National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 70 Research Studies DisplayedMarcotte LM, Deeds S, Wheat C
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
The objective of this study was to evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy. Participants in the pragmatic randomized clinical trial, conducted at a Veterans Affairs (VA) medical center, were female veterans aged 45-75 eligible for breast cancer screening and enrolled in VA primary care. The results indicated that the opt-out population-based breast cancer screening outreach approach compared with an opt-in approach did not result in a significant difference in mammography completion, but did lead to more canceled mammography referrals, which increased staff burden.
AHRQ-funded; HS026369.
Citation: Marcotte LM, Deeds S, Wheat C .
Automated opt-out vs opt-in patient outreach strategies for breast cancer screening: a randomized clinical trial.
JAMA Intern Med 2023 Nov; 183(11):1187-94. doi: 10.1001/jamainternmed.2023.4321..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Prevention, Health Promotion
Kerlikowske K, Bissell MCS, Sprague BL
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Researchers evaluated differences in body mass index (BMI) in relation to differences in dense breasts prevalence by race/ethnicity. Their results indicated that dense breasts were most prevalent among Asian women followed by non-Hispanic White, Hispanic, and Black women. Clinically important differences in breast density prevalence are present across racial/ethnic groups after accounting for age, menopausal status, and BMI. IMPACT: If breast density is the sole criterion used to notify women of dense breasts and discuss supplemental screening it may result in implementing inequitable screening strategies across racial/ethnic groups.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Bissell MCS, Sprague BL .
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Cancer Epidemiol Biomarkers Prev 2023 Nov; 32(11):1524-30. doi: 10.1158/1055-9965.Epi-23-0049..
Keywords: Obesity, Women, Racial and Ethnic Minorities, Cancer: Breast Cancer, Cancer, Imaging
Offit LR, Chikarmane SA, Lacson RC
Frequency and outcomes of BI-RADS category 3 assessments in patients with a personal history of breast cancer: full-field digital mammography versus digital breast tomosynthesis.
The purpose of this article was to compare the frequency, outcomes, and additional characteristics of BI-RADS category 3 assessments between full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in patients with a personal history of breast cancer (PHBC). This retrospective study examined electronic health records from 14,845 mammograms in 10,118 patients (mean age, 63 years) with PHBC who had undergone mastectomy and/or lumpectomy. Of these, 8422 examinations were performed by FFDM from October 2014 to October 2016 and the rest examinations by FFDM with DBT from February 2017 to December 2018. The frequency of category 3 assessment was lower for DBT than FFDM (5.6% vs 6.4%). DBT, compared with FFDM, showed a lower malignancy rate for category 3 lesions (1.8% vs 5.0%), higher malignancy rate for category 4 lesions (32.0% vs 23.2%), and no difference in malignancy rate for category 5 lesions (100.0% vs 75.0%). An analysis of index category 3 lesions included 438 lesions for FFDM and 274 lesions for DBT. For category 3 lesions, DBT, compared with FFDM, showed lower PPV3 (13.9% vs 36.1%) and a more frequent mammographic finding of mass (33.2% vs 23.1%).
AHRQ-funded; HS028616.
Citation: Offit LR, Chikarmane SA, Lacson RC .
Frequency and outcomes of BI-RADS category 3 assessments in patients with a personal history of breast cancer: full-field digital mammography versus digital breast tomosynthesis.
AJR Am J Roentgenol 2023 Sep; 221(3):313-22. doi: 10.2214/ajr.23.29067..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Women
Sprague BL, Ichikawa L, Eavey J
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
This study evaluated mammography screening failure risk among women undergoing supplemental ultrasound screening in clinical practice in comparison with women undergoing mammography alone. Screening ultrasounds and screening mammograms without supplemental screening were identified within three Breast Cancer Surveillance Consortium registries. A clinically significant proportion of women who had undergone mammography screening alone were at high mammography screening failure risk. Ultrasound screening was highly targeted to women with dense breasts, but only a small proportion were high mammography screening failure risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Ichikawa L, Eavey J .
