scholarly journals Variation in use of advanced imaging at the time of breast cancer diagnosis in a statewide registry.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 287-287
Author(s):  
Norah Lynn Henry ◽  
Thomas Braun ◽  
Elizabeth Lusk ◽  
Khan Munir ◽  
Jennifer J. Griggs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Breast Cancer Diagnosis ◽  
National Guidelines ◽  
Advanced Imaging ◽  
Average Percentage ◽  
Younger Age ◽  
Chi Squared ◽  
Bone Scans ◽  
Test Ordering

287 Background: Advanced imaging for diagnosis of metastatic disease at the time of diagnosis of stage 0-II breast cancer is not recommended according to national guidelines. The purpose of this study was to examine the variation in ordering of CT chest, abdomen, and pelvis, PET, and bone scans across the state of Michigan, and to investigate clinical and non-clinical factors associated with test ordering. Methods: We prospectively collected data from all patients diagnosed with stage 0-II breast cancer from 2008-2014 in 25 health systems in the Michigan Breast Oncology Quality Initiative (MiBOQI), a Blue Cross Blue Shield of Michigan/Blue Care Network-sponsored quality initiative. Demographic, imaging, and pathologic data were abstracted from the medical record. The primary endpoint was the percentage of patients with at least one advanced imaging test performed within 90 days after diagnosis of breast cancer. Analyses were performed using the chi-squared test of association. Results: Of the 27,011 patients, 4799 (17.8%) had at least one staging exam performed within 90 days of diagnosis. Imaging tests were primarily performed post-operatively. The average percentage of patients who had at least one staging exam performed varied by stage and by site (Table). The rate of testing decreased over time for stage 0-IIA cancers but not for stage IIB. On multivariate analysis, younger age, black race, hormone receptor negativity, HER2 positivity, and higher grade were associated with increased likelihood of undergoing imaging. Conclusions: There is considerable variability in ordering of staging scans at the time of diagnosis of early stage breast cancer across Michigan. Factors underlying use of imaging in stage IIB disease should be examined in order to develop interventions for rate reduction. [Table: see text]

scholarly journals Advanced Imaging and Receipt of Guideline Concordant Care in Women with Early Stage Breast Cancer

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Elizabeth Trice Loggers ◽  
Diana S. M. Buist ◽  
Laura S. Gold ◽  
Steven Zeliadt ◽  
Rachel Hunter Merrill ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Breast Mri ◽  
Advanced Imaging ◽  
Positron Emission ◽  
Younger Age ◽  
Pet Ct ◽  
Estrogen Receptor Positive ◽  
Magnetic Resonance Imaging Mri

Objective.It is unknown whether advanced imaging (AI) is associated with higher quality breast cancer (BC) care.Materials and Methods.Claims and Surveillance Epidemiology and End Results data were linked for women diagnosed with incident stage I-III BC between 2002 and 2008 in western Washington State. We examined receipt of preoperative breast magnetic resonance imaging (MRI) or AI (defined as computed tomography [CT]/positron emission tomography [PET]/PET/CT) versus mammogram and/or ultrasound (M-US) alone and receipt of guideline concordant care (GCC) using multivariable logistic regression.Results.Of 5247 women, 67% received M-US, 23% MRI, 8% CT, and 3% PET/PET-CT. In 2002, 5% received MRI and 5% AI compared to 45% and 12%, respectively, in 2008. 79% received GCC, but GCC declined over time and was associated with younger age, urban residence, less comorbidity, shorter time from diagnosis to surgery, and earlier year of diagnosis. Breast MRI was associated with GCC for lumpectomy plus radiation therapy (RT) (OR 1.55, 95% CI 1.08–2.26, andp=0.02) and AI was associated with GCC for adjuvant chemotherapy for estrogen-receptor positive (ER+) BC (OR 1.74, 95% CI 1.17–2.59, andp=0.01).Conclusion.GCC was associated with prior receipt of breast MRI and AI for lumpectomy plus RT and adjuvant chemotherapy for ER+ BC, respectively.

