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Hubbard RA, Su YR, Bowles EJ, Ichikawa L, Kerlikowske K, Lowry KP, Miglioretti DL, Tosteson ANA, Wernli KJ, Lee JM. Predicting five-year interval second breast cancer risk in women with prior breast cancer. J Natl Cancer Inst 2024:djae063. [PMID: 38466940 DOI: 10.1093/jnci/djae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Annual surveillance mammography is recommended for women with a personal history of breast cancer. Risk prediction models that estimate mammography failures such as interval second breast cancers could help to tailor surveillance imaging regimens to women's individual risk profiles. METHODS In a cohort of women with a history of breast cancer receiving surveillance mammography in the Breast Cancer Surveillance Consortium in 1996-2019, we used LASSO-penalized regression to estimate the probability of an interval second cancer (invasive cancer or ductal carcinoma in situ) in the one-year following a negative surveillance mammogram. Based on predicted risks from this one-year risk model, we generated cumulative risks of an interval second cancer for the five-year period following each mammogram. Model performance was evaluated using cross-validation in the overall cohort and within race and ethnicity strata. RESULTS In 173,290 surveillance mammograms, we observed 496 interval cancers. One-year risk models were well-calibrated (expected/observed ratio = 1.00) with good accuracy (area under the receiver operating characteristic curve = 0.64). Model performance was similar across race and ethnicity groups. The median five-year cumulative risk was 1.20% (interquartile range 0.93-1.63%). Median five-year risks were highest in women who were under age 40 or pre- or peri-menopausal at diagnosis and those with estrogen receptor-negative primary breast cancers. CONCLUSIONS Our risk model identified women at high risk of interval second breast cancers who may benefit from additional surveillance imaging modalities. Risk models should be evaluated to determine if risk-guided supplemental surveillance imaging improves early detection and decreases surveillance failures.
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Affiliation(s)
- Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Erin Ja Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
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Burnside ES, Lasarev MR, Sprague BL, Miglioretti DL, Alexandridis RA, Lee JM, Pisano ED, Smith RA. The Importance of Outcomes Ascertainment for Accurate Assessment of the Mammography Screening Cancer Detection Rate: A Simulation Study. J Am Coll Radiol 2024; 21:376-386. [PMID: 37922974 DOI: 10.1016/j.jacr.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Cancer detection rate (CDR), an important metric in the mammography screening audit, is designed to ensure adequate sensitivity. Most practices use biopsy results as the reference standard; however, commonly ascertainment of biopsy results is incomplete. We used simulation to determine the relationship between the cancer ascertainment rate of biopsy (AR-biopsy), CDR estimation, and associated error rates in classifying whether practices and radiologists meet the established ACR benchmark of 2.5 per 1,000. MATERIALS AND METHODS We simulated screening mammography volume, number of cancers detected, and CDR, using negative binomial and beta-binomial distributions, respectively. Simulations were performed at both the practice and radiologist level. Average CDR was based on linearly rescaling a published CDR by the AR-biopsy. CDR distributions were simulated for AR-biopsy between 5% and 100% in steps of five percentage points and were summarized with boxplots and smoothed histograms over the range of AR-biopsy, to quantify the proportion of practices and radiologists meeting the ACR benchmark at each level of AR-biopsy. RESULTS Decreasing AR-biopsy led to an increasing probability of categorizing CDR performance as being below the ACR benchmark. Our simulation predicts that at the practice level, an AR-biopsy of 65% categorizes 17.6% below the benchmark (compared to 1.6% at an AR-biopsy of 100%), and at the radiologist level, an AR-biopsy of 65% categorizes 34.7% as being below the benchmark (compared to 11.6% at an AR-biopsy of 100%). CONCLUSIONS Our simulation demonstrates that decreasing the AR-biopsy (in currently clinically relevant ranges) has the potential to artifactually lower the assessed CDR on both the practice and radiologist levels and may, in turn, increase the chance of erroneous categorization of underperformance per the ACR benchmark.
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Affiliation(s)
- Elizabeth S Burnside
- Associate Dean, Team Science and Interdisciplinary Research, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, Wisconsin.
| | | | - Brian L Sprague
- Director of the Vermont Breast Cancer Surveillance System, University of Vermont, Burlington, Vermont
| | - Diana L Miglioretti
- Division Chief of Biostatistics, Co-lead, Population Sciences and Health Disparities Program, Comprehensive Cancer Center, University of California, Davis, Davis, California
| | | | - Janie M Lee
- Section Chief of Breast Imaging, Department of Radiology, Director of Breast Imaging, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Etta D Pisano
- University of Pennsylvania, Philadelphia, Pennsylvania; and Chief Research Officer of the ACR
| | - Robert A Smith
- Senior Vice President of Early Cancer Detection Science, American Cancer Society
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Han M, Hwang S, Agusbudiman A, Lee JM, Lee KB, Kim BC, Heo DH, Kim TH. Digital coincidence counting with 4πβ(PPC)-γ for the standardization of 60Co. Appl Radiat Isot 2024; 205:111173. [PMID: 38211394 DOI: 10.1016/j.apradiso.2024.111173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
A 4πβ(PPC)-γ coincidence system has been made at KRISS based on a digital DAQ. 60Co sources were measured to verify the system. The maximum detection efficiency for beta particles was estimated to be 96.7 %. Massic activities for sample sources had 0.005 % of the sample variability error, which was well within the expanded standard uncertainty of 0.54 % (k = 2).
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Affiliation(s)
- Minji Han
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - Sanghoon Hwang
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea.
| | - Agung Agusbudiman
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - J M Lee
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - K B Lee
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - B C Kim
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
| | - D H Heo
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
| | - T H Kim
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
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4
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Youn I, Biswas D, Hippe DS, Winter AM, Kazerouni AS, Javid SH, Lee JM, Rahbar H, Partridge SC. Diagnostic Performance of Point-of-Care Apparent Diffusion Coefficient Measures to Reduce Biopsy in Breast Lesions at MRI: Clinical Validation. Radiology 2024; 310:e232313. [PMID: 38349238 PMCID: PMC10902596 DOI: 10.1148/radiol.232313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024]
Abstract
Background The Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group multicenter A6702 trial identified an optimal apparent diffusion coefficient (ADC) cutoff to potentially reduce biopsies by 21% without affecting sensitivity. Whether this performance can be achieved in clinical settings has not yet been established. Purpose To validate the performance of point-of-care ADC measurements with the A6702 trial ADC cutoff for reducing unnecessary biopsies in lesions detected at breast MRI. Materials and Methods Consecutive breast MRI examinations performed from May 2015 to January 2019 at a single medical center and showing biopsy-confirmed Breast Imaging Reporting and Data System category 4 or 5 lesions, without ipsilateral cancer, were identified. Point-of-care lesion ADC measurements collected at clinical interpretation were retrospectively evaluated. MRI examinations included axial T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Sensitivity and biopsy reduction rates were calculated by applying the A6702 optimal (ADC, 1.53 × 10-3 mm2/sec) and alternate conservative (1.68 × 10-3 mm2/sec) cutoffs. Lesion pathologic outcomes were the reference standard. To assess reproducibility, one radiologist repeated ADC measurements, and agreement was summarized using the intraclass correlation coefficient. Results A total of 240 lesions in 201 women (mean age, 49 years ± 13 [SD]) with pathologic outcomes (63 malignant and 177 benign) were included. Applying the optimal ADC cutoff produced an overall biopsy reduction rate of 15.8% (38 of 240 lesions [95% CI: 11.2, 20.9]), with a sensitivity of 92.1% (58 of 63 lesions [95% CI: 82.4, 97.4]; sensitivity was 97.2% [35 of 36 lesions] [95% CI: 82.7, 99.6] for invasive cancers). Results were similar for screening versus diagnostic examinations (P = .92 and .40, respectively). Sensitivity was higher for masses than for nonmass enhancements (NMEs) (100% vs 85.3%; P = .009). Applying the conservative ADC cutoff achieved a sensitivity of 95.2% (60 of 63 lesions [95% CI: 86.7, 99.0]), with a biopsy reduction rate of 10.4% (25 of 240 lesions [95% CI: 6.7, 14.5]). Repeated single-reader measurements showed good agreement with clinical ADCs (intraclass correlation coefficient, 0.72 [95% CI: 0.58, 0.81]). Conclusion This study validated the clinical use of ADC cutoffs to reduce MRI-prompted biopsies by up to 16%, with a suggested tradeoff of lowered sensitivity for in situ and microinvasive disease manifesting as NME. Clinical trial registration no. NCT02022579 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Honda and Iima in this issue.
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Affiliation(s)
| | - Debosmita Biswas
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Daniel S. Hippe
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Andrea M. Winter
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Anum S. Kazerouni
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Sara H. Javid
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Janie M. Lee
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Habib Rahbar
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
| | - Savannah C. Partridge
- From the Departments of Radiology (I.Y., D.B., A.M.W., A.S.K.,
J.M.L., H.R., S.C.P.) and Surgery (S.H.J.), University of Washington School of
Medicine, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109; and Clinical Research
Division, Fred Hutchinson Cancer Center (D.S.H.)
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Schopf CM, Ramwala OA, Lowry KP, Hofvind S, Marinovich ML, Houssami N, Elmore JG, Dontchos BN, Lee JM, Lee CI. Artificial Intelligence-Driven Mammography-Based Future Breast Cancer Risk Prediction: A Systematic Review. J Am Coll Radiol 2024; 21:319-328. [PMID: 37949155 PMCID: PMC10926179 DOI: 10.1016/j.jacr.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To summarize the literature regarding the performance of mammography-image based artificial intelligence (AI) algorithms, with and without additional clinical data, for future breast cancer risk prediction. MATERIALS AND METHODS A systematic literature review was performed using six databases (medRixiv, bioRxiv, Embase, Engineer Village, IEEE Xplore, and PubMed) from 2012 through September 30, 2022. Studies were included if they used real-world screening mammography examinations to validate AI algorithms for future risk prediction based on images alone or in combination with clinical risk factors. The quality of studies was assessed, and predictive accuracy was recorded as the area under the receiver operating characteristic curve (AUC). RESULTS Sixteen studies met inclusion and exclusion criteria, of which 14 studies provided AUC values. The median AUC performance of AI image-only models was 0.72 (range 0.62-0.90) compared with 0.61 for breast density or clinical risk factor-based tools (range 0.54-0.69). Of the seven studies that compared AI image-only performance directly to combined image + clinical risk factor performance, six demonstrated no significant improvement, and one study demonstrated increased improvement. CONCLUSIONS Early efforts for predicting future breast cancer risk based on mammography images alone demonstrate comparable or better accuracy to traditional risk tools with little or no improvement when adding clinical risk factor data. Transitioning from clinical risk factor-based to AI image-based risk models may lead to more accurate, personalized risk-based screening approaches.
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Affiliation(s)
- Cody M Schopf
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Ojas A Ramwala
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, Washington
| | - Kathryn P Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Solveig Hofvind
- Section Head of Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - M Luke Marinovich
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia; National Breast Cancer Foundation Chair in Breast Cancer Prevention at the University of Sydney and Coeditor of The Breast
| | - Joann G Elmore
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California; Director of UCLA's National Clinician Scholars Program and Editor-in-Chief of Adult Primary Care at Up-To-Date. https://twitter.com/JoannElmoreMD
| | - Brian N Dontchos
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Clinical Director of Breast Imaging at Fred Hutchinson Cancer Center
| | - Janie M Lee
- Section Chief of Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Director of Breast Imaging at Fred Hutchinson Cancer Center
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, and Department of Health Systems & Population Health, University of Washington School of Public Health, Seattle, WA; Director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington and Deputy Editor of Journal of the American College of Radiology.