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
Cancer 2023 Aug 15; 129(16):2456-68. doi: 10.1002/cncr.34768..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Risk
McGee-Avila JK, Richmond J, Henry KA
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
This study examined geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. The authors used data from the New Jersey State Cancer Registry. They examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. They observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. They found that Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county and were 2.7% less likely to seek out-of-state care.
AHRQ-funded; HS026122.
Citation: McGee-Avila JK, Richmond J, Henry KA .
Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.
Health Serv Res 2023 Aug; 58(Suppl 2):152-64. doi: 10.1111/1475-6773.14182..
Keywords: Disparities, Urban Health, Rural/Inner-City Residents, Cancer, Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer: Cervical Cancer
Foraker R, Phommasathit C, Clevenger K
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
The purpose of this study was to collect patients' and clinicians' perspectives on barriers and facilitators for implementing BREASTChoice, a web-based breast reconstruction decision aid, into the clinical workflow. From August 2020 to April 2021, the researchers conducted 12 qualitative interviews with patients and clinicians from two Midwestern medical specialty centers. The study found patients and clinicians agreed that BREASTChoice could provide benefits in a number of areas including: 1) BREASTChoice could assist patients make more informed decisions about their reconstruction and improve preparation for their first plastic surgery appointment; 2) BREASTChoice could improve communication and processes if the patient could view the tool at home and/or in the waiting room; 3) Clinicians recommended the information from BREASTChoice about patients' risks and preferences could be included in the patient's chart or the clinician electronic health record (EHR) inbox for access during the consultation; 5) Patients and clinicians indicated that the BREASTChoice tool does not require much time for the patient to use, efficiently fills gaps in knowledge, includes helpful information. Patients did report requiring time to properly read and digest the information.
AHRQ-funded; HS026699.
Citation: Foraker R, Phommasathit C, Clevenger K .
Using the sociotechnical model to conduct a focused usability assessment of a breast reconstruction decision tool.
BMC Med Inform Decis Mak 2023 Jul 28; 23(1):140. doi: 10.1186/s12911-023-02236-x..
Keywords: Shared Decision Making, Women, Cancer: Breast Cancer, Cancer
Lee CI, Abraham L, Miglioretti DL
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
The purpose of this study was to develop performance benchmarks for digital breast tomosynthesis (DBT) screening and assess longitudinal performance patterns in United States community practice. Between 2011 and 2018 the researchers collected DBT screening examinations from five Breast Cancer Surveillance Consortium (BCSC) registries. Measures of performance were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition and included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR). These rates were compared with previously published BCSC and National Mammography Database benchmarks, concurrent BCSC DM screening examinations, and expert opinion acceptable performance ranges. The study included a total of 896,101 women undergoing 2,301,766 screening examinations and 1,843,591 DM examinations were included in this study. All performance measures were higher for DBT except sensitivity and FNR, when compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks. The following rates of radiologists received acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity.
AHRQ-funded; HS018366.
Citation: Lee CI, Abraham L, Miglioretti DL .
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
Radiology 2023 May; 307(4):e222499. doi: 10.1148/radiol.222499..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Prevention, Women
Lowry KP, Ichikawa L, Hubbard RA
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
This study examined the timing of second breast cancers by primary cancer estrogen receptor (ER) status in the Breast Cancer Surveillance Consortium. The cohort studied included women who were diagnosed with American Joint Commission on Cancer stage I-III breast cancer identified within six Breast Cancer Surveillance Consortium registries from 2000 to 2017. Characteristics collected during 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. Cumulative incidence and second breast cancer rates by primary cancer ER status during 1-5 versus 6-10 years after diagnosis was examined. At 10 years, the cumulative second breast cancer incidence was 11.8% for women with ER-negative disease and 7.5% 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. After 5 years, second breast cancer rates were similar for women with ER-negative versus ER-positive breast cancer.
AHRQ-funded; HS018366.
