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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 13 of 13 Research Studies DisplayedKerlikowske 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
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
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
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
Vyas A, Madhavan S, Sambamoorthi U
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
The objective of this study is to determine the association between persistence with mammography screening and stage at breast cancer (BC) diagnosis among elderly women. It found that, as compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan S, Sambamoorthi U .
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
Breast Cancer Res Treat 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Elderly, Prevention, Screening, Women
Yaghjyan L, Wolin K, Chang SH
Racial disparities in healthy behaviors and cancer screening among breast cancer survivors and women without cancer: National Health Interview Survey 2005.
This study aimed to compare healthy behaviors and cancer screening practices among breast cancer survivors and respondents without cancer separately in Caucasian, African American, and Hispanic women. It found that most differences were suggestive and do not differ by race.
AHRQ-funded; HS022330.
Citation: Yaghjyan L, Wolin K, Chang SH .
Racial disparities in healthy behaviors and cancer screening among breast cancer survivors and women without cancer: National Health Interview Survey 2005.
Cancer Causes Control. 2014 May;25(5):605-14. doi: 10.1007/s10552-014-0365-7..
Keywords: Cancer: Breast Cancer, Cancer, Racial and Ethnic Minorities, Women, Disparities, Screening
Nelson HD, Pappas M, Zakher B
Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: a systematic review to update the U.S. Preventive Services Task Force recommendation.
This systematic review was done in support of the U.S. Preventive Services Task Force (USPSTF) updated recommendation on the benefit and harms of risk assessment, genetic testing, and genetic counseling for BRCA-related cancer in women. A systematic review was done on literature from 2004 to July 30, 2013 from MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Health Technology Assessment, Scopus, and reference lists. Data on the participants, study design, analysis, follow-up, and results was extracted and a second investigator confirmed key data. The studies were rated on study quality and applicability. The analysis found women with high-risk for breast cancer had decreased risk of breast cancer by 85% to 100% by having a mastectomy, and risk of mortality by 81% to 100% compared to women without surgery. There was also a lower risk of breast and ovarian cancer after having salpingo-oopherectomy surgery.
AHRQ-funded; 290200710057
Citation: Nelson HD, Pappas M, Zakher B .
Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: a systematic review to update the U.S. Preventive Services Task Force recommendation.
Ann Intern Med 2014 Feb 18;160(4):255-66. doi: 10.7326/m13-1684..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Cancer: Ovarian Cancer, Cancer, Genetics, Screening, Prevention, Guidelines, Evidence-Based Practice, Women, Risk, Family Health and History