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6
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Hsu FM, Huang TC, Guo JC, Hsu CH, Lee JM, Huang PM, Chang YL, Cheng JCH. A Prospective Study of Bevacizumab and Neoadjuvant Concurrent Chemoradiation in Locally Advanced Esophageal Squamous Cell Carcinoma: Paradoxical Increase in Circulating Vascular Endothelial Growth Factor-A and Effect on Outcome. Int J Radiat Oncol Biol Phys 2023; 117:e302-e303. [PMID: 37785104 DOI: 10.1016/j.ijrobp.2023.06.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) In the prior prospective biomarker study, high serum vascular endothelial growth factor-A (VEGF-A) was associated with a poor prognosis. We conducted a prospective phase II trial of adding Bevacizumab, an anti-VEGF-A monoclonal antibody, to neoadjuvant concurrent chemoradiation (neoCCRT) for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). This prospective biomarker study aims to evaluate the expressions of angiogenesis-associated circulating biomarkers before and after neoCCRT and compare clinical outcomes for patients receiving platinum/5-fluorouracil (PF) with or without Bevacizumab. MATERIALS/METHODS Patients with biopsy-proven resectable non-T4 LA-ESCC were enrolled for the prospective phase II trial investigating PF-neoCCRT plus Bevacizumab (BPF group). A parallel patient cohort enrolled in a prospective biomarker study receiving PF-neoCCRT was included in the present analysis as the control group (PF group). Radiotherapy was delivered with 40 Gy in 20 fractions. All patients had restaging workups after enoCCRT and underwent radical esophagectomy if the disease remained resectable. Serums were collected before and after neoCCRT. The serum concentrations of angiogenesis-associated biomarkers were determined by the multiplex enzyme-linked immunosorbent assay. Survival analyses were performed by the Kaplan-Meier method. The t-test and log-rank test were used to compare differences in biomarker expression and survival between groups. RESULTS From 2016 to 2019, 43 patients (BPF/PF group: 21/22) were enrolled in the study. Twenty patients in each group had serum samples available for biomarker analysis. 15 out of 21 patients in the BPF group and 20 out of 22 patients in the PF group underwent radical esophagectomy. Six patients in the BPF group and nine patients in the PF group achieved pathological complete responses. The median overall survival for the BPF and PF group was 20.8 months and not-reached, respectively (hazard ratio = 1.33, long rank p = 0.58). In the BPF group, the serum VEGF-A level was significantly increased from an average value of 446 pg/mL to 723 pg/mL after neoCCRT (p = 0.037), while its level was decreased from 815 ng/mL to 380 pg/mL in the PF group (p = 0.104). In addition, the expression value of circulating Angiopoietin-1 was not changed in the BPF group (before neoCCRT, mean value = 828 pg/mL; after neoCCRT, mean value 762 pg/mL, p = 0.67). In contrast, serum Angiopoietin-1 level was reduced from an average value of 659 pg/mL before neoCCRT to 271 pg/mL after neoCCRT (p = 0.002) in the PF group. CONCLUSION The addition of Bevacizumab to PF-neoCCRT did not improve pathological or survival outcomes in patients with resectable LA-ESCC. Adding a single dose of Bevacizumab paradoxically increases circulating VEGF-A while maintaining the Angiopoietin-1 serum level after neoCCRT. Further investigation by using additional VEGF-A inhibition may be required to achieve sustained angiogenesis blocked for tumor control.
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Affiliation(s)
- F M Hsu
- Department of Radiation Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - T C Huang
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C Guo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - C H Hsu
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - J M Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - P M Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Y L Chang
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - J C H Cheng
- Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
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7
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Sprague BL, Ichikawa L, Eavey J, Lowry KP, Rauscher G, O’Meara ES, Miglioretti DL, Chen S, Lee JM, Stout NK, Mandelblatt JS, Alsheik N, Herschorn SD, Perry H, Weaver DL, Kerlikowske K. Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone. Cancer 2023; 129:2456-2468. [PMID: 37303202 PMCID: PMC10506533 DOI: 10.1002/cncr.34768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone. METHODS A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014-2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5-year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6-year advanced breast cancer risk ≥0.38%. RESULTS A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p < .0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio, 1.35; 95% CI, 1.30-1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio, 0.91; 95% CI, 0.89-0.94). CONCLUSIONS Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.
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Affiliation(s)
- Brian L. Sprague
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Joanna Eavey
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Kathryn P. Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
| | - Janie M. Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Natasha K. Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jeanne S. Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, DC, USA
| | - Nila Alsheik
- Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL
| | - Sally D. Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Hannah Perry
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Donald L. Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
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8
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Lawson MB, Partridge SC, Hippe DS, Rahbar H, Lam DL, Lee CI, Lowry KP, Scheel JR, Parsian S, Li I, Biswas D, Bryant ML, Lee JM. Comparative Performance of Contrast-enhanced Mammography, Abbreviated Breast MRI, and Standard Breast MRI for Breast Cancer Screening. Radiology 2023; 308:e230576. [PMID: 37581498 PMCID: PMC10481328 DOI: 10.1148/radiol.230576] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 08/16/2023]
Abstract
Background Contrast-enhanced mammography (CEM) and abbreviated breast MRI (ABMRI) are emerging alternatives to standard MRI for supplemental breast cancer screening. Purpose To compare the diagnostic performance of CEM, ABMRI, and standard MRI. Materials and Methods This single-institution, prospective, blinded reader study included female participants referred for breast MRI from January 2018 to June 2021. CEM was performed within 14 days of standard MRI; ABMRI was produced from standard MRI images. Two readers independently interpreted each CEM and ABMRI after a washout period. Examination-level performance metrics calculated were recall rate, cancer detection, and false-positive biopsy recommendation rates per 1000 examinations and sensitivity, specificity, and positive predictive value of biopsy recommendation. Bootstrap and permutation tests were used to calculate 95% CIs and compare modalities. Results Evaluated were 492 paired CEM and ABMRI interpretations from 246 participants (median age, 51 years; IQR, 43-61 years). On 49 MRI scans with lesions recommended for biopsy, nine lesions showed malignant pathology. No differences in ABMRI and standard MRI performance were identified. Compared with standard MRI, CEM demonstrated significantly lower recall rate (14.0% vs 22.8%; difference, -8.7%; 95% CI: -14.0, -3.5), lower false-positive biopsy recommendation rate per 1000 examinations (65.0 vs 162.6; difference, -97.6; 95% CI: -146.3, -50.8), and higher specificity (87.8% vs 80.2%; difference, 7.6%; 95% CI: 2.3, 13.1). Compared with standard MRI, CEM had significantly lower cancer detection rate (22.4 vs 36.6; difference, -14.2; 95% CI: -28.5, -2.0) and sensitivity (61.1% vs 100%; difference, -38.9%; 95% CI: -66.7, -12.5). The performance differences between CEM and ABMRI were similar to those observed between CEM and standard MRI. Conclusion ABMRI had comparable performance to standard MRI and may support more efficient MRI screening. CEM had lower recall and higher specificity compared with standard MRI or ABMRI, offset by lower cancer detection rate and sensitivity compared with standard MRI. These trade-offs warrant further consideration of patient population characteristics before widespread screening with CEM. Clinical trial registration no. NCT03517813 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Chang in this issue.
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Affiliation(s)
- Marissa B. Lawson
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Savannah C. Partridge
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Daniel S. Hippe
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Habib Rahbar
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Diana L. Lam
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Christoph I. Lee
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Kathryn P. Lowry
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - John R. Scheel
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Sana Parsian
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Isabella Li
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Debosmita Biswas
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Mary Lynn Bryant
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
| | - Janie M. Lee
- From the Department of Radiology, University of Washington, Seattle,
Wash (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L., D.B., M.L.B., J.M.L.);
Department of Radiology (M.B.L., S.C.P., H.R., D.L.L., C.I.L., K.P.L., I.L.,
D.B., M.L.B., J.M.L.) and Clinical Research Division (D.S.H.), Fred Hutchinson
Cancer Center, 825 Eastlake Eve E, LG-200, Seattle, WA 98109; Department of
Radiology, Vanderbilt University, Nashville, Tenn (J.R.S.); and Department of
Radiology, Kaiser Permanente, Seattle, Wash (S.P.)
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9
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Lee JM, Ichikawa LE, Wernli KJ, Bowles EJA, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Impact of Surveillance Mammography Intervals Less Than One Year on Performance Measures in Women With a Personal History of Breast Cancer. Korean J Radiol 2023; 24:729-738. [PMID: 37500574 PMCID: PMC10400369 DOI: 10.3348/kjr.2022.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/29/2023] [Accepted: 05/18/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE When multiple surveillance mammograms are performed within an annual interval, the current guidance for one-year follow-up to determine breast cancer status results in shared follow-up periods in which a single breast cancer diagnosis can be attributed to multiple preceding examinations, posing a challenge for standardized performance assessment. We assessed the impact of using follow-up periods that eliminate the artifactual inflation of second breast cancer diagnoses. MATERIALS AND METHODS We evaluated surveillance mammograms from 2007-2016 in women with treated breast cancer linked with tumor registry and pathology outcomes. Second breast cancers included ductal carcinoma in situ or invasive breast cancer diagnosed during one-year follow-up. The cancer detection rate, interval cancer rate, sensitivity, and specificity were compared using different follow-up periods: standard one-year follow-up per the American College of Radiology versus follow-up that was shortened at the next surveillance mammogram if less than one year (truncated follow-up). Performance measures were calculated overall and by indication (screening, evaluation for breast problem, and short interval follow-up). RESULTS Of 117971 surveillance mammograms, 20% (n = 23533) were followed by another surveillance mammogram within one year. Standard follow-up identified 1597 mammograms that were associated with second breast cancers. With truncated follow-up, the breast cancer status of 179 mammograms (11.2%) was revised, resulting in 1418 mammograms associated with unique second breast cancers. The interval cancer rate decreased with truncated versus standard follow-up (3.6 versus 4.9 per 1000 mammograms, respectively), with a difference (95% confidence interval [CI]) of -1.3 (-1.6, -1.1). The overall sensitivity increased to 70.4% from 63.7%, for the truncated versus standard follow-up, with a difference (95% CI) of 6.6% (5.6%, 7.7%). The specificity remained stable at 98.1%. CONCLUSION Truncated follow-up, if less than one year to the next surveillance mammogram, enabled second breast cancers to be associated with a single preceding mammogram and resulted in more accurate estimates of diagnostic performance for national benchmarks.
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Affiliation(s)
- Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Laura E Ichikawa
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer M Specht
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Veterans Affairs, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
| | - Nehmat Houssami
- The Daffodil Centre, University of Sydney and Cancer Council New South Wales, Kings Cross, New South Wales, Australia
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena, CA, USA
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10
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Abstract
Background The wide variability of screening imaging use in patients with a personal history of breast cancer (PHBC) warrants investigation of its comparative clinical effectiveness. While more intensive screening with US or MRI at an interval of less than 1 year could increase early-stage breast cancer detection, its benefit has not been established. Purpose To investigate the outcomes of semiannual multimodality screening in patients with PHBC. Materials and Methods An academic medical center database was retrospectively searched for patients diagnosed with breast cancer between January 2015 and June 2018 who had undergone annual mammography with either semiannual incidence US or MRI screening from July 2019 to December 2019 and three subsequent semiannual screenings over a 2-year period. The primary outcome was second breast cancers diagnosed during follow-up. Examination-level cancer detection and interval cancer rates were calculated. Screening performances were compared with χ2 or Fisher exact tests or a logistic model with generalized estimating equations. Results Our final cohort included 2758 asymptomatic women (median age, 53 years; range, 20-84 years). Among 5615 US and 1807 MRI examinations, 18 breast cancers were detected after negative findings on a prior semiannual incidence US screening examination; 44% (eight of 18) were stage 0 (three detected with MRI; five, with US), and 39% (seven of 18) were stage I (three detected with MRI; four, with US). MRI had a cancer detection rate up to 17.1 per 1000 examinations (eight of 467; 95% CI: 8.7, 33.4), and the overall cancer detection rates of US and MRI were 1.8 (10 of 5615; 95% CI: 1.0, 3.3) and 4.4 (eight of 1807; 95% CI: 2.2, 8.8) per 1000 examinations, respectively (P = .11). Conclusion Supplemental semiannual US or MRI screening depicted second breast cancers after negative findings at prior semiannual incidence US examination in patients with PHBC. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Berg in this issue.
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Affiliation(s)
- Su Min Ha
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Janie M Lee
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Seon-Ok Kim
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Woo Kyung Moon
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
| | - Jung Min Chang
- From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea (S.M.H., W.K.M., J.M.C.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (J.M.L.); and Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Seoul, Republic of Korea (S.O.K.)
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11
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Lee CI, Abraham L, Miglioretti DL, Onega T, Kerlikowske K, Lee JM, Sprague BL, Tosteson ANA, Rauscher GH, Bowles EJA, diFlorio-Alexander RM, Henderson LM. National Performance Benchmarks for Screening Digital Breast Tomosynthesis: Update from the Breast Cancer Surveillance Consortium. Radiology 2023; 307:e222499. [PMID: 37039687 PMCID: PMC10323294 DOI: 10.1148/radiol.222499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
Background It is important to establish screening mammography performance benchmarks for quality improvement efforts. Purpose To establish performance benchmarks for digital breast tomosynthesis (DBT) screening and evaluate performance trends over time in U.S. community practice. Materials and Methods In this retrospective study, DBT screening examinations were collected from five Breast Cancer Surveillance Consortium (BCSC) registries between 2011 and 2018. Performance measures included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR) and were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition, and compared with concurrent BCSC DM screening examinations, previously published BCSC and National Mammography Database benchmarks, and expert opinion acceptable performance ranges. Benchmarks were derived from the distribution of performance measures across radiologists (n = 84 or n = 73 depending on metric) and were presented as percentiles. Results A total of 896 101 women undergoing 2 301 766 screening examinations (458 175 DBT examinations [median age, 58 years; age range, 18-111 years] and 1 843 591 DM examinations [median age, 58 years; age range, 18-109 years]) were included in this study. DBT screening performance measures were as follows: AIR, 8.3% (95% CI: 7.5, 9.3); CDR per 1000 screens, 5.8 (95% CI: 5.4, 6.1); sensitivity, 87.4% (95% CI: 85.2, 89.4); specificity, 92.2% (95% CI: 91.3, 93.0); and FNR per 1000 screens, 0.8 (95% CI: 0.7, 1.0). When compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks, all performance measures were higher for DBT except sensitivity and FNR, which were similar to concurrent and prior DM performance measures. The following proportions of radiologists achieved acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity. Conclusion In U.S. community practice, large proportions of radiologists met acceptable performance ranges for screening performance metrics with DBT. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Lee and Moy in this issue.