Citation: Lowry KP, Ichikawa L, Hubbard RA .
Variation in second breast cancer risk after primary invasive cancer by time since primary cancer diagnosis and estrogen receptor status.
Cancer 2023 Apr 15;129(8):1173-82. doi: 10.1002/cncr.34679.
Keywords: Cancer: Breast Cancer, Cancer, Women, Risk
Su YR, Buist DSM, Lee JM
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
The authors compared the relative predictive performance of statistical and machine learning (ML) models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer. They cross-validated seven risk prediction models for two surveillance outcomes, using 9,447 mammograms. The results suggested that regularized regression outperformed other modeling approaches for predicting breast cancer surveillance mammography outcomes and balanced the trade-off between model flexibility and interpretability.
AHRQ-funded; HS018366.
Citation: Su YR, Buist DSM, Lee JM .
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
Cancer Epidemiol Biomarkers Prev 2023 Apr 3; 32(4):561-71. doi: 10.1158/1055-9965.Epi-22-0677..
Keywords: Cancer: Breast Cancer, Cancer, Health Information Technology (HIT), Imaging
Ho TH, Bissell MCS, Lee CI
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
The purpose of this study was to establish a prioritization method for immediate interpretation of screening mammograms and potential diagnostic assessment. A cohort based on the population, comprising screening mammograms conducted from 2012 to 2020 at 126 radiology centers from 7 Breast Cancer Surveillance Consortium registries, was examined. Classification trees were used to identify combinations of clinical history (age, BI-RADS density, time elapsed since the previous mammogram, history of false-positive recall or biopsy outcome), screening technique (digital mammography, digital breast tomosynthesis), and facility features (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 classified as high and ≥16/100 as very high. The efficiency ratio was calculated as the percentage of recalls divided by the percentage of mammograms. The research cohort consisted of 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The study found that the primary predictor of recall was the time interval since the last mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening method. Recall rates were extremely high for baseline mammograms and high for women with ≥5 years since their previous mammogram. The 9.2% of mammograms in subgroups with very high and high recall rates represented 19.2% of recalls, yielding an efficiency ratio of 2.1 compared to a random strategy. Including women under 50 with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Findings incorporating facility-level characteristics were analogous.
AHRQ-funded; HS018366
Citation: Ho TH, Bissell MCS, Lee CI .
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
J Am Coll Radiol 2023 Mar;20(3):299-310. doi: 10.1016/j.jacr.2022.09.030.
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Diagnostic Safety and Quality
Miyashita M, Balogun OB, Olopade OI
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
The purpose of this study was to investigate the survival benefit of radiotherapy in de novo stage IV breast cancer. Data were taken from the National Cancer DataBase on Stage IV breast cancer patients who received breast surgery and had survived 12 months after diagnosis. Radiotherapy was found to be associated with improved survival in patients with bone or lung metastasis but not patients with liver or brain metastasis. It was also associated with improved survival in patients with one or two metastatic sites but not three or more. Survival impact did not differ among subtypes. The authors concluded that these “real-world data” show that postoperative radiotherapy might improve overall survival for de novo Stage IV breast cancer with bone or lung metastasis, regardless of subtypes.
AHRQ-funded; HS025806.
Citation: Miyashita M, Balogun OB, Olopade OI .
The optimization of postoperative radiotherapy in de novo stage IV breast cancer: evidence from real-world data to personalize treatment decisions.
Sci Rep 2023 Feb 18; 13(1):2880. doi: 10.1038/s41598-023-29888-z..
Keywords: Cancer: Breast Cancer, Cancer, Evidence-Based Practice, Women
Rosenberg SM, Zheng Y, Gelber S
Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer.
