Assessing Breast Density's Value in Imaging - A Comparative Effectiveness Study

NCT ID: NCT02980848

Last Updated: 2021-11-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

1341172 participants

Study Classification

OBSERVATIONAL

Study Start Date

2016-09-30

Study Completion Date

2022-02-28

Brief Summary

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This Breast Cancer Surveillance Consortium (BCSC) ADVANCE study is a large, observational pragmatic comparative effectiveness research study using high-quality, prospectively collected data from BCSC registries to generate evidence on how breast density should be integrated into decision making around breast cancer screening and preoperative diagnostic work-up. We will augment existing BCSC registry infrastructure with additional prospective data collection and collection of patient reported outcomes (PROs), CISNET modeling of long-term screening outcomes, and qualitative data from focus groups with women represented in two aims.

Detailed Description

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Aim 1: Compare the effectiveness of breast cancer screening using digital mammography alone versus digital mammography plus supplemental screening (digital breast tomosynthesis or MRI) by extent of breast density.

Sub aim 1: Evaluate whether the performance of tomosynthesis improves with years of experience, and whether any "learning curve" depends on radiologist specialty (i.e., breast imaging specialist vs. general radiologist).

Aim 2: Compare the effectiveness of preoperative MRI versus no MRI by extent of breast density among women with an initial, pathologically confirmed diagnosis of DCIS or invasive breast cancer.

Covid-19 Enhancement Aim and Hypotheses:

Develop patient-focused messaging content through focus groups that radiology facilities can use when scheduling appointments to inform women of the safety to schedule or postpone breast screening or diagnostic services.

Conditions

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Breast Cancer

Keywords

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digital mammography digital breast tomosynthesis breast magnetic resonance imaging screening breast density breast imaging pre-operative magnetic resonance imaging

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Screening group

Women without a history of breast cancer undergoing screening digital mammography, screening digital breast tomosynthesis, or screening breast magnetic resonance imaging.

Screening digital mammography

Intervention Type OTHER

Screening with digital mammography alone

Screening digital breast tomosynthesis

Intervention Type OTHER

Screening with digital mammography plus digital breast tomosynthesis

Screening breast magnetic resonance imaging

Intervention Type OTHER

Screening with digital mammography plus breast magnetic resonance imaging

Women with breast cancer

Women diagnosed with stage 0-III breast cancer undergoing pre-operative work-up with diagnostic mammography alone or diagnostic mammography plus pre-operative breast magnetic resonance imaging.

Diagnostic mammography

Intervention Type OTHER

Pre-operative diagnostic work-up with mammography alone

Pre-operative breast magnetic resonance imaging

Intervention Type OTHER

Pre-operative diagnostic work-up with mammography plus breast magnetic resonance imaging

Interventions

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Screening digital mammography

Screening with digital mammography alone

Intervention Type OTHER

Screening digital breast tomosynthesis

Screening with digital mammography plus digital breast tomosynthesis

Intervention Type OTHER

Screening breast magnetic resonance imaging

Screening with digital mammography plus breast magnetic resonance imaging

Intervention Type OTHER

Diagnostic mammography

Pre-operative diagnostic work-up with mammography alone

Intervention Type OTHER

Pre-operative breast magnetic resonance imaging

Pre-operative diagnostic work-up with mammography plus breast magnetic resonance imaging

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Women aged 40-79 undergoing screening mammography from 2010-2017 for comparisons with tomosynthesis and 2005-2017 for comparison with breast MRI at a facility that participates in one of six BCSC breast imaging registries


* Women aged 40-74 years undergoing screening mammography, with or without supplemental screening with digital breast tomosynthesis or breast MRI, at selected BCSC facilities
* Women within 12 months of a digital screening mammogram with known breast density and no known breast cancer diagnosis
* For MRI subgroup, we will include women with a screening MRI within the prior 24 months
* Within strata defined by BCSC registry, breast density subgroup (dense vs. not dense), and race/ethnicity, women with supplemental screening with digital breast tomosynthesis or breast MRI will be matched to women without supplemental screening

Aim 1 Focus Groups


* Women age 40-74 years undergoing screening mammography, with or without supplemental screening (defined as digital breast tomosynthesis or breast MRI)
* Women within 12 months post-most recent screening examination with known dense breasts from most recent screening mammogram and no known breast cancer diagnosis
* Women who are able to speak English and can travel to a nearby location for a discussion

Subaim 1


* Radiologists interpreting digital mammography and/or tomosynthesis for at least one year from 2010-2017 at a facility that participates in the BCSC


* Women at least 18 years of age with a first breast cancer diagnosis (DCIS or invasive) from 2005-2017 for whom there was a mammogram performed within the year prior to breast cancer diagnosis at one of the participating BCSC registry facilities
* Women for whom we have pathologically-confirmed breast cancer (DCIS or invasive) with a pathology or biopsy record related to the incident cancer diagnosis in the BCSC data
* MRI and mammography examinations performed for pre-operative work-up from 2005-2017 at one of the participating BCSC registry facilities in women meeting eligibility criteria