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Affiliation(s)
- Christoph I. Lee
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Linn Abraham
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Tracy Onega
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Janie M. Lee
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Garth H. Rauscher
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Roberta M. diFlorio-Alexander
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Louise M. Henderson
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - for the Breast Cancer Surveillance Consortium
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
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12
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Lowry KP, Ichikawa L, Hubbard RA, Buist DSM, Bowles EJA, Henderson LM, Kerlikowske K, Specht JM, Sprague BL, Wernli KJ, Lee JM. Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status. Cancer 2023; 129:1173-1182. [PMID: 36789739 PMCID: PMC10409444 DOI: 10.1002/cncr.34679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/01/2022] [Accepted: 12/30/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND In women with previously treated breast cancer, occurrence and timing of second breast cancers have implications for surveillance. The authors examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. METHODS Women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer were identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected at primary breast cancer diagnosis included demographics, ER status, and treatment. Second breast cancer events included subsequent ipsilateral or contralateral breast cancers diagnosed >6 months after primary diagnosis. The authors examined cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis. RESULTS At 10 years, the cumulative second breast cancer incidence was 11.8% (95% confidence interval [CI], 10.7%-13.1%) for women with ER-negative disease and 7.5% (95% CI, 7.0%-8.0%) for those with ER-positive disease. Women with ER-negative cancer had higher second breast cancer rates than those with ER-positive cancer during the first 5 years of follow-up (16.0 per 1000 person-years [PY]; 95% CI, 14.2-17.9 per 1000 PY; vs. 7.8 per 1000 PY; 95% CI, 7.3-8.4 per 1000 PY, respectively). After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer (12.1 per 1000 PY; 95% CI, 9.9-14.7; vs. 9.3 per 1000 PY; 95% CI, 8.4-10.3 per 1000 PY, respectively). CONCLUSIONS ER-negative primary breast cancers are associated with a higher risk of second breast cancers than ER-positive cancers during the first 5 years after diagnosis. Further study is needed to examine the potential benefit of more intensive surveillance targeting these women in the early postdiagnosis period.
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Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diana S. M. Buist
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Erin J. A. Bowles
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Louise M. Henderson
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jennifer M. Specht
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington, USA
| | - Brian L. Sprague
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, Vermont, USA
| | - Karen J. Wernli
- Kaiser Permanente Washington, Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Janie M. Lee
- Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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13
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Su YR, Buist DSM, Lee JM, Ichikawa L, Miglioretti DL, Bowles EJA, Wernli KJ, Kerlikowske K, Tosteson A, Lowry KP, Henderson LM, Sprague BL, Hubbard RA. Performance of Statistical and Machine Learning Risk Prediction Models for Surveillance Benefits and Failures in Breast Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2023; 32:561-571. [PMID: 36697364 PMCID: PMC10073265 DOI: 10.1158/1055-9965.epi-22-0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/02/2022] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Machine learning (ML) approaches facilitate risk prediction model development using high-dimensional predictors and higher-order interactions at the cost of model interpretability and transparency. We compared the relative predictive performance of statistical and ML models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer (PHBC). METHODS We cross-validated seven risk prediction models for two surveillance outcomes, failure (breast cancer within 12 months of a negative surveillance mammogram) and benefit (surveillance-detected breast cancer). We included 9,447 mammograms (495 failures, 1,414 benefits, and 7,538 nonevents) from years 1996 to 2017 using a 1:4 matched case-control samples of women with PHBC in the Breast Cancer Surveillance Consortium. We assessed model performance of conventional regression, regularized regressions (LASSO and elastic-net), and ML methods (random forests and gradient boosting machines) by evaluating their calibration and, among well-calibrated models, comparing the area under the receiver operating characteristic curve (AUC) and 95% confidence intervals (CI). RESULTS LASSO and elastic-net consistently provided well-calibrated predicted risks for surveillance failure and benefit. The AUCs of LASSO and elastic-net were both 0.63 (95% CI, 0.60-0.66) for surveillance failure and 0.66 (95% CI, 0.64-0.68) for surveillance benefit, the highest among well-calibrated models. CONCLUSIONS For predicting breast cancer surveillance mammography outcomes, regularized regression outperformed other modeling approaches and balanced the trade-off between model flexibility and interpretability. IMPACT Regularized regression may be preferred for developing risk prediction models in other contexts with rare outcomes, similar training sample sizes, and low-dimensional features.
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Affiliation(s)
- Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Diana SM Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
| | - Anna Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA
| | | | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington, VT
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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Brier LM, Chen S, Sherafati A, Bice AR, Lee JM, Culver JP. Transient disruption of functional connectivity and depression of neural fluctuations in a mouse model of acute septic encephalopathy. Cereb Cortex 2023; 33:3548-3561. [PMID: 35972424 PMCID: PMC10068285 DOI: 10.1093/cercor/bhac291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Septic encephalopathy leads to major and costly burdens for a large percentage of admitted hospital patients. Elderly patients are at an increased risk, especially those with dementia. Current treatments are aimed at sedation to combat mental status changes and are not aimed at the underlying cause of encephalopathy. Indeed, the underlying pathology linking together peripheral infection and altered neural function has not been established, largely because good, acutely accessible readouts of encephalopathy in animal models do not exist. Behavioral testing in animals lasts multiple days, outlasting the time frame of acute encephalopathy. Here, we propose optical fluorescent imaging of neural functional connectivity (FC) as a readout of encephalopathy in a mouse model of acute sepsis. Imaging and basic behavioral assessment were performed at baseline, Hr8, Hr24, and Hr72 following injection of either lipopolysaccharide or phosphate buffered saline. Neural FC strength decreased at Hr8 and returned to baseline by Hr72 in motor, somatosensory, parietal, and visual cortical regions. Additionally, neural fluctuations transiently declined at Hr8 and returned to baseline by Hr72. Both FC strength and fluctuation tone correlated with neuroscore indicating this imaging methodology is a sensitive and acute readout of encephalopathy.
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Affiliation(s)
- L M Brier
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - S Chen
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - A Sherafati
- Department of Physics, Washington University School of Arts and Science, St. Louis, MO 63110, USA
| | - A R Bice
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - J M Lee
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - J P Culver
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Physics, Washington University School of Arts and Science, St. Louis, MO 63110, USA
- Department of Biomedical Engineering, Washington University School of Engineering, St. Louis, MO 63110, USA
- Department of Electrical and Systems Engineering, Washington University School of Engineering, St. Louis, MO 63110, USA
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15
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Lee JM, Lee YS, Lee YJ, Lee JH, Han TY, Choi JE. Generalized painful papulovesicular eruption following the COVID-19 BNT162b2 mRNA vaccine. J Eur Acad Dermatol Venereol 2023. [PMID: 36914917 DOI: 10.1111/jdv.19043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Affiliation(s)
- J M Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Y S Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Y J Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - J H Lee
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - T Y Han
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - J E Choi
- Department of Dermatology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
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16
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Ho TQH, Bissell MCS, Lee CI, Lee JM, Sprague BL, Tosteson ANA, Wernli KJ, Henderson LM, Kerlikowske K, Miglioretti DL. Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall. J Am Coll Radiol 2023; 20:299-310. [PMID: 36273501 PMCID: PMC10044471 DOI: 10.1016/j.jacr.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. METHODS A population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. RESULTS The study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. CONCLUSIONS Prioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.
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Affiliation(s)
- Thao-Quyen H Ho
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam; Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Michael C S Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California
| | - Christoph I Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, Seattle, Washington; Deputy Editor, JACR
| | - Janie M Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Breast Imaging, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and Co-Leader, Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, Burlington, Vermont
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Associate Director for Population Sciences, Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Karen J Wernli
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; Cancer Epidemiology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, California; Women's Health Comprehensive Clinic, and Director, Advanced Postdoctoral Fellowship in Women's Health, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington; Biostatistics and Population Sciences and Health Disparities Program, University of California, Davis, Comprehensive Cancer Center, Davis, California.
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17
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Wong FL, Lee JM, Leisenring WM, Neglia JP, Howell RM, Smith SA, Oeffinger KC, Moskowitz CS, Henderson TO, Mertens A, Nathan PC, Yasui Y, Landier W, Armstrong GT, Robison LL, Bhatia S. Health Benefits and Cost-Effectiveness of Children's Oncology Group Breast Cancer Screening Guidelines for Chest-Irradiated Hodgkin Lymphoma Survivors. J Clin Oncol 2023; 41:1046-1058. [PMID: 36265088 PMCID: PMC9928841 DOI: 10.1200/jco.22.00574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/02/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the outcomes and cost-effectiveness of the Children's Oncology Group Guideline recommendation for breast cancer (BC) screening using mammography (MAM) and breast magnetic resonance imaging (MRI) in female chest-irradiated childhood Hodgkin lymphoma (HL) survivors. Digital breast tomosynthesis (DBT), increasingly replacing MAM in practice, was also examined. METHODS Life years (LYs), quality-adjusted LYs (QALYs), BC mortality, health care costs, and false-positive screen frequencies of undergoing annual MAM, DBT, MRI, MAM + MRI, and DBT + MRI from age 25 to 74 years were estimated by microsimulation. BC risks and non-BC mortality were estimated from female 5-year survivors of HL in the Childhood Cancer Survivor Study and the US population. Test performance of MAM and MRI was synthesized from HL studies, and that of DBT from the general population. Costs (2017 US dollars [USD]) and utility weights were obtained from the medical literature. Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS With 100% screening adherence, annual BC screening extended LYs by 0.34-0.46 years over no screening. If the willingness-to-pay threshold to gain a quality-adjusted LY was ICER < $100,000 USD, annual MAM at age 25-74 years was the only cost-effective strategy. When nonadherence was taken into consideration, only annual MAM at age 30-74 years (ICER = $56,972 USD) was cost-effective. Supplementing annual MAM with MRI costing $545 USD was not cost-effective under either adherence condition. If MRI costs were reduced to $300 USD, adding MRI to annual MAM at age 30-74 years could become more cost-effective, particularly in the reduced adherence condition (ICER = $133,682 USD). CONCLUSION Annual BC screening using MAM at age 30-74 years is effective and cost-effective in female chest-irradiated HL survivors. Although annual adjunct MRI is not cost-effective at $545 USD cost, it could become cost-effective as MRI cost is reduced, a plausible scenario with the emergent use of abbreviated MRI.
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Affiliation(s)
| | - Janie M. Lee
- University of Washington School of Medicine, Seattle, WA
| | | | | | | | - Susan A. Smith
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA
| | - Paul C. Nathan
- The Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Yutaka Yasui
- St Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
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18
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Lawson MB, Herschorn SD, Sprague BL, Buist DSM, Lee SJ, Newell MS, Lourenco AP, Lee JM. Imaging Surveillance Options for Individuals With a Personal History of Breast Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:854-868. [PMID: 35544374 PMCID: PMC9691521 DOI: 10.2214/ajr.22.27635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Annual surveillance mammography is recommended for breast cancer survivors on the basis of observational studies and meta-analyses showing reduced breast cancer mortality and improved quality of life. However, breast cancer survivors are at higher risk of subsequent breast cancer and have a fourfold increased risk of interval breast cancers compared with individuals without a personal history of breast cancer. Supplemental surveillance modalities offer increased cancer detection compared with mammography alone, but utilization is variable, and benefits must be balanced with possible harms of false-positive findings. In this review, we describe the current state of mammographic surveillance, summarize evidence for supplemental surveillance in breast cancer survivors, and explore a risk-based approach to selecting surveillance imaging strategies. Further research identifying predictors associated with increased risk of interval second breast cancers and development of validated risk prediction tools may help physicians and patients weigh the benefits and harms of surveillance breast imaging and decide on a personalized approach to surveillance for improved breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, University of Vermont Cancer Center, Burlington, VT
| | - Brian L Sprague
- Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Su-Ju Lee
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Mary S Newell
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Ana P Lourenco
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, 825 Eastlake Ave E, LG-200, Seattle, WA 98040
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19
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Vink CEM, Hoef TP, Lee JM, Boerhout CKM, Koo BK, Escaned J, Piek JJ, Kakuta T, Appelman Y, De Waard G. Sex-differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome – analysis from the multi-center international ILIAS Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Guideline-directed management of chronic coronary syndrome (CCS) remains focused on obstructive causes of angina, and is based on established therapies derived from studies predominantly including men. This occurs despite documented higher mortality from cardiovascular causes in women compared to men, which is hypothesized to be related to a higher prevalence of coronary microvascular dysfunction (CMD) in women. However, data on the relationship between sex, the different endotypes of CCS, and related sex-specific clinical outcomes are limited.
Purpose
This study aimed to investigate the relationship between sex and the different endotypes of CCS, as well as sex-specific clinical outcomes of CCS endotypes.
Method
In patients with stable angina undergoing coronary angiography, the following invasive coronary hemodynamics were characterized: fractional flow reserve (FFR; <0.80 considered abnormal), coronary flow reserve (CFR; <2.0 considered abnormal) and microcirculatory resistance (MR) (hyperemic microvascular resistance; >2.5mmHg/cm/sec or index of microvascular resistance >25 considered abnormal). Patients were stratified into three groups: 1) hemodynamically significant obstructive coronary artery disease (oCAD) (FFR abnormal or a severe coronary stenosis requiring revascularization), 2) no-obstructive coronary artery disease but with CMD (FFR normal, but abnormal CFR and/or MR), or 3) no-obstructive coronary artery disease and no CMD (FFR normal, and normal CFR and MR). We assessed the prevalence of the CCS endotypes across sex, and sex-specific cardiovascular outcomes over a follow-up of 7 years defined as the composite endpoint of death or acute myocardial infarction.