The purpose of this study was to describe oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer to inform strategies to improve adherence. The researchers identified 693 women with hormone receptor-positive, stage I to III breast cancer enrolled in a cohort of women diagnosed with breast cancer at 40 years or less, assessed ET decision-making and identified variables related with non-initiation/non-persistence and to assess the relationship between non-persistence and recurrence. The study found that by 18 months, 9% had not initiated ET. Black women had a greater chances and women with a college degree had lower chances of non-initiation. Of the 607 women who initiated, 20% were non-persistent. The researchers specified that younger age, being married or partnered, and indicating greater weight issues were related with higher chances of non-persistence. Having received chemotherapy and higher burdens of hot flashes and vaginal symptoms were related with lower odds of non-persistence. Women who initiated therapy had an increased likelihood of reporting shared decision-making than non-initiators (57% vs. 38%), and women who were non-persistent were less likely to report high confidence with the decision than women who were persistent (40% vs. 63%).
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Zheng Y, Gelber S .
Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer.
Breast Cancer Res Treat 2023 Feb; 197(3):547-58. doi: 10.1007/s10549-022-06810-1..
Keywords: Cancer: Breast Cancer, Cancer, Women, Shared Decision Making, Patient Adherence/Compliance
Conley CC, Wernli KJ, Knerr S
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
The objective of this study was to evaluate direct and indirect effects of a web-based, Protection Motivation Theory (PMT)-informed education and decision support tool for risk-reducing medication and breast MRI among women with high risk of breast cancer. Findings indicated that PMT-informed intervention effected behavioral intentions. No direct intervention effect on intentions for risk-reducing medication or MRI were found, but there were significant indirect effects on risk-reducing medication intentions via perceived risk, self-efficacy, and response efficacy, and on MRI intentions via perceived risk and response efficacy, The authors suggested that future research should extend these findings from intentions to behavior.
AHRQ-funded; HS022982.
Citation: Conley CC, Wernli KJ, Knerr S .
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
J Cancer Educ 2023 Feb; 38(1):292-300. doi: 10.1007/s13187-021-02114-y..
Keywords: Cancer: Breast Cancer, Cancer, Risk, Education: Patient and Caregiver, Health Information Technology (HIT)
Khoong EC, Rivadeneira NA, Pacca L
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
This report’s objective was to describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. The authors conducted a retrospective cohort study using data from five California public hospital systems between July 2015 and June 2017. The authors assessed follow-up rates of colonoscopy after positive fecal immunochemical tests (FIT) and breast tissue biopsy within 21 days after a BIRADS 4/5 mammogram. Negative associations with follow-up colonoscopy were associated with older age, Medicaid insurance, lack of insurance, English language and site; while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 64% received a timely biopsy; only site was associated with timely follow-up biopsy. Site-level factors were found to have a larger, more consistent impact on follow-up rates than patient sociodemographic traits.
AHRQ-funded; HS024412.
Citation: Khoong EC, Rivadeneira NA, Pacca L .
Extent of follow-up on abnormal cancer screening in multiple California public hospital systems: a retrospective review.
J Gen Intern Med 2023 Jan; 38(1):21-29. doi: 10.1007/s11606-022-07657-4..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Screening, Disparities, Women
Fuzesi S, Becetti K, Klassen AF
Expectations of breast-conserving therapy: a qualitative study.
The goal of this study was to describe expectations of breast-conserving therapy (BCT) among patients with early breast cancer and aimed to inform preoperative patient education and improve the patient experience through knowledge. The researchers identified themes related to patient expectations of BCT and found that patients had a clear knowledge gap regarding BCT. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.
AHRQ-funded; T32HS00066.
Citation: Fuzesi S, Becetti K, Klassen AF .
Expectations of breast-conserving therapy: a qualitative study.
J Patient Rep Outcomes 2019 Dec 27;3(1):73. doi: 10.1186/s41687-019-0167-5..
Keywords: Cancer: Breast Cancer, Cancer, Education: Patient and Caregiver, Surgery
Kunst NR, Alarid-Escudero F, Paltiel AD
A value of information analysis of research on the 21-gene assay for breast cancer management.
The authors aimed to quantify the value of conducting further research to reduce decision uncertainty in the use of the 21-gene assay Oncotype DX (21-GA). They found that current evidence strongly supports the use of the 21-GA in intermediate- and high-risk women and recommended that further research focus on low-risk women.
