Grant Number:	5U01CA088283-09 Interpret this number
Primary Investigator:	Mandelblatt, Jeanne
Organization:	Georgetown University
Project Title:	CISNET: the "Spectrum" of Breast Cancer Disparities
Fiscal Year:	2009

DESCRIPTION (provided by applicant): Breast cancer remains the second most common cancer in women, and is one of the few cancer sites for which incidence rates continue to rise. In addition, despite improvements in breast cancer survival, racial disparities in mortality remain pervasive. These mortality disparities have been widening over the last two decades, with the odds of dying from breast cancer for Black vs. White women increasing from 1.27 in 1984 to 1.85 in 1999. This racial inequality in breast cancer outcomes is cast on the backdrop of an obesity epidemic. We have assembled an experienced multidisciplinary team from Georgetown University, Einstein College of Medicine, Erasmus University, and RAND to use two established models (SPECTRUM and MISCAN) to develop a mini "base case" with common parameters to simulate how obesity (defined as BMI >30) interacts with risk, screening outcomes, and treatment effectiveness to effect trends in overall and race specific US breast cancer incidence and mortality from 1975 to 2015. We will also project results to 2025 to capture the lag time in effects of obesity (and screening). We have selected obesity as a key modifiable risk factor to be examined since it has been identified as a proximate target for change to achieve the Healthy People 2010 targets, disproportionately effects Black women, and impacts breast cancer incidence and mortality through several mechanisms with potentially competing effects. As secondary goals, we will also examine how screening policies and treatment improvements are likely to impact future differences in rates of breast cancer between Black and White women. Our objectives will be accomplished in three phases: In the first phase, we will focus on developing the common data inputs needed to address our research questions. In phase 2, we will use the models to synthesize the data and conduct analyses. Finally, in Phase 3, we will use the results to inform policy and practice relevant discussions and make the models available to others to address emerging research questions. Throughout, we will also collaborate with other CISNET modeling groups. By working together with 2 models, we can achieve important economies of scale, test the impact of model structure on results, provide a range of plausible projections, and contribute to a better understanding of the science of modeling. Overall, the information generated by these models will provide a framework to inform policy debates about equity in care and how to best achieve targeted reductions in breast cancer morbidity and mortality for all US women.




Structure, Function, and Applications of the Georgetown-Einstein (GE) Breast Cancer Simulation Model.
Authors: Schechter C.B. , Near A.M. , Jayasekera J. , Chandler Y. , Mandelblatt J.S. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2018 Apr; 38(1_suppl), p. 66S-77S.
PMID: 29554462
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Estimating Breast Cancer Survival by Molecular Subtype in the Absence of Screening and Adjuvant Treatment.
Authors: Munoz D.F. , Plevritis S.K. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2018 Apr; 38(1_suppl), p. 32S-43S.
PMID: 29554464
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Common Model Inputs Used in CISNET Collaborative Breast Cancer Modeling.
Authors: Mandelblatt J.S. , Near A.M. , Miglioretti D.L. , Munoz D. , Sprague B.L. , Trentham-Dietz A. , Gangnon R. , Kurian A.W. , Weedon-Fekjaer H. , Cronin K.A. , et al. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2018 Apr; 38(1_suppl), p. 9S-23S.
PMID: 29554466
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Introduction to the Cancer Intervention and Surveillance Modeling Network (CISNET) Breast Cancer Models.
Authors: Alagoz O. , Berry D.A. , de Koning H.J. , Feuer E.J. , Lee S.J. , Plevritis S.K. , Schechter C.B. , Stout N.K. , Trentham-Dietz A. , Mandelblatt J.S. , et al. .
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2018 Apr; 38(1_suppl), p. 3S-8S.
PMID: 29554472
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Benefits and harms of mammography screening after age 74 years: model estimates of overdiagnosis.
Authors: van Ravesteyn N.T. , Stout N.K. , Schechter C.B. , Heijnsdijk E.A. , Alagoz O. , Trentham-Dietz A. , Mandelblatt J.S. , de Koning H.J. .
Source: Journal Of The National Cancer Institute, 2015 Jul; 107(7), .
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Transition From Film To Digital Mammography: Impact For Breast Cancer Screening Through The National Breast And Cervical Cancer Early Detection Program
Authors: van Ravesteyn N.T. , van Lier L. , Schechter C.B. , Ekwueme D.U. , Royalty J. , Miller J.W. , Near A.M. , Cronin K.A. , Heijnsdijk E.A. , Mandelblatt J.S. , et al. .