Results
Amongst a total of 1987 included patients, 1435 (72.2%) were men and 552 (27.8%) were women. oCAD occurred in 904 (45.5%) patients, which was significantly more prevalent in men (48.9% (701/1435) of men vs. 36.8% (203/552) of women, p<0.001). In contrast, CMD was significantly more prevalent in women (19.6% (281/1435) of men vs. 24.1% (133/552) of women, p=0.031). Across the population, either oCAD or CMD occurred in 68.4% of men versus 60.9% of women (p=0.002). There were no sex-specific differences in cardiovascular outcomes across CCS entities (Figure 1).
Conclusion
In patients evaluated for CCS who underwent clinically indicated coronary angiography and physiological assessment, men were more likely to have oCAD and women were more likely to be classified as CMD. There were no sex-related differences in the prognosis associated with the individual CCS endotypes. Therefore, pathophysiological changes in the coronary circulation potentially underlying angina pectoris are similarly prevalent in men and women, but the high incidence of CMD in women makes women prone to underdiagnosis if no additional physiological measurements are assessed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C E M Vink
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - T P Hoef
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - J M Lee
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
| | - C K M Boerhout
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - B K Koo
- University of Ulsan, Cardiology , Ulsan , Korea (Republic of)
| | - J Escaned
- Hospital Clinico San Carlos , Madrid , Spain
| | - J J Piek
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Cardiology , Tsuchiura , Japan
| | - Y Appelman
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - G De Waard
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
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20
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Travieso A, Mejia-Renteria H, Jeronimo-Baza A, Hyun Jung J, Doh JH, Nam CW, Shin ES, Hoshino M, Sugiyama T, Kanaji Y, Gonzalo N, Lee JM, Kakuta T, Koo BK, Escaned J. Hyperaemic and non-hyperaemic pressure indices of coronary stenosis severity in patients with chronic kidney disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence regarding the use of pressure indices for the assessment of coronary stenoses in patients with chronic kidney disease (CKD) is scarce.
Methods
We assessed the relation between eGFR, FFR and resting Pd/Pa in 1147 consecutive patients (1316 vessels) included in the International Collaboration of Comprehensive Physiologic Assessment Study. We also compared FFR and Pd/Pa against a standardized cut-off of coronary flow reserve (CFR<2.0). Finally, we examined the occurrence of vessel-oriented composite outcome (VOCO: cardiac death, vessel-specific revascularization, vessel-specific myocardial infarction) across negative/positive results of both FFR and CFR in patients with and without CKD.
Results
FFR increases as renal function worsens (beta −10.5, 95% CI −20.0 to −11.03, p=0.030), a relation that was not seen with resting Pd/Pa (beta −6.14, 95% CI −19.9 to 6.78, p=0.351). Both indices had similar diagnostic accuracies for the detection of a CFR<2.0 in the presence of CKD (AUC 0.629 for FFR vs 0.663 for resting Pd/Pa, p=0.192). However, CKD patients showed a higher proportion of vessels with negative FFR but low CFR (24.5% vs 13.4%, p=0.015).
CFR decreased linearly with deteriorating eGFR, and this was mainly driven by higher resting coronary flow in CKD patients (p=0.026), while hyperaemic coronary flow remained similar (p=0.403). IMR did not change significantly with eGFR (beta −0.02, 95% −0.09 to 0.05, p=0.557).
The incidence of VOCO was higher in patients with CKD and FFR>0.80 when compared to non-CKD patients and FFR>0.80 (12.7% vs 6.90%, p=0.062). Prognosis was worse for those with CKD, negative FFR and CFR<2.0 (20.59% vs. 8.44% in non-CKD, p=0.038).
Conclusions
The assessment of a given coronary stenosis in patients with CKD with either FFR or resting Pd/Pa is equivalent when compared to underlying coronary flow. In CKD, impaired CFR is caused by a state of increased resting flow. The assessment of CFR on top of standard pressure wire examination significantly improves prognostic stratification in CKD patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Travieso
- San Carlos Clinical Hospital , Madrid , Spain
| | | | | | - J Hyun Jung
- Sejong General Hospital , Bucheon , Korea (Republic of)
| | - J H Doh
- Ilsan Paik Hospital , Ilsan , Korea (Republic of)
| | - C W Nam
- Dongsan Medical Center. Keimyung University , Daegu , Korea (Republic of)
| | - E S Shin
- Ulsan University Hospital , Ulsan , Korea (Republic of)
| | - M Hoshino
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - T Sugiyama
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - Y Kanaji
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - N Gonzalo
- San Carlos Clinical Hospital , Madrid , Spain
| | - J M Lee
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T Kakuta
- Tsuchiura Kyodo General Hospital , Ibaraki , Japan
| | - B K Koo
- Seoul National University Hospital , Seoul , Korea (Republic of)
| | - J Escaned
- Seoul National University Hospital , Seoul , Korea (Republic of)
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21
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Kwon W, Yang JH, Lee SH, Choi KH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Ko YG, Yu CW, Jang WJ, Kim HJ, Kwon SU. Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.
Methods and results
1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI >25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.
Conclusions
Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Kwon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Lee
- Chonnam National University Hospital , Gwangju , Korea (Republic of)
| | - K H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J M Lee
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - Y B Song
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J Y Hahn
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - C M Ahn
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - Y G Ko
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - W J Jang
- Ewha Womans University Seoul Hospital , Seoul , Korea (Republic of)
| | - H J Kim
- Konkuk University Hospital , Seoul , Korea (Republic of)
| | - S U Kwon
- Inje University Sanggye Paik Hospital , Seoul , Korea (Republic of)
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22
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Kwon O, Myong JP, Lee Y, Choi YJ, Yi JE, Seo SM, Jang SW, Kim PJ, Lee JM. Sodium-glucose co-transporter-2 inhibitors after acute myocardial infarction in type 2 diabetes patients: a population-based investigation from South Korea. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Whether the early use of sodium-glucose co-transporter-2 (SGLT2) inhibitors has cardioprotective effects following acute myocardial infarction (AMI) is unknown.
Purpose
We aimed to evaluate the association between the early initiation of SGLT2 inhibitors and cardiac event rates in diabetes patients with AMI undergoing percutaneous coronary intervention (PCI).
Methods
Based on the National Health Insurance claims data in South Korea, patients aged 18 years or older who had undergone PCI for the diagnosis of AMI between 2014 and 2018 were analyzed. Patients treated with SGLT2 inhibitors or other glucose-lowering drugs were matched based on a propensity score. The primary endpoint was a composite of all-cause mortality and hospitalizations for heart failure (HF). Major adverse cardiac events (MACE; a composite of all-cause death, non-fatal MI, and ischemic stroke) were compared as the secondary endpoint.
Results
After 1:2 propensity score matching, a total of 26,814 patients were assigned to the SGLT2 inhibitors group (938 patients) and the no use of SGLT2 inhibitors group (1,876 patients), respectively. During a median follow-up of 2.1 years, compared to no use of SGLT2 inhibitors, the early use of SGLT2 inhibitors was associated with lower risks of both the primary endpoint (9.8% vs. 13.9%, adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI]: 0.54 to 0.87, p=0.002) and secondary endpoint (9.1% vs. 11.6%, adjusted HR = 0.77, 95% CI: 0.60 to 0.99, p=0.04) (Figure 1). All-cause mortality and hospitalizations for HF were significantly lower in the early use of SLGT2 inhibitors group (adjusted HR = 0.55; 95% CI: 0.37 to 0.80; p=0.002; and HR = 0.74; 95% CI: 0.56 to 0.98; p=0.03, respectively). The incidence of non-fatal MI and ischemic stroke were not statistically different (Figure 2).
Conclusions
The early use of SGLT2 inhibitors in diabetes patients treated with PCI for AMI was associated with a significantly lower risk of cardiovascular events including all-cause mortality, hospitalizations for HF, and MACE. Our results suggest that the use of SGLT2 inhibitors could expand to the acute phase of AMI survivors with diabetes to reduce mortality and the subsequent development of congestive HF and ischemic events.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This work was partly supported by the Research Institute of Medical Science, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.
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Affiliation(s)
- O Kwon
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J P Myong
- The Catholic University of Korea Seoul St. Mary's Hospital, Department of Occupational & Environmental Medicine , Seoul , Korea (Republic of)
| | - Y Lee
- The Catholic University of Korea Seoul St. Mary's Hospital, Department of Urology , Seoul , Korea (Republic of)
| | - Y J Choi
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J E Yi
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - S M Seo
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - S W Jang
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - P J Kim
- Eunpyeoung St. Mary's Hospital, Division of Cardiology, Department of Internal Medicine , Seoul , Korea (Republic of)
| | - J M Lee
- Eunpyeoung St. Mary's Hospital, Division of Endocrinology, Department of Internal Medicine , Seoul , Korea (Republic of)
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23
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Haas CB, Bowles EJA, Lee JM, Specht J, Buist DSM. Accuracy of tumor registry versus pharmacy dispensings for breast cancer adjuvant endocrine therapy. Cancer Causes Control 2022; 33:1145-1153. [PMID: 35796846 PMCID: PMC9746882 DOI: 10.1007/s10552-022-01603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Accounting for endocrine therapy use for breast cancer treatment is important for studies of survivorship. We evaluated the accuracy of Surveillance, Epidemiology, and End Results (SEER) breast cancer endocrine therapy data compared with pharmacy dispensings from an integrated health system. METHODS We included women with non-metastatic hormone receptor positive primary breast cancer diagnosed between 1995 and 2017 enrolled in Kaiser Permanente Washington, linking their data with SEER. We used pharmacy dispensings for endocrine therapy within one year following diagnosis as our reference standard. We calculated kappa (concordance), positive predictive value (PPV), and negative predictive values (NPV) overall and stratified by woman and tumor characteristics of interest. RESULTS Of 5,055 women, mean age at diagnosis was 62 years (interquartile range = 53-71); 53% had localized stage, 56% received lumpectomy with radiation, and 31% received chemotherapy. SEER data alone identified 67% of women as having received endocrine therapy; this increased to 75% with pharmacy dispensings. SEER's concordance with pharmacy dispensings was 0.68 (PPV = 91%; NPV = 76%). PPV did not vary by tumor or women characteristics; however, NPV declined with younger age at diagnosis (64% in < 45 years vs. 86% in 75+ years), increasing tumor stage (49% in regional stage vs. 91% in DCIS), and chemotherapy treatment (41% in those with chemotherapy vs. 83% in those without chemotherapy). CONCLUSION Pharmacy dispensings enable more complete endocrine therapy capture, particularly in women with more advanced tumors or who receive chemotherapy. We determined woman, tumor, and treatment characteristics that contribute to underascertainment of endocrine therapy use in tumor registries.
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Affiliation(s)
- Cameron B Haas
- Kaiser Permanente Washington Health Research Institute, 1730, Minor Ave, Seattle, WA, 98101, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, 98105, USA.
| | | | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Jennifer Specht
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Diana S M Buist
- Department of Epidemiology, University of Washington, Seattle, WA, 98105, USA
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Lee JM, Park CH, Yoo JI, Kim JT, Cha Y. Atypical periprosthetic femoral fracture with stem breakage: a case report. Osteoporos Int 2022; 33:2043-2047. [PMID: 35688896 DOI: 10.1007/s00198-022-06463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
Although the American Society for Bone and Mineral Research definition of atypical femoral fracture excludes periprosthetic fractures, fractures around the prosthesis with clinical features of atypical femoral fractures have been reported in the literature. All fractures reported thus far have been distal to the prosthetic segment; however, we encountered a case of a stress fracture in the middle of the femoral component segment. An 86-year-old woman with a history of bisphosphonate osteoporosis treatment and revisional total hip arthroplasty visited our outpatient clinic complaining of pain in the left thigh and groin. We diagnosed an incomplete atypical femoral fracture around the hip prosthesis; medical treatment was implemented. Two months later, the patient visited the emergency department with a complete subtrochanteric fracture with stem breakage. Without revision of the broken stem, two plates were applied after reduction. In this case, we recognized the possibility of a stress fracture but overlooked the possibility of stem breakage in an atypical femoral fracture. Even if it is not evident on the radiograph before complete fracture, clinicians should be alert to the signs of stress fracture in the middle of the femoral component segment, as they may be clues to atypical periprosthetic femoral fracture with stem failure. Isolated medical treatment plans are not recommended for incomplete subtrochanteric atypical periprosthetic femoral fracture. Instead, concomitant prophylactic plate fixation is recommended.
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Affiliation(s)
- J M Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea
| | - C H Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, South Korea
| | - J-I Yoo
- Department of Orthopedics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - J-T Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, South Korea.
| | - Y Cha
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan-Seoro, Seo-gu, Daejeon, 302-799, South Korea.