AHRQ-funded; HS023900.
Citation: Kunst NR, Alarid-Escudero F, Paltiel AD .
A value of information analysis of research on the 21-gene assay for breast cancer management.
Value Health 2019 Oct;22(10):1102-10. doi: 10.1016/j.jval.2019.05.004..
Keywords: Genetics, Cancer: Breast Cancer, Cancer, Shared Decision Making, Research Methodologies
Nelson HD, Fu R, Zakher B
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to update the 2013 US Preventive Services Task Force systematic review on medications to reduce risk of primary (first diagnosis) invasive breast cancer in women. Investigators abstracted data on methods, participant characteristics, eligibility criteria, outcome ascertainment, and follow-up; individual trial results were combined using a profile likelihood random-effects model. Results showed that tamoxifen, raloxifene, and aromatase inhibitors were associated with lower risk of primary invasive breast cancer in women but also were associated with adverse effects that differed between medications. Risk stratification methods to identify patients with increased breast cancer risk demonstrated low accuracy.
AHRQ-funded; 290201500009I.
Citation: Nelson HD, Fu R, Zakher B .
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Sep 3;322(9):868-86. doi: 10.1001/jama.2019.5780..
Keywords: Cancer: Breast Cancer, Cancer, Medication, U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Prevention, Primary Care
Rosenberg SM, Vaz-Luis I, Gong J
Employment trends in young women following a breast cancer diagnosis.
This cohort study examined employment trends in young women (age 40 or less) following a breast cancer diagnosis and treatment. The participants were 911 women who were enrolled in the Young Women’s Breast Cancer Study with non-metastatic breast cancer who were surveyed about employment-related outcomes 1 year post-diagnosis. Most women (80%) were employed 1 year after diagnosis. Among employed women, 7% said treatment affected their job performance. Seven percent of women reported unemployment at 1 year, with half of them reporting health reasons for their unemployment. Women with Stage 3 disease, and those who reporting having money to pay bills after cutting back or difficulty paying bills at baseline were more likely to be unemployed.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, Vaz-Luis I, Gong J .
Employment trends in young women following a breast cancer diagnosis.
Breast Cancer Res Treat 2019 Aug;177(1):207-14. doi: 10.1007/s10549-019-05293-x..
Keywords: Cancer: Breast Cancer, Cancer, Women, Young Adults
Sepucha KR, Langford AT, Belkora JK
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545.
AHRQ-funded; HS025718.
Citation: Sepucha KR, Langford AT, Belkora JK .
Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients.
Med Decis Making 2019 Aug;39(6):642-50. doi: 10.1177/0272989x19862545..
Keywords: Shared Decision Making, Cancer: Breast Cancer, Cancer, Surgery
Knerr S, Bowles EJA, Leppig KA
Trends in BRCA test utilization in an integrated health system, 2005-2015.
The authors reported 10-year trends in BRCA testing in an integrated health-care system with long-standing access to genetic services. They found that many eligible women did not receive BRCA testing despite having insurance coverage and access to specialty genetic services, thus underscoring challenges to primary and secondary hereditary cancer prevention.
AHRQ-funded; HS022982.
Citation: Knerr S, Bowles EJA, Leppig KA .
Trends in BRCA test utilization in an integrated health system, 2005-2015.
J Natl Cancer Inst 2019 Aug;111(8):795-802. doi: 10.1093/jnci/djz008..
Keywords: Cancer: Breast Cancer, Cancer: Ovarian Cancer, Cancer, Genetics, Screening, Prevention, Healthcare Utilization, Healthcare Delivery, Women
Bateni SB, Davidson AJ, Arora M
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
The purpose of this study was to compare overall survival rates among male breast cancer patients who underwent breast-conserving therapy (BCT) versus mastectomy. A retrospective analysis identified 8445 stage I-II male breast cancer patients from the National Cancer Database and grouped them according to surgical and radiation therapy (RT). Most of the patients underwent total mastectomy, while 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. Partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse overall survival rates compared with BCT. The authors conclude that BCT is associated with greater survival, but the underlying mechanisms of this association warrant further study.
