medicine, Burlington6University of Vermont Cancer Center, University of Vermont College of Medicine, Burlington
| | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire8Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Diana S M Buist
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | | | - Robert A Smith
- Cancer Control Science Department, American Cancer Society, Atlanta, Georgia
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Parks RM, Cheung KL. Patient pathway for breast cancer: turning points and future aspirations. Future Oncol 2016; 11:1059-70. [PMID: 25804121 DOI: 10.2217/fon.15.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Improved survival from breast cancer can be attributed to a number of advances in the patient pathway from screening to advanced disease. The benefit of population screening has been established with national programs implemented. There has been improvement in the methodology of diagnostic assessment, relating to imaging techniques, methods of obtaining histological evidence and evaluation of lymph node status. Sentinel node biopsy is now routine, as is oncoplastic surgery. New forms and improved adjuvant systemic therapies are being explored. The prognosis of breast cancer can be more reliably evaluated to provide individualized information and to personalize treatments. Developments have also been seen in other areas improving the treatment and care of patients with advanced disease.
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Affiliation(s)
- Ruth Mary Parks
- School of Medicine, University of Nottingham, Nottingham, UK
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Haas JS, Sprague BL, Klabunde CN, Tosteson ANA, Chen JS, Bitton A, Beaber EF, Onega T, Kim JJ, MacLean CD, Harris K, Yamartino P, Howe K, Pearson L, Feldman S, Brawarsky P, Schapira MM. Provider Attitudes and Screening Practices Following Changes in Breast and Cervical Cancer Screening Guidelines. J Gen Intern Med 2016; 31:52-9. [PMID: 26129780 PMCID: PMC4700005 DOI: 10.1007/s11606-015-3449-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Changes to national guidelines for breast and cervical cancer screening have created confusion and controversy for women and their primary care providers. OBJECTIVE To characterize women's primary health care provider attitudes towards screening and changes in practice in response to recent revisions in guidelines for breast and cervical cancer screening. DESIGN, SETTING, PARTICIPANTS In 2014, we distributed a confidential web and mail survey to 668 women's health care providers affiliated with the four clinical care networks participating in the three PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium breast cancer research centers (385 respondents; response rate 57.6 %). MAIN MEASURES We assessed self-reported attitudes toward breast and cervical cancer screening, as well as practice changes in response to the most recent revisions of the U.S. Preventive Services Task Force (USPSTF) recommendations. KEY RESULTS The majority of providers believed that mammography screening was effective for reducing cancer mortality among women ages 40-74 years, and that Papanicolaou (Pap) testing was very effective for women ages 21-64 years. While the USPSTF breast and cervical cancer screening recommendations were widely perceived by the respondents as influential, 75.7 and 41.2 % of providers (for mammography and cervical cancer screening, respectively) reported screening practices in excess of those recommended by USPSTF. Provider-reported barriers to concordance with guideline recommendations included: patient concerns (74 and 36 % for breast and cervical, respectively), provider disagreement with the recommendations (50 and 14 %), health system measurement of a provider's screening practices that use conflicting measurement criteria (40 and 21 %), concern about malpractice risk (33 and 11 %), and lack of time to discuss the benefits and harms with their patients (17 and 8 %). CONCLUSIONS Primary care providers do not consistently follow recent USPSTF breast and cervical cancer screening recommendations, despite noting that these guidelines are influential.
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Affiliation(s)
- Jennifer S Haas
- Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
| | | | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Anna N A Tosteson
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Jane S Chen
- Brigham and Women's Hospital, Boston, MA, USA
| | - Asaf Bitton
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Tracy Onega
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Jane J Kim
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Phillip Yamartino
- University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA
| | | | - Loretta Pearson
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Sarah Feldman
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Marilyn M Schapira
- University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, PA, USA
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Veenstra DL. The value of routine pharmacogenomic screening-Are we there yet? A perspective on the costs and benefits of routine screening-shouldn't everyone have this done? Clin Pharmacol Ther 2015; 99:164-6. [PMID: 26565561 DOI: 10.1002/cpt.299] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although there are several examples in which pharmacogenomic testing seems to provide clinical and economic value, use of pharmacogenomics as a tool to improve drug therapy through routine screening of unselected patients is currently tentative. An informal evaluation of the clinical benefits and economic costs of pharmacogenomic screening suggests that improving the evidence base, addressing uncertainty, and facilitating implementation can lead to practical and cost-effective pharmacogenomic screening programs.
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Affiliation(s)
- D L Veenstra
- University of Washington, Seattle, Washington, USA
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Kopans DB. Breast cancer screening panels continue to confuse the facts and inject their own biases. ACTA ACUST UNITED AC 2015; 22:e376-9. [PMID: 26628879 DOI: 10.3747/co.22.2880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Additional confusion has been added to the “debate” about breast cancer. [...]
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Affiliation(s)
- D B Kopans
- Breast Imaging Division, Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Center, Boston, Massachusetts, U.S.A
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Personalized Screening for Breast Cancer: A Wolf in Sheep's Clothing? AJR Am J Roentgenol 2015; 205:1365-71. [DOI: 10.2214/ajr.15.15293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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