Grant Number:	7R01CA266377-05 Interpret this number
Primary Investigator:	Lee, Christoph
Organization:	University Of Wisconsin-Madison
Project Title:	Improving Outcomes in the Breast Cancer Screening and Diagnostic Continuum
Fiscal Year:	2025

Specific subpopulations of U.S. women, including those with lower education, lower income, rural residence, and the underinsured experience higher breast cancer disease burden and lower survival rates than women without these characteristics, despite recent improvements in screening access and treatments. The majority of efforts to mitigate poor outcomes have focused on screening mammography access, but women must navigate multiple additional steps when cancer is suspected, including more imaging, biopsies, and specialist consultations. Each year, >12 million U.S. women enter this diagnostic care continuum. Failure to receive timely, quality evaluation leads to delayed diagnosis, more invasive procedures, advanced cancer stage at diagnosis, and greater mortality. Compared to screening, surprisingly little is known about drivers of patient outcomes during this diagnostic period. It is estimated that up to 30% of women with abnormalities detected by mammography fail to obtain appropriate or timely follow-up. A clearer understanding of the variable care and outcomes during the diagnostic continuum is hindered by the decentralized nature of breast cancer screening and diagnosis in the U.S., with differences in care likely due to a complex combination of individual, residential, and healthcare delivery factors. We propose to conduct the largest U.S. observational study of diagnostic breast imaging to date. Specifically, we aim to 1) identify specific subpopulations of women with lower access to and use of key diagnostic imaging technologies; 2) determine differences in diagnostic outcomes that can serve as quality of care indicators across different subpopulations; and 3) identify differences in timeliness of diagnostic evaluation across different subpopulations. We will use multi-level statistical modeling and mediation analyses to account for multifactorial interactions that likely influence diagnostic care. Our team, the Breast Cancer Surveillance Consortium, consists of national experts in breast cancer epidemiology, biostatistics, health services research, medicine, and radiology. The BCSC represents the largest longitudinal breast cancer imaging data resource linked to long-term outcomes that is representative of the general U.S. population. We systematically collect woman-, exam-, residential-, practice-, provider- and tumor-level data across seven regional registries and more than 200 individual practices. With data collected for 13 million breast imaging exams, our team is well-positioned to carry out the proposed analyses. Our study will help shift the breast cancer screening research paradigm from focusing on screening access to evaluating the entire episode of care. By identifying novel quality of care metrics and “early warning” indicators of worse outcomes, our results will inform both practice-level interventions aimed at closing local quality gaps and national practice guidelines and policies directed towards more effective breast cancer diagnostic evaluation.




Establishing the Evidence Needed for AI-driven Mammography Screening.
Authors: Milch H.S. , Lee C.I. .
Source: Radiology. Artificial Intelligence, 2025 May; 7(3), p. e250152.
PMID: 40172323
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Diagnostic Management Pathways for Workup of Abnormal Screening With Digital Mammography Versus Digital Breast Tomosynthesis.
Authors: Henderson L.M. , Zhu W. , Onega T. , Kerlikowske K. , Miglioretti D.L. , Aiello Bowles E.J. , Sprague B.L. , Weaver D.L. , Tosteson A.N.A. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2025-04-10 00:00:00.0; , .
EPub date: 2025-04-10 00:00:00.0.
PMID: 40216286
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Disparities in Standard-of-Care, Advanced, and Same-Day Diagnostic Services among Patients with Abnormal Screening Mammography.
Authors: Lawson M.B. , Zhu W. , Miglioretti D.L. , Onega T. , Henderson L.M. , Rauscher G.H. , Kerlikowske K. , Sprague B.L. , Bowles E.J.A. , O'Meara E.S. , et al. .
Source: Radiology, 2025 Feb; 314(2), p. e241673.
PMID: 39964269
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Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort.