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Carnahan MB, Sharpe RE, Oluyemi E, Parra L, Hippe DS, Lorans R, Perry H, Moey THL, Bagadiya N, Lee JM. Women's Experience With Screening Mammography During the COVID-19 Pandemic: A Multi-Institutional Prospective Survey Study. J Breast Imaging 2022; 4:253-262. [PMID: 38416975 PMCID: PMC9129165 DOI: 10.1093/jbi/wbac022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evaluate women's anxiety and experience undergoing screening mammography during the COVID-19 pandemic. METHODS An IRB-approved anonymous survey was administered to women receiving screening mammography across six sites in the U.S. and Singapore from October 7, 2020, to March 11, 2021. Using a 1-5 Likert scale, women rated their pre- and post-visit anxiety regarding having their mammogram during the COVID-19 pandemic, importance of observed COVID-19 precautions, and personal risk factors for breast cancer and severe COVID-19 illness. Post-visit change in anxiety was evaluated. Multivariable logistic regression was used to test associations of pre-visit anxiety with breast cancer and COVID-19 risk factors. RESULTS In total, 1086 women completed the survey. Of these, 59% (630/1061) had >1 breast cancer risk factor; 27% (282/1060) had >1 COVID-19 risk factors. Forty-two percent (445/1065) experienced pre-visit anxiety. Pre-visit anxiety was independently associated with risk factors for severe COVID-19 (OR for >2 vs 0 risk factors: 2.04, 95% confidence interval [CI]: 1.11-3.76) and breast cancer (OR for >2 vs 0 risk factors: 1.71, 95% CI: 1.17-2.50), after adjusting for age and site. Twenty-six percent (272/1065) of women reported post-visit anxiety, an absolute 16% decrease from pre-visit anxiety (95% CI: 14%-19%, P < 0.001). Provider masking (941/1075, 88%) and physical distancing (861/1085, 79%) were rated as the most important precautions. CONCLUSION Pre-visit anxiety was associated with COVID-19 or breast cancer risk factors and declined significantly after screening mammography. Provider masking and physical distancing were rated the most important precautions implemented by imaging clinics.
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Affiliation(s)
| | | | - Eniola Oluyemi
- Johns Hopkins School of Medicine, Department of Radiology, Baltimore, MD, USA
| | - Laura Parra
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Daniel S Hippe
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
| | - Roxanne Lorans
- Mayo Clinic Arizona, Department of Radiology, Phoenix, AZ, USA
| | - Hannah Perry
- University of Vermont, Department of Radiology, Burlington, VT, USA
| | - Tammy Hui Lin Moey
- Singapore General Hospital, Department of Diagnostic Radiology, Singapore, Singapore
| | - Neeti Bagadiya
- Emory University, Department of Radiology, Atlanta, GA USA
| | - Janie M Lee
- University of Washington, Department of Radiology, Seattle, WA, USA
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Kerlikowske K, Chen S, Golmakani MK, Sprague BL, Tice JA, Tosteson ANA, Rauscher GH, Henderson LM, Buist DSM, Lee JM, Gard CC, Miglioretti DL. Cumulative Advanced Breast Cancer Risk Prediction Model Developed in a Screening Mammography Population. J Natl Cancer Inst 2022; 114:676-685. [PMID: 35026019 PMCID: PMC9086807 DOI: 10.1093/jnci/djac008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Estimating advanced breast cancer risk in women undergoing annual or biennial mammography could identify women who may benefit from less or more intensive screening. We developed an actionable model to predict cumulative 6-year advanced cancer (prognostic pathologic stage II or higher) risk according to screening interval. METHODS We included 931 186 women aged 40-74 years in the Breast Cancer Surveillance Consortium undergoing 2 542 382 annual (prior mammogram within 11-18 months) or 752 049 biennial (prior within 19-30 months) screening mammograms. The prediction model includes age, race and ethnicity, body mass index, breast density, family history of breast cancer, and prior breast biopsy subdivided by menopausal status and screening interval. We used fivefold cross-validation to internally validate model performance. We defined higher than 95th percentile as high risk (>0.658%), higher than 75th percentile to 95th or less percentile as intermediate risk (0.380%-0.658%), and 75th or less percentile as low to average risk (<0.380%). RESULTS Obesity, high breast density, and proliferative disease with atypia were strongly associated with advanced cancer. The model is well calibrated and has an area under the receiver operating characteristics curve of 0.682 (95% confidence interval = 0.670 to 0.694). Based on women's predicted advanced cancer risk under annual and biennial screening, 69.1% had low or average risk regardless of screening interval, 12.4% intermediate risk with biennial screening and average risk with annual screening, and 17.4% intermediate or high risk regardless of screening interval. CONCLUSION Most women have low or average advanced cancer risk and can undergo biennial screening. Intermediate-risk women may consider annual screening, and high-risk women may consider supplemental imaging in addition to annual screening.
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Affiliation(s)
- Karla Kerlikowske
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Shuai Chen
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - Brian L Sprague
- Department of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Jeffrey A Tice
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Garth H Rauscher
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington, and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Charlotte C Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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Lowry KP, Callaway KA, Lee JM, Zhang F, Ross-Degnan D, Wharam JF, Kerlikowske K, Wernli KJ, Kurian AW, Henderson LM, Stout NK. Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016. J Natl Compr Canc Netw 2022; 20:379-386.e9. [PMID: 35390766 DOI: 10.6004/jnccn.2021.7081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. METHODS We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40-49 vs 50-64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. RESULTS Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, -0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, -1.9% to -1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, -3.4% to -2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, -1.9% to -1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, -1.7%; 95% CI, -2.1% to -1.4%) or a primary care provider (APC, -1.6%; 95% CI, -2.1% to -1.2%) in the prior year. CONCLUSIONS Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.
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Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Katherine A Callaway
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Janie M Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J Frank Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Karla Kerlikowske
- Department of Medicine, and.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; and
| | - Natasha K Stout
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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28
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Lee JM, Hwang SH, Lee KB, Byun JI, Hwang HY. Standardization of 129I using the movable 4πβ(LS)-X(NaI(Tl)) system. Appl Radiat Isot 2021; 179:110022. [PMID: 34781075 DOI: 10.1016/j.apradiso.2021.110022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/13/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
The 129I standardization, using the movable 4πβ(LS)-X(NaI(Tl)) coincidence system, was performed for two 129I radioactive sources - one was dissolved in 0.1M NaOH solution and the other in 0.1M HNO3 solution. The system incorporates three movable PM tubes for a β-counter placed on a plane and a X-ray detector that can be moved up to the bottom of the vial. The β-efficiency depending on the amount of radioactive solution was investigated with 14 liquid scintillation samples prepared by gravimetrically dispensing 4.4-145 mg of 129I radioactive solution. The β-efficiencies above 90% were observed at less than 56 mg, but it was at most 70% at 145 mg. This occurred regardless of the activity of the sample or the type of chemical solution used to dissolve 129I source. The activity concentration of each 129I source was determined by efficiency-extrapolation method for samples with an activity range of 0.28-4.5 kBq. The β-efficiency points were derived over 10 intervals by moving 3-PM tubes in fine steps of about 1 mm from the sample. The highest value for β-efficiency was 95%. The combined uncertainty were 0.25% and 0.26%, respectively. The stated precision obtained using the system is better than that previously reported in the literature obtained by the triple to double coincidence ratio (TDCR) or the CIEMAT/NIST efficiency tracing method.
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Affiliation(s)
- J M Lee
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - S H Hwang
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - K B Lee
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - J I Byun
- Korea Institute of Nuclear Safety, Gwahak-ro, Yuseong-gu, Daejeon, 62, South Korea
| | - H Y Hwang
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea.
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29
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Sprague BL, O'Meara ES, Lee CI, Lee JM, Henderson LM, Buist DSM, Alsheik N, Macarol T, Perry H, Tosteson ANA, Onega T, Kerlikowske K, Miglioretti DL. Prioritizing breast imaging services during the COVID pandemic: A survey of breast imaging facilities within the Breast Cancer Surveillance Consortium. Prev Med 2021; 151:106540. [PMID: 34217424 PMCID: PMC8241650 DOI: 10.1016/j.ypmed.2021.106540] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
The COVID-19 pandemic disrupted breast cancer screening and diagnostic imaging in the United States. We sought to evaluate how medical facilities prioritized breast imaging services during periods of reduced capacity or upon re-opening after closures. In fall 2020, we surveyed 77 breast imaging facilities within the Breast Cancer Surveillance Consortium in the United States. The survey ascertained the pandemic's impact on clinical practices during March-September 2020. Nearly all facilities (97%) reported closing or operating at reduced capacity at some point during this period. All facilities were open by August 2020, though 14% were still operating at reduced capacity in September 2020. During periods of re-opening or reduced capacity, 93% of facilities reported prioritizing diagnostic breast imaging over breast cancer screening. For diagnostic imaging, facilities prioritized based on rescheduling canceled appointments (89%), specific indication for diagnostic imaging (89%), patient demand (84%), individual characteristics and risk factors (77%), and time since last imaging examination (72%). For screening mammography, facilities prioritized based on rescheduled cancelations (96%), patient demand (83%), individual characteristics and risk factors (73%), and time since last mammogram (71%). For biopsy services, more than 90% of facilities reported prioritization based on rescheduling of canceled exams, patient demand, patient characteristics and risk factors and level of suspicion on imaging. The observed patterns from this large and geographically diverse sample of facilities in the United States indicate that multiple factors were commonly used to prioritize breast imaging services during periods of reduced capacity.
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Affiliation(s)
- Brian L Sprague
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA; Department of Radiology and University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Christoph I Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Louise M Henderson
- Departments of Radiology and Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Nila Alsheik
- Advocate Aurora Health, System Breast Imaging, Downers Grove, IL, USA
| | - Teresita Macarol
- Advocate Aurora Health, System Breast Imaging, Downers Grove, IL, USA
| | - Hannah Perry
- Department of Radiology and University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA; Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
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30
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Sprague BL, Lowry KP, Miglioretti DL, Alsheik N, Bowles EJA, Tosteson ANA, Rauscher G, Herschorn SD, Lee JM, Trentham-Dietz A, Weaver DL, Stout NK, Kerlikowske K. Changes in Mammography Use by Women's Characteristics During the First 5 Months of the COVID-19 Pandemic. J Natl Cancer Inst 2021; 113:1161-1167. [PMID: 33778894 PMCID: PMC8083761 DOI: 10.1093/jnci/djab045] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/08/2021] [Accepted: 03/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics. METHODS We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic stratified by age, race and ethnicity, breast density, and family history of breast cancer. RESULTS Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of the April 2019 prepandemic volumes, respectively, but by July 2020 had rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of the July 2019 prepandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of the July 2019 prepandemic volume, respectively. CONCLUSIONS Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women, and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.
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Affiliation(s)
- Brian L Sprague
- Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Nila Alsheik
- Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, 1700 Luther Lane, Park Ridge, IL
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, Washington
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Janie M Lee
- Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Donald L Weaver
- University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
- Department of Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA
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31
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Lee JM, Ichikawa LE, Wernli KJ, Bowles E, Specht JM, Kerlikowske K, Miglioretti DL, Lowry KP, Tosteson ANA, Stout NK, Houssami N, Onega T, Buist DSM. Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016. Radiology 2021; 300:290-300. [PMID: 34003059 PMCID: PMC8328154 DOI: 10.1148/radiol.2021204581] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 01/13/2023]
Abstract
Background Since 2007, digital mammography and digital breast tomosynthesis (DBT) replaced screen-film mammography. Whether these technologic advances have improved diagnostic performance has, to the knowledge of the authors, not yet been established. Purpose To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. Materials and Methods In this observational cohort study, five Breast Cancer Surveillance Consortium registries provided prospectively collected mammography data linked with tumor registry and pathologic outcomes. This study identified asymptomatic women with American Joint Committee on Cancer anatomic stages 0-III primary breast cancer who underwent surveillance mammography from 2007 to 2016. The primary outcome was a second breast cancer diagnosis within 1 year of mammography. Performance measures included the recall rate, cancer detection rate, interval cancer rate, positive predictive value of biopsy recommendation, sensitivity, and specificity. Results Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. Conclusion In transitioning from screen-film to digital mammography and digital breast tomosynthesis, surveillance mammography performance demonstrated minimal improvement over time and remained inferior to the performance of screening mammography benchmarks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moy and Gao in this issue.
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Affiliation(s)
- Janie M. Lee
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Laura E. Ichikawa
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Karen J. Wernli
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Erin Bowles
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Jennifer M. Specht
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Karla Kerlikowske
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Diana L. Miglioretti
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Kathryn P. Lowry
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Anna N. A. Tosteson
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Natasha K. Stout
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Nehmat Houssami
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Tracy Onega
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
| | - Diana S. M. Buist
- From the Departments of Radiology (J.M.L., K.P.L.) and Medicine
(J.M.S.), University of Washington School of Medicine, Seattle, Wash; Seattle
Cancer Care Alliance, 1144 Eastlake Ave East, LG2-200, Seattle, WA 98109
(J.M.L., J.M.S., K.P.L.); Kaiser Permanente Washington Health Research
Institute, Seattle, Wash (L.E.I., K.J.W., E.B., D.L.M., D.S.M.B.); Department of
Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine,
Pasadena, Calif (K.J.W., D.S.M.B.); Department of Medicine, Division of General
Internal Medicine, Department of Veterans Affairs, and Department of
Epidemiology and Biostatistics, University of California, San Francisco, San
Francisco, Calif (K.K.); Division of Biostatistics, Department of Public Health
Sciences, University of California Davis School of Medicine, Davis, Calif
(D.L.M.); Dartmouth Institute for Health Policy and Clinical Practice (A.N.A.T.,
T.O.) and Norris Cotton Cancer Center (A.N.A.T.), Geisel School of Medicine,
Dartmouth College, Lebanon, NH; Department of Population Medicine, Harvard
Medical School and Harvard Pilgrim Health Care Institute, Harvard University,
Boston, Mass (N.K.S.); Faculty of Medicine and Health, Sydney School of Public
Health, University of Sydney, New South Wales, Australia (N.H.); and Huntsman
Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.)