Aim 2 Patient Reported Outcomes


* Women at least 18 years of age with a first pathology-confirmed breast cancer diagnosis (DCIS or stage I-III invasive) within 6-18 months
* Known breast density at the time of breast cancer diagnosis

Aim 2 Focus Groups


* Women age ≥18 with a first breast cancer diagnosis (DCIS or stage I-III invasive cancer) within 1-5 years and after completion of active breast cancer treatment who have undergone mammography or MRI pre-operatively.
* Women who are able to speak English and can travel to a nearby location for a discussion

COVID-19 Enhancement Focus Groups


* Women age 18-74 who were due for breast imaging services during the COVID pandemic and have either canceled their appointment, delayed their appointment, or kept their appointment
* Women who are able to speak English and can attend calls virtually through Zoom or over the phone
* In addition, for focus groups with women who have prior breast cancer:

1. First breast cancer diagnosis (DCIS or stage I-III invasive cancer) within 1-3 years prior to March, 2020.
2. Completed active cancer treatment (ongoing endocrine and Herceptin therapy acceptable)
3. No evidence of a second breast cancer event in cancer registry or pathology data before recruitment.

Exclusion Criteria

* Exams performed on women with a history of breast cancer, mastectomy, or breast augmentation.
* Unilateral mammograms and mammograms performed within 9 months of a prior mammogram to avoid classifying diagnostic exams as screening
* Exams without complete cancer capture during the follow-up period

Aim 1 Patient Reported Outcomes


* Exams performed on women with a history of breast cancer, mastectomy, or breast augmentation
* Unilateral mammograms and mammograms performed within 9 months of a prior mammogram to avoid classifying diagnostic exams as screening
* Exams without complete cancer capture during one year following the screening mammogram

Aim 2 Clinical Outcomes
Minimum Eligible Age

18 Years

Maximum Eligible Age

89 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Patient-Centered Outcomes Research Institute

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role collaborator

Dartmouth College

OTHER

Sponsor Role collaborator

Kaiser Permanente

OTHER

Sponsor Role collaborator

University of Vermont

OTHER

Sponsor Role collaborator

University of North Carolina

OTHER

Sponsor Role collaborator

University of Illinois at Chicago

OTHER

Sponsor Role collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role collaborator

Harvard Pilgrim Health Care

OTHER

Sponsor Role collaborator

Albert Einstein College of Medicine

OTHER

Sponsor Role collaborator

Erasmus Medical Center

OTHER

Sponsor Role collaborator

University of California, Davis

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Diana L Miglioretti, PhD

Role: PRINCIPAL_INVESTIGATOR

University of California, Davis

Locations

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Sacramento Area Breast Imaging Registry

Davis, California, United States

Site Status

San Francisco Mammography Registry

San Francisco, California, United States

Site Status

Metro Chicago Breast Cancer Registry

Chicago, Illinois, United States

Site Status

New Hampshire Mammography Network

Lebanon, New Hampshire, United States

Site Status

Carolina Mammography Registry

Chapel Hill, North Carolina, United States

Site Status

Vermont Breast Cancer Surveillance System

Burlington, Vermont, United States

Site Status

Kaiser Permanente Washington Breast Cancer Surveillance Registry

Seattle, Washington, United States

Site Status

Countries

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United States

References

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Smith RE, Sprague BL, Henderson LM, Kerlikowske K, Miglioretti DL, Wernli KJ, Onega T, diFlorio-Alexander RM, Tosteson ANA. Breast density knowledge and willingness to delay treatment for pre-operative breast cancer imaging among women with a personal history of breast cancer. Breast Cancer Res. 2024 Apr 29;26(1):73. doi: 10.1186/s13058-024-01820-x.

Reference Type DERIVED
PMID: 38685119 (View on PubMed)

Tosteson ANA, Schifferdecker KE, Smith RE, Wernli KJ, Zhao W, Kaplan CP, Buist DSM, Henderson LM, Sprague BL, Onega T, Budesky J, Jackson-Nefertiti G, Johnson D, Miglioretti DL, Kerlikowske K. Women's Breast Cancer Screening Confidence by Screening Modality and Breast Density: A Breast Cancer Surveillance Consortium Survey Study. J Womens Health (Larchmt). 2022 Nov;31(11):1547-1556. doi: 10.1089/jwh.2021.0649.

Reference Type DERIVED
PMID: 36356184 (View on PubMed)

Onega T, Zhu W, Kerlikowske K, Miglioretti DL, Lee CI, Henderson LM, Tosteson ANA, Wernli KJ, diFlorio R, Weaver DL, Buist DSM. Preoperative MRI in breast cancer: effect of breast density on biopsy rate and yield. Breast Cancer Res Treat. 2022 Jan;191(1):177-190. doi: 10.1007/s10549-021-06418-x. Epub 2021 Oct 22.

Reference Type DERIVED
PMID: 34686934 (View on PubMed)

Related Links

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https://www.bcsc-research.org/

Breast Cancer Surveillance Consortium (BCSC)

Other Identifiers

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PCS-1504-30370

Identifier Type: OTHER

Identifier Source: secondary_id

941466

Identifier Type: -

Identifier Source: org_study_id