Simple and fast isolation of circulating exosomes with chitosan modified shuttle flow microchip towards breast cancer diagnosis

Lab on a Chip ◽  
2021 ◽  
Author(s):  
Wenwen Chen ◽  
Rongkai Cao ◽  
Wentao Su ◽  
xu zhang ◽  
Yuhai Xu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Medical Treatment ◽  
Cancer Diagnosis ◽  
Biological Samples ◽  
Early Stage ◽  
Breast Cancer Diagnosis ◽  
Early Stage Cancer ◽  
Tumor Prognosis ◽  
Huge Challenge

Tumor-derived exosomes have been recognized as promising biomarkers for early-stage cancer diagnosis, tumor prognosis monitoring and individual medical treatment. However, separating exosomes from trace biological samples is a huge challenge...

scholarly journals Overview of Breast Cancer and Implications of Overtreatment of Early-Stage Breast Cancer: An Indian Perspective

2020 ◽  
pp. 789-798
Author(s):  
Gouri Shankar Bhattacharyya ◽  
Dinesh C. Doval ◽  
Chirag J. Desai ◽  
Harit Chaturvedi ◽  
Sanjay Sharma ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Economic Status ◽  
Breast Cancer Diagnosis ◽  
Distant Recurrence ◽  
Response To Therapy ◽  
Fear Of Recurrence ◽  
Physical And Mental Health ◽  
Her Family ◽  
Anticancer Chemotherapy

The prevalence and mortality of breast cancer is increasing in Asian countries, including India. With advances in medical technology leading to better detection and characterization of the disease, it has been possible to classify breast cancer into various subtypes using markers, which helps predict the risk of distant recurrence, response to therapy, and prognosis using a combination of molecular and clinical parameters. Breast cancer and its therapy, mainly surgery, systemic therapy (anticancer chemotherapy, hormonal therapy, targeted therapy, and immunotherapy), and radiation therapy, are associated with significant adverse influences on physical and mental health, quality of life, and the economic status of the patient and her family. The fear of recurrence and its devastating effects often leads to overtreatment, with a toxic cost to the patient financially and physically in cases in which this is not required. This article discusses some aspects of a breast cancer diagnosis and its impact on the various facets of the life of the patient and her family. It further elucidates the role of prognostic factors, the currently available biomarkers and prognostic signatures, and the importance of ethnically validating biomarkers and prognostic signatures.

scholarly journals A Technical Review of Convolutional Neural Network-Based Mammographic Breast Cancer Diagnosis

2019 ◽  
Vol 2019 ◽  
pp. 1-16 ◽  
Author(s):  
Lian Zou ◽  
Shaode Yu ◽  
Tiebao Meng ◽  
Zhicheng Zhang ◽  
Xiaokun Liang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neural Network ◽  
Convolutional Neural Network ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
Breast Cancer Diagnosis ◽  
Fine Tuning ◽  
Learning Tools ◽  
Pros And Cons ◽  
Future Work

This study reviews the technique of convolutional neural network (CNN) applied in a specific field of mammographic breast cancer diagnosis (MBCD). It aims to provide several clues on how to use CNN for related tasks. MBCD is a long-standing problem, and massive computer-aided diagnosis models have been proposed. The models of CNN-based MBCD can be broadly categorized into three groups. One is to design shallow or to modify existing models to decrease the time cost as well as the number of instances for training; another is to make the best use of a pretrained CNN by transfer learning and fine-tuning; the third is to take advantage of CNN models for feature extraction, and the differentiation of malignant lesions from benign ones is fulfilled by using machine learning classifiers. This study enrolls peer-reviewed journal publications and presents technical details and pros and cons of each model. Furthermore, the findings, challenges and limitations are summarized and some clues on the future work are also given. Conclusively, CNN-based MBCD is at its early stage, and there is still a long way ahead in achieving the ultimate goal of using deep learning tools to facilitate clinical practice. This review benefits scientific researchers, industrial engineers, and those who are devoted to intelligent cancer diagnosis.

scholarly journals Non-Invasive Biomarkers for Early Detection of Breast Cancer

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2767
Author(s):  
Jiawei Li ◽  
Xin Guan ◽  
Zhimin Fan ◽  
Lai-Ming Ching ◽  
Yan Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
False Negative ◽  
Breast Cancer Diagnosis ◽  
Diagnostic Biomarkers ◽  
Circulating Micrornas ◽  
Non Invasive ◽  
Common Cancer ◽  
Volatile Organic