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Lawson MB, Lee CI, Hippe DS, Chennupati S, Fedorenko CR, Malone KE, Ramsey SD, Lee JM. Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes. J Natl Compr Canc Netw 2021; 19:1156-1164. [PMID: 34330103 DOI: 10.6004/jnccn.2020.7801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. PATIENTS AND METHODS Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. RESULTS Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80-4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64-2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10-6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26-3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67-2.61). Nonreceipt of mammography was associated with younger age (40-49 vs 50-59 years; OR, 1.69; 95% CI, 1.45-1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03-1.07). CONCLUSIONS In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.
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Affiliation(s)
- Marissa B Lawson
- 1Department of Radiology, University of Washington School of Medicine; and
| | - Christoph I Lee
- 1Department of Radiology, University of Washington School of Medicine; and.,2Hutchinson Institute for Cancer Outcomes Research, and
| | - Daniel S Hippe
- 1Department of Radiology, University of Washington School of Medicine; and
| | | | | | - Kathleen E Malone
- 3Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Scott D Ramsey
- 2Hutchinson Institute for Cancer Outcomes Research, and.,3Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Janie M Lee
- 1Department of Radiology, University of Washington School of Medicine; and.,2Hutchinson Institute for Cancer Outcomes Research, and
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Tsauo J, Noh SY, Shin JH, Gwon DI, Han K, Lee JM, Jeon UB, Kim YH. Retrograde transvenous obliteration for the prevention of variceal rebleeding in patients with hepatocellular carcinoma: a multicentre retrospective study. Clin Radiol 2021; 76:681-687. [PMID: 34140137 DOI: 10.1016/j.crad.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/14/2021] [Indexed: 12/14/2022]
Abstract
AIM To evaluate the effectiveness and safety of retrograde transvenous obliteration (RTO) for the prevention of variceal rebleeding variceal rebleeding in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS This multicentre retrospective study enrolled 79 patients with HCC who underwent RTO for the prevention of variceal rebleeding. Successful occlusion of the gastrorenal shunt and obliteration of the gastric varices were achieved in 74 patients, with a technical success rate of 93.7%. Of the remaining 74 patients (mean age, 64.9±10.3 years; 56 men), 66 (90.4%) had gastroesophageal varices and seven (9.6%) had isolated gastric varices. Thirty-two patients (43.8%) underwent balloon-occluded RTO, 40 patients (54.8%) underwent plug-assisted RTO, and one patient (1.4%) underwent coil-assisted RTO. No patients had major procedural complications. RESULTS Rebleeding occurred in seven patients (9.6%) during the follow-up period. The 6-week and 1-year actuarial probabilities of patients remaining free of rebleeding were 90.8±3.6% and 88.6±4.1%, respectively. The median survival was 12.6 (95% confidence interval [CI] 8-17.3) months. The 6-week, 1-year, and 3-year actuarial probabilities of survival were 83.2±4.4%, 51.1±6.6%, and 32.7±7%, respectively. New or worsening ascites and oesophageal varices occurred in 12 (16.4%) and 13 patients (17.8%), respectively, during the follow-up period. Overt hepatic encephalopathy occurred in one patient (1.4%) during the follow-up period. The Child-Pugh score remained comparable to that at baseline at 1 and 3 months. CONCLUSION RTO was effective and safe in preventing variceal rebleeding in patients with HCC.
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Affiliation(s)
- J Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S Y Noh
- Department of Radiology, Kyung Hee University Seoul Hospital, Seoul, South Korea
| | - J H Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - D I Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - K Han
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - J M Lee
- Department of Radiology, Soonchunhyang University Hospital, Bucheon, South Korea
| | - U B Jeon
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Y H Kim
- Department of Radiology, Daegu Catholic University Medical Center, Daegu, South Korea
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34
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Wong FL, Lee JM, Leisenring WM, Neglia JP, Howell RM, Smith SA, Oeffinger KC, Moskowitz CS, Henderson TO, Mertens A, Nathan PC, Yasui Y, Landier W, Armstrong GT, Robison LL, Bhatia S. Efficacy of clinical breast examination in chest-irradiated female survivors of childhood Hodgkin lymphoma (HL). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.10028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10028 Background: Female survivors of childhood HL treated with ≥10 Gy of chest radiation are at high risk for breast cancer (BC). The Children’s Oncology Group (COG) guidelines recommend CBE annually starting at puberty and then semiannually from age 25, plus lifetime annual mammography (MAM) and breast Magnetic Resonance Imaging (MRI) starting 8y after chest radiation or age 25, whichever is later. While imaging-based screening recommendations are largely consistent with US guidelines for women at high BC risk, only the COG guidelines recommend CBE. The benefits of lifetime CBE starting from puberty for life in chest-irradiated HL survivors is unknown. Methods: Life-years (LYs) and lifetime BC mortality risk were estimated from a simulated cohort of 5-million HL survivors using the data from 5y female survivors of HL in the Childhood Cancer Survivor Study (CCSS) treated with ≥10 Gy of chest radiation. The simulated cohort underwent annual MAM+MRI from age 25 for life, with and without annual CBE from age 11 (presumed age of puberty) to age 24 and with and without semiannual CBE from age 25 for life with 100% adherence. BC included in-situ and invasive BC. Treatment-related BC incidence and non-BC mortality risks were estimated from the CCSS data. Risks at age <25 were extrapolated from the CCSS estimates while risks beyond age 50 were extrapolated additionally using the US population rates. CBE sensitivity (17.8%, in-situ and invasive BC) and specificity (98%) and MAM+MRI sensitivity (84.2-86.0%, in-situ; 96.7-97.1%, invasive) and specificity (75.3%) were obtained from the medical literature. Results: The CCSS cohort included 1057 female HL survivors. BC (all invasive) developed in three patients at age <25 (ages: 23, 24, 24). In the simulated cohort receiving no screening, lifetime BC risk was 40.8% and BC mortality was 17.5%. HL survivors around age 50 were at a 7.4-fold higher risk of developing BC and a 5.2-fold higher risk of non-BC mortality when compared with the general population. Compared to no annual CBE for ages 11-24y, undergoing annual CBE did not increase gains in LYs or reduce lifetime BC mortality relative to no screening (Table). Among those who survived to age ≥25, undergoing semiannual CBE from age 25 for life compared to no semiannual CBE also resulted in little gain in LYs or reduction in lifetime BC mortality relative to no screening. Conclusions: Lifetime CBE starting at puberty in conjunction with MAM+MRI appears to add little survival benefits compared with no CBE, suggesting that COG guidelines may be revised without adverse effect on long-term outcomes for chest-irradiated female survivors of childhood HL.[Table: see text]
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Affiliation(s)
| | - Janie M. Lee
- University of Washington School of Medicine, Seattle, WA
| | | | | | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan A. Smith
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA
| | - Paul C. Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
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35
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Wong FL, Lee JM, Leisenring WM, Neglia JP, Howell RM, Smith SA, Oeffinger KC, Moskowitz CS, Henderson TO, Mertens A, Nathan PC, Yasui Y, Landier W, Armstrong GT, Robison LL, Bhatia S. Efficacy and cost-effectiveness of breast cancer (BC) screening in female survivors of childhood Hodgkin lymphoma (HL). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6593 Background: Female childhood HL survivors treated with ≥10 Gy of chest radiation are at high risk of developing BC. The Children’s Oncology Group (COG) guidelines recommend lifetime annual mammography (MAM) and breast Magnetic Resonance Imaging (MRI) starting 8y after chest radiation or age 25, whichever is later, and clinical breast examination (CBE) annually from puberty and semiannually from age 25. Initial model results suggest that CBE adds no survival benefit in this cohort. Digital breast tomosynthesis (DBT) is increasingly replacing digital MAM in clinical practice. Here, we present the efficacy and cost-effectiveness of COG’s imaging-based screening recommendations. Methods: Life-years (LYs), quality-adjusted LYs (QALYs), BC mortality, and costs (2017 U.S.$) were estimated from simulating the lifetimes of 5-million chest-irradiated 25y old HL survivors who underwent BC screening with each of the following strategies: annual digital MAM, MRI, MAM+MRI, annual DBT or DBT+MRI from age 25 onward. Treatment-related BC risk (in-situ and invasive) and non-BC mortality were estimated from female 5y HL survivors in the Childhood Cancer Survivor Study and from U.S. population rates. Test sensitivity was 70-74% for MAM (based on prior HL studies) and 89% for DBT and MRI (based on women at high risk of de novo BC). Costs and quality of life weights were obtained from medical literature. Results: For HL survivors with no screening, lifetime BC risk was 42.7% and BC mortality was 18.1%. BC risk and non-BC mortality were, respectively, 7.4- and 5.2-fold higher at age 50 in HL survivors relative to the general population. Screening at ages 25-74 had similar LY gain and BC mortality reduction compared to lifetime screening; hence, we focused on screening for ages 25-74. For all strategies screening provided LY gain of 0.34-0.47 and reduced BC mortality by 6.7-9.8% compared with no screening; incremental cost-effectiveness ratio (ICER), or cost per QALY gained, for MAM alone was $58,726 and for DBT alone was $62,989. ICER of adding MRI to MAM ($385,285) or to DBT ($513,358) indicated lower cost-effectiveness of supplemental MRI (Table). Conclusions: Annual screening at ages 25-74y in chest-irradiated HL survivors appears beneficial. Using $100K per QALY gained as cost-effectiveness threshold, annual MAM or DBT are more cost-effective, whereas adding MRI to MAM is less cost-effective.[Table: see text]
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Affiliation(s)
| | - Janie M. Lee
- University of Washington School of Medicine, Seattle, WA
| | | | | | - Rebecca M. Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan A. Smith
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Ann Mertens
- Emory University School of Medicine, Atlanta, GA
| | - Paul C. Nathan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
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Hovis KK, Lee JM, Hippe DS, Linden H, Flanagan MR, Kilgore MR, Yee J, Partridge SC, Rahbar H. Accuracy of Preoperative Breast MRI Versus Conventional Imaging in Measuring Pathologic Extent of Invasive Lobular Carcinoma. J Breast Imaging 2021; 3:288-298. [PMID: 34061121 PMCID: PMC8139612 DOI: 10.1093/jbi/wbab015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether invasive lobular carcinoma (ILC) extent is more accurately depicted with preoperative MRI (pMRI) than conventional imaging (mammography and/or ultrasound). METHODS After IRB approval, we retrospectively identified women with pMRIs (February 2005 to January 2014) to evaluate pure ILC excluding those with ipsilateral pMRI BI-RADS 4 or 5 findings or who had neoadjuvant chemotherapy. Agreement between imaging and pathology sizes was summarized using Bland-Altman plots, absolute and percent differences, and the intraclass correlation coefficient (ICC). Rates of underestimation and overestimation were evaluated and their associations with clinical features were explored. RESULTS Among the 56 women included, pMRI demonstrated better agreement with pathology than conventional imaging by mean absolute difference (1.6 mm versus -7.8 mm, P < 0.001), percent difference (10.3% versus -16.4%, P < 0.001), and ICC (0.88 versus 0.61, P = 0.019). Conventional imaging more frequently underestimated ILC span than pMRI using a 5 mm difference threshold (24/56 (43%) versus 10/56 (18%), P < 0.001), a 25% threshold (19/53 (36%) versus 10/53 (19%), P = 0.035), and T category change (17/56 (30%) versus 7/56 (13%), P = 0.006). Imaging-pathology size concordance was greater for MRI-described solitary masses than other lesions for both MRI and conventional imaging (P < 0.05). Variability of conventional imaging was lower for patients ≥ the median age of 62 years than for younger patients (SD: 12 mm versus 22 mm, P = 0.012). CONCLUSION MRI depicts pure ILC more accurately than conventional imaging and may have particular value for younger women.
