Grant Number:	7R01CA207361-02 Interpret this number
Primary Investigator:	Braithwaite, Dejana
Organization:	Georgetown University
Project Title:	Comorbidity and Screening Outcomes Among Older Women Undergoing Mammography
Fiscal Year:	2018

Project Summary Breast cancer is a major cause of cancer death in older women and screening mammography has proven to be effective in reducing breast cancer mortality in women aged 50-69 years. However, screening mammography has not been proven beneficial in women aged 70 and older and diminished life expectancy with aging decreases the potential chance of screening benefit and likely increases the risk of harms, which tend to be immediate. Randomized trials of screening mammography cannot provide the answers because the trials excluded women older than age 75 and those with significant comorbidity. To address this clinical and policy conundrum, the proposal makes innovative use of data from the Breast Cancer Surveillance Consortium (BCSC)—the largest collection of breast cancer surveillance data in the nation— and Medicare claims-based data to determine the consequences following screening in older women. The proposal also applies simulation modeling to compare benefits and harms of screening across levels of advancing age, comorbid illness and functional status. We will use data from 351,566 multi-ethnic women aged 66 years and older who underwent screening mammography in the BCSC between 1998 and 2016. This large-scale study enables the evaluation of benefits and harms of screening by including subgroups of women with favorable 10-year life expectancy and women with limited life expectancy. Our specific aims are: 1) Determine cumulative risk of screening outcomes, including benefits and harms, over the course of 10 years of screening mammography among older women across levels of advancing age, comorbidity and functional status. 2) Determine 10-year risk of mortality among older women undergoing screening mammography across levels of advancing age, comorbidity and functional status. 3) Evaluate comparative effectiveness of screening mammography strategies in older women using a simulation model across levels of advancing age, comorbidity and functional status. To optimize the delivery of high quality health care to older women, there is an urgent need to compare the benefits and harms of screening mammography according to age, comorbidity and functional status, which are key predictors of life expectancy. By identifying subgroups of older women most and least likely to benefit from screening mammography, our proposal speaks directly to the National Cancer Institute’s precision cancer screening initiative.




Clinician and patient perspectives on screening mammography among women age 75 and older: A pilot study of a novel decision aid.
Authors: Braithwaite D. , Chicaiza A. , Lopez K. , Lin K.W. , Mishori R. , Karanth S.D. , Anton S. , Miller K. , Schonberg M.A. , Schoenborn N.L. , et al. .
Source: Pec Innovation, 2023 Dec; 2, .
EPub date: 2023-01-31 00:00:00.0.
PMID: 37124453
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Cancer incidence after asthma diagnosis: Evidence from a large clinical research network in the United States.
Authors: Guo Y. , Bian J. , Chen Z. , Fishe J.N. , Zhang D. , Braithwaite D. , George T.J. , Shenkman E.A. , Licht J.D. .
Source: Cancer Medicine, 2023 May; 12(10), p. 11871-11877.
EPub date: 2023-03-31 00:00:00.0.
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Breast biopsy patterns and findings among older women undergoing screening mammography: The role of age and comorbidity.
Authors: Advani S. , Abraham L. , Buist D.S.M. , Kerlikowske K. , Miglioretti D.L. , Sprague B.L. , Henderson L.M. , Onega T. , Schousboe J.T. , Demb J. , et al. .
Source: Journal Of Geriatric Oncology, 2022 03; 13(2), p. 161-169.
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Cost-Effectiveness of Screening Mammography Beyond Age 75 Years : A Cost-Effectiveness Analysis.
Authors: Schousboe J.T. , Sprague B.L. , Abraham L. , O'Meara E.S. , Onega T. , Advani S. , Henderson L.M. , Wernli K.J. , Zhang D. , Miglioretti D.L. , et al. .
Source: Annals Of Internal Medicine, 2022 01; 175(1), p. 11-19.
EPub date: 2021-11-23 00:00:00.0.
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Mammography adherence in relation to function-related indicators in older women.
Authors: Zhang D. , Abraham L. , Sprague B.L. , Onega T. , Advani S. , Demb J. , Miglioretti D.L. , Henderson L.M. , Wernli K.J. , Walter L.C. , et al. .
Source: Preventive Medicine, 2021-11-09 00:00:00.0; 154, p. 106869.
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Source: Jama Network Open, 2021-08-02 00:00:00.0; 4(8), p. e2122810.
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Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort.
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Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2021 Aug; 30(8), p. 1582-1590.
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The role of sex and rurality in cancer fatalistic beliefs and cancer screening utilization in Florida.
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The association between cognitive impairment and breast and colorectal cancer screening utilization.
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Mammography use in relation to comorbidities and functional limitations among older breast cancer survivors.
Authors: Zhang D. , Advani S. , Zhu Z. , Dang L. , Walter L.C. , Braithwaite D. .
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Source: Bmj Open, 2020-01-06 00:00:00.0; 10(1), p. e031823.
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Screening mammography outcomes: risk of breast cancer and mortality by comorbidity score and age.
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Family History and Breast Cancer Risk Among Older Women in the Breast Cancer Surveillance Consortium Cohort.
Authors: Braithwaite D. , Miglioretti D.L. , Zhu W. , Demb J. , Trentham-Dietz A. , Sprague B. , Tice J.A. , Onega T. , Henderson L.M. , Buist D.S.M. , et al. .
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Screening mammography use in older women according to health status: a systematic review and meta-analysis.
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Source: Clinical Interventions In Aging, 2018; 13, p. 1987-1997.
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Optimal breast cancer screening strategies for older women: current perspectives.
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