Source: American Journal Of Preventive Medicine, 2015 May; 48(5), p. 535-42.
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Personalizing age of cancer screening cessation based on comorbid conditions: model estimates of harms and benefits.
Authors: Lansdorp-Vogelaar I. , Gulati R. , Mariotto A.B. , Schechter C.B. , de Carvalho T.M. , Knudsen A.B. , van Ravesteyn N.T. , Heijnsdijk E.A. , Pabiniak C. , van Ballegooijen M. , et al. .
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Cost-effectiveness of internet and telephone treatment for smoking cessation: an economic evaluation of The iQUITT Study.
Authors: Graham A.L. , Chang Y. , Fang Y. , Cobb N.K. , Tinkelman D.S. , Niaura R.S. , Abrams D.B. , Mandelblatt J.S. .
Source: Tobacco Control, 2013 Nov; 22(6), p. e11.
PMID: 23010696
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Black-white Differences In Breast Cancer Outcomes Among Older Medicare Beneficiaries: Does Systemic Treatment Matter?
Authors: Mandelblatt J.S. , Sheppard V.B. , Neugut A.I. .
Source: Jama, 2013-07-24 00:00:00.0; 310(4), p. 376-7.
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Which strategies reduce breast cancer mortality most? Collaborative modeling of optimal screening, treatment, and obesity prevention.
Authors: Mandelblatt J. , van Ravesteyn N. , Schechter C. , Chang Y. , Huang A.T. , Near A.M. , de Koning H. , Jemal A. .
Source: Cancer, 2013-07-15 00:00:00.0; 119(14), p. 2541-8.
EPub date: 2013-07-15 00:00:00.0.
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Influence of study features and methods on overdiagnosis estimates in breast and prostate cancer screening.
Authors: Etzioni R. , Gulati R. , Mallinger L. , Mandelblatt J. .
Source: Annals Of Internal Medicine, 2013-06-04 00:00:00.0; 158(11), p. 831-8.
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To screen or not to screen older women for breast cancer: a conundrum.
Authors: Braithwaite D. , Mandelblatt J.S. , Kerlikowske K. .
Source: Future Oncology (london, England), 2013 Jun; 9(6), p. 763-6.
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Screening outcomes in older US women undergoing multiple mammograms in community practice: does interval, age, or comorbidity score affect tumor characteristics or false positive rates?
Authors: Braithwaite D. , Zhu W. , Hubbard R.A. , O'Meara E.S. , Miglioretti D.L. , Geller B. , Dittus K. , Moore D. , Wernli K.J. , Mandelblatt J. , et al. .
Source: Journal Of The National Cancer Institute, 2013-03-06 00:00:00.0; 105(5), p. 334-41.
EPub date: 2013-03-06 00:00:00.0.
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Costs, evidence, and value in the Medicare program: the challenges of technology innovation in breast cancer prevention and control.
Authors: Mandelblatt J.S. , Tosteson A.N. , van Ravesteyn N.T. .
Source: Jama Internal Medicine, 2013-02-11 00:00:00.0; 173(3), p. 227-8.
PMID: 23303388
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Collaborative modeling of the impact of obesity on race-specific breast cancer incidence and mortality.
Authors: Chang Y. , Schechter C.B. , van Ravesteyn N.T. , Near A.M. , Heijnsdijk E.A. , Adams-Campbell L. , Levy D. , de Koning H.J. , Mandelblatt J.S. .
Source: Breast Cancer Research And Treatment, 2012 Dec; 136(3), p. 823-35.
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Tipping the balance of benefits and harms to favor screening mammography starting at age 40 years: a comparative modeling study of risk.
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Computational Modeling And Multilevel Cancer Control Interventions
Authors: Morrissey J.P. , Lich K.H. , Price R.A. , Mandelblatt J. .
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Prediction Of Higher Mortality Reduction For The Uk Breast Screening Frequency Trial: A Model-based Approach On Screening Intervals
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Evaluating the cost-effectiveness of cancer patient navigation programs: conceptual and practical issues.
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Hanging in the balance: making decisions about the benefits and harms of breast cancer screening among the oldest old without a safety net of scientific evidence.
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Source: The New England Journal Of Medicine, 2005-10-27 00:00:00.0; 353(17), p. 1784-92.
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