Breast cancer is the most common cancer in women worldwide. Accurate early diagnosis of breast cancer is critical in the management of the disease. Although mammogram screening has been widely used for breast cancer screening, high false-positive and false-negative rates and radiation from mammography have always been a concern. Over the last 20 years, the emergence of “omics” strategies has resulted in significant advances in the search for non-invasive biomarkers for breast cancer diagnosis at an early stage. Circulating carcinoma antigens, circulating tumor cells, circulating cell-free tumor nucleic acids (DNA or RNA), circulating microRNAs, and circulating extracellular vesicles in the peripheral blood, nipple aspirate fluid, sweat, urine, and tears, as well as volatile organic compounds in the breath, have emerged as potential non-invasive diagnostic biomarkers to supplement current clinical approaches to earlier detection of breast cancer. In this review, we summarize the current progress of research in these areas.

Use of advanced imaging and biomarker tests for post-treatment surveillance in early-stage breast cancer survivors.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 168-168
Author(s):  
Erin E. Hahn ◽  
Kaizeen C. Mody ◽  
Amy Ann Jacobson ◽  
Patricia A. Ganz
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Early Stage ◽  
Chest Ct ◽  
Post Treatment ◽  
Advanced Imaging ◽  
Abdominal Ct ◽  
Recommended Services

168 Background: The American Society of Clinical Oncology (ASCO) released a “Top Five” list of opportunities to improve the quality of cancer care. #4 focused on post-treatment surveillance in breast cancer patients treated with curative intent. The ASCO guideline on breast cancer follow up advises against using advanced imaging and biomarkers in this setting. We undertook an examination of the patterns of follow-up care for breast cancer survivors treated at an academic medical center to evaluate use of non-recommended services. Methods: Claims data and medical records were reviewed and abstracted for early stage (0-IIIA) breast cancer survivors starting one year post diagnosis, with an average of 5 years of follow-up data. A trained abstractor classified imaging tests as diagnostic/surveillance based on medical record content. A 10% random sample was abstracted by a second abstractor and compared for concordance. Descriptive statistics were generated for patient demographic and medical characteristics, and proportions for receipt of non-recommended services, including if imaging procedures were performed for diagnostic/surveillance purposes. Multivariate logistic regression modeling was used to determine factors associated with receiving non-recommended services. Results: Records were available for 258 patients. The mean age was 62 (SD 13), mean time since diagnosis was 6 years (SD 2), 66% were stage 0/1. 35% received at least one abdominal CT, 31% at least one chest CT, 20% at least one PET, 30% at least one bone scan. Of these services, 90 abdominal CT scans (47%), 131 chest CT scans (65%), 77 PET scans (90%), and 29 bone scans (26%) were classified as surveillance. 80% received CEA and/or CA 27.29 tests; 8% received CA 15-3 tests. Logistic regression revealed no consistent association of medical, demographic, or provider factors with receiving non-recommended services. Conclusions: Use of non-recommended services for surveillance occurs frequently among early stage survivors. Providers in this academic center had no personal financial incentive for ordering these services. There are opportunities to increase use of guideline concordant post-treatment care for breast cancer survivors.

Use of diagnostic testing for patients with early-stage breast cancer in a multi-hospital quality collaborative in Michigan.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 242-242
Author(s):  
Tara M. Breslin ◽  
James Kubus ◽  
Haythem Y. Ali ◽  
T. Trevor Singh ◽  
Paul T. Adams ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Imaging ◽  
Early Stage ◽  
Diagnostic Testing ◽  
Early Stage Breast Cancer ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Positron Emission ◽  
Bone Scans