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Affiliation(s)
- Keegan K Hovis
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Janie M Lee
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Daniel S Hippe
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Hannah Linden
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington School of Medicine, Department of Medical Oncology, Seattle, WA, USA
| | - Meghan R Flanagan
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington School of Medicine, Department of Surgery, Seattle, WA, USA
| | - Mark R Kilgore
- Seattle Cancer Care Alliance, Seattle, WA, USA
- University of Washington School of Medicine, Department of Laboratory Medicine and Pathology, Seattle, WA, USA
| | - Janis Yee
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
| | - Savannah C Partridge
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Habib Rahbar
- University of Washington School of Medicine, Department of Radiology, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
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37
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Lee JM, Agung A, Hwang SH, Lee KB, Hwang HY. Development of a movable 4πβ(LS)-γ coincidence counting system for activity standardization of β-γ emitters. Appl Radiat Isot 2021; 174:109743. [PMID: 33915348 DOI: 10.1016/j.apradiso.2021.109743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/23/2020] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
A new movable 3PM-γ coincidence system, based on 4πβ(LS)-γ coincidence counting, for activity measurement of β-γ emitters has been designed at the Korea Research Institute of Standards and Science (KRISS). The system incorporates 3 PM tubes on the plane and two detectors placed above and below the center of the plane. The 3 PM tubes for β-counters in the plane are movable up to 100 mm from a liquid scintillation vial, thus enabling the variation of β-detection efficiencies by a geometrical technique. A NaI(Tl) γ-counter was set above for the present work. The β-event is determined by counting the logical sum of three double coincidences. All the necessary electronics, i.e., logical sum, adjusting the duration of dead-time of each counting channel and coincidence resolving times, and analyzing coincidence relation, were specially designed to be fabricated in an integrated circuit. Details of the detectors, the electronics, the overall movable 3PM-γ coincidence system are presented, as well as the results of investigations to assess its operating characteristics. Validation measurements have been performed with 60Co and 57Co sources. The highest β-detection efficiency achieved with 60Co and 57Co was 97% and 95%, respectively. The activity concentration determined with a new system agreed with calibrated values within the uncertainty range. Further results from validation measurements and the corresponding uncertainty budgets are presented.
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Affiliation(s)
- J M Lee
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - A Agung
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - S H Hwang
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - K B Lee
- Korea Research Institute of Standards and Science, Gajeong-ro, Yuseong-gu, Daejeon, 267, South Korea
| | - H Y Hwang
- Mokwon University, Doanbuk-ro, Seo-gu, Daejeon, 88, South Korea.
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38
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Kerlikowske K, Bissell MCS, Sprague BL, Buist DSM, Henderson LM, Lee JM, Miglioretti DL. Response to Pisano, Gastonis, Sparano, et al. J Natl Cancer Inst 2021; 113:940-941. [PMID: 33783538 DOI: 10.1093/jnci/djab056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Michael C S Bissell
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Janie M Lee
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA.,Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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39
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Miglioretti DL, Bissell MCS, Kerlikowske K, Buist DSM, Cummings SR, Henderson LM, Onega T, O’Meara ES, Rauscher GH, Sprague BL, Tosteson ANA, Wernli KJ, Lee JM, Lee CI. Assessment of a Risk-Based Approach for Triaging Mammography Examinations During Periods of Reduced Capacity. JAMA Netw Open 2021; 4:e211974. [PMID: 33764423 PMCID: PMC7994953 DOI: 10.1001/jamanetworkopen.2021.1974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
Importance Breast cancer screening, surveillance, and diagnostic imaging services were profoundly limited during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. Objective To develop a risk-based strategy for triaging mammograms during periods of decreased capacity. Design, Setting, and Participants This population-based cohort study used data collected prospectively from mammography examinations performed in 2014 to 2019 at 92 radiology facilities in the Breast Cancer Surveillance Consortium. Participants included individuals undergoing mammography. Data were analyzed from August 10 to November 3, 2020. Exposures Clinical indication for screening, breast symptoms, personal history of breast cancer, age, time since last mammogram/screening interval, family history of breast cancer, breast density, and history of high-risk breast lesion. Main Outcomes and Measures Combinations of clinical indication, clinical history, and breast cancer risk factors that subdivided mammograms into risk groups according to their cancer detection rate were identified using classification and regression trees. Results The cohort included 898 415 individuals contributing 1 878 924 mammograms (mean [SD] age at mammogram, 58.6 [11.2] years) interpreted by 448 radiologists, with 1 722 820 mammograms in individuals without a personal history of breast cancer and 156 104 mammograms in individuals with a history of breast cancer. Most individuals were aged 50 to 69 years at imaging (1 113 174 mammograms [59.2%]), and 204 305 (11.2%) were Black, 206 087 (11.3%) were Asian or Pacific Islander, 126 677 (7.0%) were Hispanic or Latina, and 40 021 (2.2%) were another race/ethnicity or mixed race/ethnicity. Cancer detection rates varied widely based on clinical indication, breast symptoms, personal history of breast cancer, and age. The 12% of mammograms with very high (89.6 [95% CI, 82.3-97.5] to 122.3 [95% CI, 108.1-138.0] cancers detected per 1000 mammograms) or high (36.1 [95% CI, 33.1-39.3] to 47.5 [95% CI, 42.4-53.3] cancers detected per 1000 mammograms) cancer detection rates accounted for 55% of all detected cancers and included mammograms to evaluate an abnormal mammogram or breast lump in individuals of all ages regardless of breast cancer history, to evaluate breast symptoms other than lump in individuals with a breast cancer history or without a history but aged 60 years or older, and for short-interval follow-up in individuals aged 60 years or older without a breast cancer history. The 44.2% of mammograms with very low cancer detection rates accounted for 13.1% of detected cancers and included annual screening mammograms in individuals aged 50 to 69 years (3.8 [95% CI, 3.5-4.1] cancers detected per 1000 mammograms) and all screening mammograms in individuals younger than 50 years regardless of screening interval (2.8 [95% CI, 2.6-3.1] cancers detected per 1000 mammograms). Conclusions and Relevance In this population-based cohort study, clinical indication and individual risk factors were associated with cancer detection and may be useful for prioritizing mammography in times and settings of decreased capacity.
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Affiliation(s)
- Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Michael C. S. Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco
| | | | - Tracy Onega
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Garth H. Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago
| | - Brian L. Sprague
- Office of Health Promotion Research, University of Vermont Cancer Center, Department of Surgery, Larner College of Medicine at the University of Vermont, Burlington
| | - Anna N. A. Tosteson
- Norris Cotton Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Janie M. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle
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40
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Abstract
Breast magnetic resonance (MR) imaging is the most sensitive imaging modality for breast cancer detection and guidelines recommend its use, in addition to screening mammography, for high-risk women. The most recent American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) manual coordinated cross-modality BI-RADS terminology and established an outcome monitoring section that helps guide a medical imaging outcomes audit. This article provides a framework for performing a breast MR imaging audit in clinical practice, incorporating ACR BI-RADS guidance and more recently published data, clarifies common pitfalls, and discusses audit challenges related to evolving clinical practice.
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Affiliation(s)
- Diana L Lam
- Department of Radiology, University of Washington School of Medicine, 1144 Eastlake Avenue East, LG-200, Seattle, WA 98109, USA.
| | - Janie M Lee
- Department of Radiology, University of Washington School of Medicine, 1144 Eastlake Avenue East, LG-200, Seattle, WA 98109, USA
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41
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Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.
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Affiliation(s)
- Habib Rahbar
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
| | - Janie M. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle Cancer Care Alliance, Seattle, WA
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42
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Kerlikowske K, Bissell MCS, Sprague BL, Buist DSM, Henderson LM, Lee JM, Miglioretti DL. Advanced Breast Cancer Definitions by Staging System Examined in the Breast Cancer Surveillance Consortium. J Natl Cancer Inst 2020; 113:909-916. [PMID: 33169794 DOI: 10.1093/jnci/djaa176] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/10/2020] [Accepted: 10/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Advanced breast cancer is an outcome used to evaluate screening effectiveness. The advanced cancer definition resulting in the best discrimination of breast cancer death has not been studied in a breast imaging population. METHODS A total of 52 496 women aged 40-79 years participating in the Breast Cancer Surveillance Consortium diagnosed with invasive cancer were staged using the 8th edition of American Joint Committee on Cancer (AJCC) anatomic and prognostic pathologic systems and Tomosynthesis Mammographic Imaging Screening Trial (TMIST) tumor categories. We calculated the area under the receiver operating characteristic curve for predicting 5-year breast cancer death and the sensitivity and specificity for predicting 5-year breast cancer death for 3 advanced cancer classifications: anatomic stage IIB or higher, prognostic pathologic stage IIA or higher, and TMIST advanced cancer. RESULTS The area under the receiver operating characteristic curves for predicting 5-year breast cancer death for AJCC anatomic stage, AJCC prognostic pathologic stage, and TMIST tumor categories were 0.826 (95% confidence interval [CI] = 0.817 to 0.835), 0.856 (95% CI = 0.846 to 0.866), and 0.789 (95% CI = 0.780 to 0.797), respectively. AJCC prognostic pathologic stage had statistically significantly better discrimination than AJCC anatomic stage (difference = 0.030, bootstrap 95% CI = 0.024 to 0.037) and TMIST tumor categories (difference = 0.067, bootstrap 95% CI = 0.059 to 0.075). The sensitivity and specificity for predicting 5-year breast cancer death for AJCC anatomic stage IIB or higher, AJCC prognostic pathologic stage IIA or higher, and TMIST advanced cancer were 72.6%, 76.7%, and 96.1%; and 78.9%, 81.6%, and 41.1%, respectively. CONCLUSIONS Defining advanced cancer as AJCC prognostic pathologic stage IIA or higher most accurately predicts breast cancer death. Use of this definition by investigators will facilitate comparing breast cancer screening effectiveness studies.
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Affiliation(s)
- Karla Kerlikowske
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Michael C S Bissell
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | - Brian L Sprague
- Department of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Janie M Lee
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA.,Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.,University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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43
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Oh JY, Song CY, Ko YJ, Lee JM, Kang WN, Yang DS, Kang B. Strong correlation between flux pinning and epitaxial strain in the GdBa 2Cu 3O 7-x /La 0.7Sr 0.3MnO 3 nanocrystalline heterostructure. RSC Adv 2020; 10:39102-39108. [PMID: 35518394 PMCID: PMC9057360 DOI: 10.1039/d0ra06431a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/19/2020] [Indexed: 11/24/2022] Open
Abstract
The effect of magnetic flux pinning is investigated in GdBa2Cu3O7 (GdBCO) thin films with two different types of ferromagnetic La0.7Sr0.3MnO3 (LSMO) buffers (nanoparticles and a layer) deposited on an STO substrate. Magnetization analyses reveal the presence of multiple flux pinning mechanisms responsible for the improvement in the critical current density of GdBCO films. While core pinning becomes a dominant pinning mechanism in GdBCO films with LSMO nanoparticles, a hybrid effect of magnetic-volume and core-point pinning is observed in GdBCO films with LSMO layers. Examinations of local structures for both LSMO and GdBCO using extended X-ray absorption fine structure spectroscopy (EXAFS) exhibit a close relation between the parameters in the pinning force scaling and the length ratio of the Mn–O bond to the Cu–O bond. This result implies that the origin of core pinning is probably attributed to epitaxial strain induced by lattice mismatch between LSMO and GdBCO. Therefore, an appropriate strain state of LSMO is required for an effective operation of magnetic pinning. The effect of magnetic flux pinning is investigated in GdBa2Cu3O7 (GdBCO) thin films with two different types of ferromagnetic La0.7Sr0.3MnO3 (LSMO) buffers (nanoparticles and a layer) deposited on an STO substrate.![]()
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Affiliation(s)
- J Y Oh
- Department of Physics, Chungbuk National University Cheongju Korea +82 43 274 7811 +82 43 261 3394
| | - C Y Song
- Department of Physics, Chungbuk National University Cheongju Korea +82 43 274 7811 +82 43 261 3394
| | - Y J Ko
- Department of Physics, Chungbuk National University Cheongju Korea +82 43 274 7811 +82 43 261 3394
| | - J M Lee
- Department of Physics, Sungkyunkwan University Suwon Korea
| | - W N Kang
- Department of Physics, Sungkyunkwan University Suwon Korea
| | - D S Yang
- Department of Physics Education, Chungbuk National University Cheongju Korea
| | - B Kang
- Department of Physics, Chungbuk National University Cheongju Korea +82 43 274 7811 +82 43 261 3394
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Wernli KJ, Callaway KA, Henderson LM, Kerlikowske K, Lee JM, Ross‐Degnan D, Wallace JK, Wharam JF, Zhang F, Stout NK. Trends in screening breast magnetic resonance imaging use among US women, 2006 to 2016. Cancer 2020; 126:5293-5302. [DOI: 10.1002/cncr.33140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/05/2020] [Accepted: 06/27/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute Seattle Washington
| | - Katherine A. Callaway
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Louise M. Henderson
- Department of Radiology University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Karla Kerlikowske
- Department of Medicine University of California at San Francisco San Francisco California
- Department of Epidemiology and Biostatistics University of California at San Francisco San Francisco California
- General Internal Medicine Section Department of Veterans Affairs University of California at San Francisco San Francisco California
| | - Janie M. Lee
- Department of Radiology University of Washington Seattle Washington
| | - Dennis Ross‐Degnan
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Jamie K. Wallace
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - J. Frank Wharam
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Fang Zhang
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
| | - Natasha K. Stout
- Department of Population Medicine Harvard Medical SchoolHarvard Pilgrim Health Care Institute Boston Massachusetts
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45
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Moiseev S, Lee JM, Zykova A, Bulanov N, Novikov P, Gitel E, Bulanova M, Safonova E, Shin JI, Kronbichler A, Jayne DRW. The alternative complement pathway in ANCA-associated vasculitis: further evidence and a meta-analysis. Clin Exp Immunol 2020; 202:394-402. [PMID: 32691878 DOI: 10.1111/cei.13498] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 12/11/2022] Open
Abstract
We compared the common pathway components C3a, C5a and membrane attack complex (MAC), also known as C5b-9, and the alternative pathway components factor B and properdin in patients with ANCA-associated vasculitis (AAV) and healthy controls, and conducted a meta-analysis of the available clinical evidence for the role of complement activation in the pathogenesis of AAV. Complement components were evaluated in 59 patients with newly diagnosed or relapsing granulomatosis with polyangiitis or microscopic polyangiitis and 36 healthy volunteers. In 28 patients, testing was repeated in remission. Next, we performed a meta-analysis by searching databases to identify studies comparing complement levels in AAV patients and controls. A random-effects model was used for statistical analyses. The median concentrations of MAC, C5a, C3a and factor B were higher in active AAV patients (P < 0·001). Achievement of remission was associated with reductions in C3a (P = 0·005), C5a (P = 0·035) and factor B levels (P = 0·045), whereas MAC and properdin levels did not change. In active AAV, there were no effects of ANCA specificity, disease phenotype, previous immunosuppression or disease severity on complement levels. A total of 1122 articles were screened, and five studies, including this report, were entered into the meta-analysis. Plasma MAC, C5a and factor B in patients with active AAV were increased compared to patients in remission (excluding factor B) and controls. Changes in C3a were of borderline significance. Our findings and the results of the meta-analysis support activation of the complement system predominantly via the alternative pathway in AAV patients.