Authors: Miglioretti D.L. , Abraham L. , Sprague B.L. , Lee C.I. , Bissell M.C.S. , Ho T.H. , Bowles E.J.A. , Henderson L.M. , Hubbard R.A. , Tosteson A.N.A. , et al. .
Source: Annals Of Internal Medicine, 2024-09-03 00:00:00.0; , .
EPub date: 2024-09-03 00:00:00.0.
PMID: 39222505
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Toward More Equitable Breast Cancer Outcomes.
Authors: Elmore J.G. , Lee C.I. .
Source: Jama, 2024-04-30 00:00:00.0; , .
EPub date: 2024-04-30 00:00:00.0.
PMID: 38687474
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Using Machine Learning to Predict Adherence to Recommended Imaging Follow-Up.
Authors: Lawson M.B. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2024-03-08 00:00:00.0; , .
EPub date: 2024-03-08 00:00:00.0.
PMID: 38461916
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Population Attributable Risk of Advanced-Stage Breast Cancer by Race and Ethnicity.
Authors: Kerlikowske K. , Chen S. , Bissell M.C.S. , Lee C.I. , Tice J.A. , Sprague B.L. , Miglioretti D.L. .
Source: Jama Oncology, 2024-02-01 00:00:00.0; 10(2), p. 167-175.
PMID: 38060241
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Racial and ethnic variation in diagnostic mammography performance among women reporting a breast lump.
Authors: Nyante S.J. , Abraham L. , Aiello Bowles E.J. , Lee C.I. , Kerlikowske K. , Miglioretti D.L. , Sprague B.L. , Henderson L.M. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2023-07-13 00:00:00.0; , .
EPub date: 2023-07-13 00:00:00.0.
PMID: 37440458
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Risk of cancer versus risk of cancer diagnosis? Accounting for diagnostic bias in predictions of breast cancer risk by race and ethnicity.
Authors: Gard C.C. , Lange J. , Miglioretti D.L. , O'Meara E.S. , Lee C.I. , Etzioni R. .
Source: Journal Of Medical Screening, 2023-06-12 00:00:00.0; , p. 9691413231180028.
EPub date: 2023-06-12 00:00:00.0.
PMID: 37306245
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Addressing Racial Inequities in Access to State-of-the-Art Breast Imaging.
Authors: Lee C.I. , Lawson M.B. .
Source: Radiology, 2023 Feb; 306(2), p. e222405.
EPub date: 2022-10-11 00:00:00.0.
PMID: 36219120
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Improving Health Equity in Adherence to Diagnostic Breast Imaging Workup Recommendations.
Authors: Lopez E.J. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2022 Dec; 19(12), p. 1310-1311.
EPub date: 2022-10-05 00:00:00.0.
PMID: 36208840
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Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity.
Authors: Lawson M.B. , Bissell M.C.S. , Miglioretti D.L. , Eavey J. , Chapman C.H. , Mandelblatt J.S. , Onega T. , Henderson L.M. , Rauscher G.H. , Kerlikowske K. , et al. .
Source: Jama Oncology, 2022-08-01 00:00:00.0; 8(8), p. 1115-1126.
PMID: 35737381
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Diagnostic Mammography Performance across Racial and Ethnic Groups in a National Network of Community-Based Breast Imaging Facilities.
Authors: Nyante S.J. , Abraham L. , Aiello Bowles E.J. , Lee C.I. , Kerlikowske K. , Miglioretti D.L. , Sprague B.L. , Henderson L.M. , Breast Cancer Surveillance Consortium .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2022-07-01 00:00:00.0; 31(7), p. 1324-1333.
PMID: 35712862
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Tackling Health Disparities in Radiology: A Practical Conceptual Framework.
Authors: Lawson M.B. , Scheel J.R. , Onega T. , Carlos R.C. , Lee C.I. .
Source: Journal Of The American College Of Radiology : Jacr, 2022 02; 19(2 Pt B), p. 344-347.
PMID: 35152959
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