242 Background: In 2012, ASCO identified five opportunities to improve the quality of cancer care and reduce costs. Two of these recommendations focused on limiting use of advanced diagnostic imaging with computed tomography (CT), Positron Emission Tomography (PET), and radionuclide bone scans (BS) at diagnosis and during surveillance for women with early stage breast cancer with a low risk of metastasis. We describe the use of diagnostic imaging among patients with early stage breast cancer treated at hospitals in Michigan. Methods: The Michigan Breast Oncology Quality Initiative is a collaboration between Michigan hospitals, the University of Michigan Comprehensive Cancer Center, and the National Comprehensive Cancer Network (NCCN). This collaborative collects longitudinal demographic, staging, treatment, and follow up data using the NCCN Breast Outcomes Database platform. We analyzed use of advanced diagnostic testing with CT, PET, BS and contrast it with use of traditional imaging (mammography/ultrasound) at diagnosis and during follow up in patients with stage 0, I, II breast cancer between 1998 to 2009. Patients who died or recurred were excluded. Results: The cohort included 7,632 patients (19.6% stage 0, 48.1% stage I, 32.3% stage II) treated at 17 hospitals. Use of traditional imaging was documented in nearly 100% of patients at diagnosis and throughout the follow up period. With respect to advanced diagnostic imaging, 20.3 % underwent CT, 4.7% underwent PET, and 11.6% underwent BS at diagnosis. Advanced testing use decreased over time (Table). Conclusions: Despite published guidelines, which recommend against their routine use, advanced diagnostic imaging use was prevalent among patients treated for early breast cancer at MiBOQI hospitals. Education efforts should target physicians and patients on the lack of proven benefit and potential risks of using advanced diagnostic imaging in this population. [Table: see text]

Correlation of Breast Cancer Index (BCI) prognostic and predictive results to Ki67 and tumor grade in early stage HR+ breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12075-e12075
Author(s):  
Carla Isadora Falkson ◽  
Jeffrey Kepes ◽  
Graham M. Poage ◽  
Junmei Liu ◽  
Catherine A. Schnabel
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Early Stage ◽  
Tumor Biology ◽  
Tumor Grade ◽  
Distant Recurrence ◽  
Wide Distribution ◽  
Individual Risk ◽  
Chi Squared ◽  
Extended Endocrine Therapy

e12075 Background: Markers of tumor proliferative status, e.g., Ki67 and grade (G), are prognostic for early distant recurrence (DR) in HR+ breast cancer and integrated in adjuvant chemotherapy decisions; however, their impact on late DR and extended endocrine therapy (EET) decisions is less clear. BCI is a genomic assay that provides 2 results: BCI Predictive, based on HoxB13/IL17BR (H/I ratio), reports a prediction of likelihood of benefit from EET; BCI Prognostic, based on the algorithmic combination of H/I and proliferation genes, reports risk of late DR. In this study, BCI results were examined within clinicopathologic risk categories based on Ki67 and G. Methods: The BCI Clinical Database for Correlative Studies is an IRB-approved de-identified database that contains > 50 clinicopathologic and molecular variables from cases submitted for BCI testing in clinical practice (N = 14,463). Clinicopathologic variables were abstracted from pathology reports, and were available for a subset of cases. High Ki67 was defined as ≥14%. Chi-squared tests were used to compare BCI results between Ki67 and G subgroups. Results: Analyses included 3395 LN- pts (median age 59.1y; 73% ≥ 50y). BCI Prognostic showed a wide distribution of individual risk assessments in pts with high or low Ki67. A greater proportion of pts with high Ki67 was classified by BCI as high risk of late DR compared to low Ki67 (68.2% vs 26.5%; P < 0.0001); however, substantial proportions of high Ki67 pts were classified as BCI low risk (31.8%) and pts with low Ki67 classified as BCI high risk (26.5%). Overall, there was a moderate correlation between individual BCI Scores and individual Ki67 scores (Correlation = 0.519). 45.5% of pts with high Ki67 were classified as High BCI Predictive (H/I) compared to 35.5% of pts with low Ki67 (p < 0.001). Both BCI Prognostic and BCI Predictive (H/I) classified increasing proportions of pts as high risk or high benefit with increasing G (P < 0.0001). Conclusions: These findings help characterize differential stratification based on tumor biology vs Ki67/G for pts considering EET. While moderately correlated, both BCI Prognostic and BCI Predictive (H/I) identified distinct populations compared to Ki67 and G.