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Affiliation(s)
- S Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - J M Lee
- Department of Pediatrics, Chungnam National University Hospital and College of Medicine, Daejeon, Korea
| | - A Zykova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Lomonosov Moscow State University, Moscow, Russia
| | - N Bulanov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - P Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - E Gitel
- Central Laboratory, Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Bulanova
- Vladimir Regional Clinical Hospital, Vladimir, Russia
| | - E Safonova
- Lomonosov Moscow State University, Moscow, Russia
| | - J I Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.,Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea.,Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, South Korea
| | - A Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
| | - D R W Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
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Miles RC, Lee CI, Sun Q, Bansal A, Lyman GH, Specht JM, Fedorenko CR, Greenwood-Hickman MA, Ramsey SD, Lee JM. Patterns of Surveillance Advanced Imaging and Serum Tumor Biomarker Testing Following Launch of the Choosing Wisely Initiative. J Natl Compr Canc Netw 2020; 17:813-820. [PMID: 31319393 DOI: 10.6004/jnccn.2018.7281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/06/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to assess advanced imaging (bone scan, CT, or PET/CT) and serum tumor biomarker use in asymptomatic breast cancer survivors during the surveillance period. PATIENTS AND METHODS Cancer registry records for 2,923 women diagnosed with primary breast cancer in Washington State between January 1, 2007, and December 31, 2014, were linked with claims data from 2 regional commercial insurance plans. Clinical data including demographic and tumor characteristics were collected. Evaluation and management codes from claims data were used to determine advanced imaging and serum tumor biomarker testing during the peridiagnostic and surveillance phases of care. Multivariable logistic regression models were used to identify clinical factors and patterns of peridiagnostic imaging and biomarker testing associated with surveillance advanced imaging. RESULTS Of 2,923 eligible women, 16.5% (n=480) underwent surveillance advanced imaging and 31.8% (n=930) received surveillance serum tumor biomarker testing. Compared with women diagnosed before the launch of the Choosing Wisely campaign in 2012, later diagnosis was associated with lower use of surveillance advanced imaging (odds ratio [OR], 0.68; 95% CI, 0.52-0.89). Factors significantly associated with use of surveillance advanced imaging included increasing disease stage (stage III: OR, 3.65; 95% CI, 2.48-5.38), peridiagnostic advanced imaging use (OR, 1.76; 95% CI, 1.33-2.31), and peridiagnostic serum tumor biomarker testing (OR, 1.35; 95% CI, 1.01-1.80). CONCLUSIONS Although use of surveillance advanced imaging in asymptomatic breast cancer survivors has declined since the launch of the Choosing Wisely campaign, frequent use of surveillance serum tumor biomarker testing remains prevalent, representing a potential target for further efforts to reduce low-value practices.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Christoph I Lee
- Department of Radiology, University of Washington Medical Center
| | - Qin Sun
- Fred Hutchinson Cancer Research Center
| | | | | | - Jennifer M Specht
- Department of Oncology, University of Washington Medical Center, and
| | | | | | | | - Janie M Lee
- Department of Radiology, University of Washington Medical Center
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47
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Dela Rue B, Lee JM, Eastwood CR, Macdonald KA, Gregorini P. Short communication: Evaluation of an eating time sensor for use in pasture-based dairy systems. J Dairy Sci 2020; 103:9488-9492. [PMID: 32747112 DOI: 10.3168/jds.2020-18173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/19/2020] [Indexed: 11/19/2022]
Abstract
The assessment of grazing behavior is important for research and practice in pasture-grazed dairy farm systems. However, few devices are available that enable assessment of cow grazing behavior at an individual animal level. This study investigated whether commercially available Smarttag "eating time" sensors (Nedap Livestock Management, Groenlo, the Netherlands) were suitable for recording the grazing time of cows. Smarttag sensors were mounted on the neck collars of multiparous Holstein-Friesian cows in a herd in Taranaki, New Zealand. Cows were randomly selected each observation day from the milking herd for 8 separate days across a 1-mo period. Trained observers conducted 90-min observation periods to evaluate the relationship between the sensor eating time measure and grazing time. A set of 5 defined cow behaviors (2 "head up" and 3 "head down" behaviors) were assessed. In total, observations of 37 cows were recorded in 14 sessions over 8 d in the study period, providing 55.5 total hours of observations. Observation data were aligned with sensor data according to the sensor time stamps and grouped into matching 15-min intervals. Interobserver reliability was assessed both before and after the main trial period, and the mean percentage eating time per observer had a coefficient of variation of 0.46% [mean 93.2, standard deviation (SD) 0.425] before and 0.07% (mean 96.3, SD 0.074) after. In the main trial, the relationship between observed (mean 70.8%) and sensor-derived (mean 69.3%) percentage eating time over the observation period gave a Pearson correlation coefficient of 0.971, concordance correlation coefficient 0.968, mean difference 1.50% points, and SD 5.8% points. Therefore, sensor-identified percentage "eating time" and observed percentage active grazing time were shown to be both very well correlated and concordant (in agreement, with high correlation and little bias). Therefore, the relationship between observed and sensor-derived data had a high degree of agreement for identifying cow grazing activity. In conclusion, Smarttag sensors are a valid and useful tool for estimating grazing activity at time periods of 1 h or more.
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Affiliation(s)
- B Dela Rue
- DairyNZ Ltd., Private Bag 3221, Hamilton 3240, New Zealand
| | - J M Lee
- DairyNZ Ltd., Private Bag 3221, Hamilton 3240, New Zealand
| | - C R Eastwood
- DairyNZ Ltd., Private Bag 3221, Hamilton 3240, New Zealand.
| | - K A Macdonald
- DairyNZ Ltd., Private Bag 3221, Hamilton 3240, New Zealand
| | - P Gregorini
- Lincoln University, Department of Agricultural Sciences, Faculty of Agricultural and Life Sciences, Lincoln 7647, Christchurch, New Zealand
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48
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Lowry KP, Coley RY, Miglioretti DL, Kerlikowske K, Henderson LM, Onega T, Sprague BL, Lee JM, Herschorn S, Tosteson ANA, Rauscher G, Lee CI. Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density. JAMA Netw Open 2020; 3:e2011792. [PMID: 32721031 PMCID: PMC7388021 DOI: 10.1001/jamanetworkopen.2020.11792] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Importance Digital mammography (DM) and digital breast tomosynthesis (DBT) are used for routine breast cancer screening. There is minimal evidence on performance outcomes by age, screening round, and breast density in community practice. Objective To compare DM vs DBT performance by age, baseline vs subsequent screening round, and breast density category. Design, Setting, and Participants This comparative effectiveness study assessed 1 584 079 screening examinations of women aged 40 to 79 years without prior history of breast cancer, mastectomy, or breast augmentation undergoing screening mammography at 46 participating Breast Cancer Surveillance Consortium facilities from January 2010 to April 2018. Exposures Age, Breast Imaging Reporting and Data System breast density category, screening round, and modality. Main Outcomes and Measures Absolute rates and relative risks (RRs) of screening recall and cancer detection. Results Of 1 273 492 DM and 310 587 DBT examinations analyzed, 1 028 891 examinations (65.0%) were of white non-Hispanic women; 399 952 women (25.2%) were younger than 50 years; and 671 136 women (42.4%) had heterogeneously dense or extremely dense breasts. Adjusted differences in DM vs DBT performance were largest on baseline examinations: for example, per 1000 baseline examinations in women ages 50 to 59, recall rates decreased from 241 examinations for DM to 204 examinations for DBT (RR, 0.84; 95% CI, 0.73-0.98), and cancer detection rates increased from 5.9 with DM to 8.8 with DBT (RR, 1.50; 95% CI, 1.10-2.08). On subsequent examinations, women aged 40 to 79 years with heterogeneously dense breasts had improved recall rates and improved cancer detection with DBT. For example, per 1000 examinations in women aged 50 to 59 years, the number of recall examinations decreased from 102 with DM to 93 with DBT (RR, 0.91; 95% CI, 0.84-0.98), and cancer detection increased from 3.7 with DM to 5.3 with DBT (RR, 1.42; 95% CI, 1.23-1.64). Women aged 50 to 79 years with scattered fibroglandular density also had improved recall and cancer detection rates with DBT. Women aged 40 to 49 years with scattered fibroglandular density and women aged 50 to 79 years with almost entirely fatty breasts benefited from improved recall rates without change in cancer detection rates. No improvements in recall or cancer detection rates were observed in women with extremely dense breasts on subsequent examinations for any age group. Conclusions and Relevance This study found that improvements in recall and cancer detection rates with DBT were greatest on baseline mammograms. On subsequent screening mammograms, the benefits of DBT varied by age and breast density. Women with extremely dense breasts did not benefit from improved recall or cancer detection with DBT on subsequent screening rounds.
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Affiliation(s)
- Kathryn P. Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | | | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Brian L. Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Janie M. Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
| | - Sally Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hamsphire
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago
| | - Christoph I. Lee
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle
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49
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Seon Y, Hwang SH, Lee JM, Lee KB, Heo DH, Han MJ, Kim HJ. The primary system for measurement of beta emitting radioactive gases at KRISS. Appl Radiat Isot 2020; 164:109238. [PMID: 32554125 DOI: 10.1016/j.apradiso.2020.109238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/10/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
Korea Research Institute of Standards and Science (KRISS) is developing a length-compensated proportional counting (LCPC) system as a primary system for standardization of beta emitting radioactive gases. The pilot experiment was performed with 85Kr and the optimized high voltage and pressure were found to be 1700 V and 0.203 MPa, respectively. The total activity of 85Kr was deduced by the length compensation of each count. The expanded uncertainty was estimated to be around 0.8% (k = 2) for the 85Kr measurement.
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Affiliation(s)
- Y Seon
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; Department of Physics, Kyungpook National University, Daegu, 41566, South Korea
| | - S H Hwang
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea.
| | - J M Lee
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - K B Lee
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - D H Heo
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea
| | - M J Han
- Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, South Korea; University of Science & Technology (UST), Daejeon, 34113, South Korea
| | - H J Kim
- Department of Physics, Kyungpook National University, Daegu, 41566, South Korea
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50
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Kim BJ, Lee KB, Lee JM, Hwang SH, Heo DH, Han KH. Design of optimal digital filter and digital signal processing for a CdZnTe high resolution gamma-ray system. Appl Radiat Isot 2020; 162:109171. [PMID: 32501226 DOI: 10.1016/j.apradiso.2020.109171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/20/2019] [Accepted: 04/03/2020] [Indexed: 11/18/2022]
Abstract
We have developed an online digital signal processing system based on an FPGA. The system consists of pile-up rejection, baseline restorer, peak detection and pole-zero cancellation for evaluation of deposited energy in the detector. The shaping algorithm employed is a Moving Window Deconvolution (MWD) to shape digitized data into a trapezoidal form. For the purpose of verification, the developed digital system was tested for 137Cs gamma rays. The entire system is programmed using the LabVIEW environment.
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Affiliation(s)
- B J Kim
- Ionizing Radiation Center, Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, Republic of Korea; University of Science & Technology (UST), Daejeon, 34113, Republic of Korea
| | - K B Lee
- Ionizing Radiation Center, Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, Republic of Korea; University of Science & Technology (UST), Daejeon, 34113, Republic of Korea.
| | - J M Lee
- Ionizing Radiation Center, Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, Republic of Korea; University of Science & Technology (UST), Daejeon, 34113, Republic of Korea
| | - S H Hwang
- Ionizing Radiation Center, Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, Republic of Korea
| | - D H Heo
- Ionizing Radiation Center, Korea Research Institute of Standards and Science (KRISS), Daejeon, 34113, Republic of Korea
| | - K H Han
- ULS Co., Ltd., Daejeon, 34186, Republic of Korea
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