AHRQ-funded; HS022236.
Citation: Bateni SB, Davidson AJ, Arora M .
Is breast-conserving therapy appropriate for male breast cancer patients? A national cancer database analysis.
Ann Surg Oncol 2019 Jul;26(7):2144-53. doi: 10.1245/s10434-019-07159-4..
Keywords: Cancer, Cancer: Breast Cancer, Shared Decision Making, Mortality, Outcomes, Patient-Centered Outcomes Research
Rotter J, Wilson L, Greiner MA
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
This study examined the impact of physician networks have on the adoption of genomic testing for women with early stage breast cancer. The genomic assay discussed in this paper is Oncotype DX (ODX) which stratifies risk. The study used retrospective data from the SEER-Medicare database from 2008 to 2012. Early adoption was more likely if the oncologists shared two or more patients during that period. There was a 1.7-fold increase in providers’ adoption of ODX in 2008-2009, and a 1.5-fold increase in their patients receiving ODX in 2010-2012.
AHRQ-funded; HS022189.
Citation: Rotter J, Wilson L, Greiner MA .
Shared-patient physician networks and their impact on the uptake of genomic testing in breast cancer.
Breast Cancer Res Treat 2019 Jul;176(2):445-51. doi: 10.1007/s10549-019-05248-2..
Keywords: Cancer, Cancer: Breast Cancer, Genetics, Screening
Miglioretti DL, Abraham L, Lee CI
Digital breast tomosynthesis: radiologist learning curve.
This study examined if detect rates and lower recall rates occurred with the adoption of digital breast tomosynthesis (DBT) than for traditional breast mammography. Performance was compared before and after DBT adoption using data from the Breast Cancer Surveillance Consortium cohort. There was a small improvement in recall rates, with more improvement in women with nondense breasts. Cancer detection rates were similar.
AHRQ-funded; HS018366.
Citation: Miglioretti DL, Abraham L, Lee CI .
Digital breast tomosynthesis: radiologist learning curve.
Radiology 2019 Apr;291(1):34-42. doi: 10.1148/radiol.2019182305..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women
Sprague BL, Kerlikowske K, Bowles EJA
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
Changes to mammography practice, including revised Breast Imaging Reporting and Data System (BI-RADS) density classification guidelines and implementation of digital breast tomosynthesis (DBT), may impact clinical breast density assessment. In this study, the authors investigated temporal trends in clinical breast density assessment among 2 990 291 digital mammography (DM) screens and 221 063 DBT screens interpreted by 722 radiologists from 144 facilities in the Breast Cancer Surveillance Consortium.
AHRQ-funded; HS018366.
Citation: Sprague BL, Kerlikowske K, Bowles EJA .
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
J Natl Cancer Inst 2019 Jun;111(6):629-32. doi: 10.1093/jnci/djy210..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women
Hoover DS, Pappadis MR, Housten AJ
Preferences for communicating about breast cancer screening among racially/ethnically diverse older women.
The purpose of this study was to examine preferences for communicating about screening mammography among racially/ethnically diverse older women. Through in-depth interviews, findings revealed that older women desire information about the benefits and harms of screening mammography and would prefer to learn this information through discussions with healthcare providers and multiple other formats. Results were consistent regardless of participants' age, race/ethnicity, or education.
AHRQ-funded; HS022134.
Citation: Hoover DS, Pappadis MR, Housten AJ .
Preferences for communicating about breast cancer screening among racially/ethnically diverse older women.
Health Commun 2019 Jun;34(7):702-06. doi: 10.1080/10410236.2018.1431026..
Keywords: Cancer, Cancer: Breast Cancer, Clinician-Patient Communication, Communication, Elderly, Women, Prevention, Racial and Ethnic Minorities, Screening