Mammography use in breast cancer survivors: An administrative claims study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6531-6531 ◽  
Author(s):  
Kathryn Jean Ruddy ◽  
Lindsey R. Sangaralingham ◽  
Heather B. Neuman ◽  
Caprice Christian Greenberg ◽  
Rachel A. Freedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Breast Cancer Survivors ◽  
Breast Tissue ◽  
Early Stage ◽  
Breast Cancer Diagnosis ◽  
First Year ◽  
Administrative Claims ◽  
Mammography Use

6531 Background: Annual mammography is recommended to screen residual breast tissue for new cancers and recurrent disease after treatment for early stage breast cancer. This study aimed to assess mammography rates over time in breast cancer survivors. Methods: We used administrative claims data from a large U.S. commercial insurance database, OptumLabs, to retrospectively identify privately- and Medicare Advantage-insured women with operable breast cancer who had residual breast tissue after definitive breast surgery between 2006 and 2015. We required coverage for at least 13 months following surgery. For each subsequent 13-month time period, we only included women without a loss of coverage, bilateral mastectomy, metastatic breast cancer diagnosis, or non-breast cancer diagnosis. We calculated the proportion of patients who had a mammogram during each 13-month period following breast surgery. We used multivariable logistic regression to test for factors associated with mammography in the first 13 months. Results: The cohort included 26,011 women followed for a median of 2.9 years (IQR 1.9-4.6) after surgery; 63.1% were less than 65 years of age, and 74.4% were white. In their first year of follow-up, 86% underwent mammography, but by year 7, this decreased to 73%. Fewer than 1% underwent MRI instead of mammography. In multivariable analysis, mammograms were less likely during the first year after surgery among women aged < 50 years (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6 to 0.8), African Americans (OR, 0.7; 95% CI, 0.7 to 0.8), patients who underwent mastectomy (OR, 0.7; 95% CI, 0.6 to 0.7), and patients residing in the Western part of the country (OR, 0.9; 95% CI, 0.7 to 0.9). Those with 1-2 comorbidities were more likely (OR, 1.1; 95% CI 1.1-1.2) than those with none to have a mammogram during that period. Mammography use did not differ significantly by year of diagnosis (2006-2015). Conclusions: Even in an insured cohort, a substantial proportion of breast cancer survivors do not undergo annual surveillance mammography. Mammography use falls as the time from the early stage breast cancer diagnosis increases. Understanding factors associated with lack of mammographic screening may help improve survivorship care.

Patterns in provider types and cost of surveillance testing in early-stage breast cancer patients: A regional study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6582-6582 ◽  
Author(s):  
Gary H. Lyman ◽  
Catherine R. Fedorenko ◽  
Julia Rose Walker ◽  
Laura Elizabeth Panattoni ◽  
Stuart Greenlee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Marker ◽  
Early Stage ◽  
Financial Burden ◽  
Choosing Wisely ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Advanced Imaging ◽  
Surveillance Period ◽  
Physician Visits

6582 Background: Although ASCO Choosing Wisely guidelines recommend against routine surveillance testing or imaging for asymptomatic individuals with early-stage breast cancer (ESBC) treated with curative intent, they are frequently performed. Physician specialty and costs associated with surveillance testing and imaging were examined in ESBC patients. Methods: Cancer registry patient records in Western Washington from 2007 to 2015 were linked with claims from two regional commercial insurers. Selected patients had been diagnosed with stage I/II breast cancer and treated with mastectomy or lumpectomy + radiation. Surveillance was considered from the first 4 month gap in treatment (surgery, chemo, radiation) through 13 months or restart of treatment. Evaluation and Management (E&M) and procedure codes for tumor marker (CEA, CA 15-3, CA 27.29) and advanced imaging (PET, CT, bone scan) were identified. Specialty codes were used to determine provider type. Physician visits were matched to tests using E&M codes in the +/- 7 days around each test. Cost included total reimbursed amount from insurers during the surveillance period. Results: During surveillance, 2,193 patients averaged 13.3 physician visits [median: 11, IQR: 8-17]. Oncologists (91%) and PCPs (83%) were the most common specialties with an average of 3.7 visits each. Overall, 37% of patients received tumor marker tests (avg = 2.8 tests/patient) and 17% received advanced imaging (avg = 1.5 images/patient). The mean total cost during the surveillance period was $18,403 (SD $26,640). Costs were higher for those patients who received tumor marker testing or advanced imaging. Conclusions: Patients frequently see oncologists and PCPs during early surveillance. Targeting oncologists to improve appropriate tumor marker testing could have the largest impact on aligning practice with Choosing Wisely recommendations and potentially reducing the financial burden on patients. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document