Research Publications and Outputs

Problems in comparing tobacco regulatory models and excise when only two countries are considered.

Thu, 14 May 2026 00:00:00 GMT

Problems in comparing tobacco regulatory models and excise when only two countries are considered. Chapman, Simon; Egger, Sam; Freeman, Becky Preprint of a response to: Borland R, Martin J, Jegasothy E, Youdan B, Hall W. Has Australia lost control of its tobacco and nicotine markets? Addiction 2026; https://doi.org/10.1111/add.70428

Policy Analysis of the Virtual Hospital Model: A Case Study of Sydney Local Health District Virtual Hospital

Tue, 05 May 2026 00:00:00 GMT

Policy Analysis of the Virtual Hospital Model: A Case Study of Sydney Local Health District Virtual Hospital Gallo, Enrico This research study was conducted within 8 months and was part of Enrico Gallo’s PhD research. It was supported by A/Prof. Philip Haywood from the Leeder Centre for Health Policy, Economics and Data and Miranda Shaw, General Manager at Sydney Local Health District Virtual Hospital (Sydney Virtual)

Coronary calcium artery scoring for support of shared decision making in adults who do not have a history of cardiovascular disease (CACS Study) dataset

Wed, 01 Jan 2025 00:00:00 GMT

Coronary calcium artery scoring for support of shared decision making in adults who do not have a history of cardiovascular disease (CACS Study) dataset Bonner, Carissa This dataset includes 1629 participants aged 45-79; living in Australia, who never had a heart attack or stroke nor been diagnosed with a CVD. This randomised experiment aimed to test different content options amongst consumers with varying health literacy. A 2 x 2 x 2 factorial design tested how to present risk assessment and management options (basic vs detailed) and uncertainty (implicit vs explicit) to enhance understanding to different final risk outcome groups (low vs high). \r\n The data includes participants' demographics and health literacy as well as their responses to various information (either basic description of CVD risk factors management options or detailed description of the triage method and intervention effects). The file type is .XLS

MEL-SELF dataset: a randomised controlled trial of patient-led surveillance compared to clinician-led surveillance in people treated for localised melanoma

Wed, 18 Mar 2026 00:00:00 GMT

MEL-SELF dataset: a randomised controlled trial of patient-led surveillance compared to clinician-led surveillance in people treated for localised melanoma Bell, Katy The MEL-SELF trial is a randomised controlled trial comparing patient-led surveillance with clinician-led surveillance in people who have been previously treated for localised melanoma. Stage 0/I/II melanoma patients (n=500) from dermatology, surgical, or general practice clinics in Australia, will be randomised (1:1) to the intervention (patient-led surveillance, n=250) or control (usual care, n=250). The primary outcome, measured at 12-months, is the proportion of participants diagnosed with a subsequent new primary or recurrent melanoma diagnosed at an unscheduled clinic visit. Clinical secondary outcomes include time from randomisation to diagnosis of any skin cancer (melanoma or keratinocyte cancer), clinicopathological characteristics of subsequent new primary or recurrent melanomas (including AJCC stage), number of lesions surgically evaluated, and number of clinic visits attended. Patient-reported outcomes collected at baseline, 6 and 12 months, include thoroughness, confidence, beliefs, and knowledge of skin self-examination, adherence with recommended clinician SSE practice guidelines, fear of new or recurrent melanoma severity and general anxiety, stress, and depression. A nested qualitative study will include interviews with patients and clinicians, and a costing study will compare costs from a societal perspective. The data will be available in CSV format.

Better to be looked over than overlooked: 50 years of public health research and advocacy

Wed, 14 Jan 2026 00:00:00 GMT

Better to be looked over than overlooked: 50 years of public health research and advocacy Chapman, Simon Simon Chapman AO is emeritus professor of public health in the School of Public Health. He retired from the University in 2016 but has since continued his contributions publishing three books with Sydney University Press (available open access in this repository), several highly cited research papers, many articles for The Conversation, and a blog. Starting from the very earliest beginnings of his career in the 1970s, this memoir of his 50 years as a highly influential public researcher and advocate highlights work he did on four major issues to which he contributed most: • tobacco control • gun control • discrediting attacks on wind farms, mobile phones and transmission towers, and exposing the non-disease of electrosensitivity • his pioneering teaching, writing and practice of public health advocacy and a large amount of related research into the ways that public health issues are reported and framed in news media which both contribute to and diminish public and political understanding of these issues. Intersecting with these topic-focussed emphases were two enduring themes: Public health scepticism and myth-busting. A lengthy chapter looks at his sceptical contributions to public health since the earliest days of his career. These include: • challenging government messaging that ‘everyone’ was at risk of acquiring HIV • criticism of the enduring effort to convince smokers that they should not try to quit unaided, when that it is exactly how the great majority of ex-smokers have always quit • challenging the ethics of outdoor smoking bans • questioning proposals that employers should be able to not employ smokers • questioning those who want to see all movies showing smoking given R (18+) classifications • challenging argument that eliciting fear in health messaging is often unethical • questioning calls for all men to be screened for prostate cancer and • looking at the evidence for the extent to which public health intervention research is taken up in ‘real world’ settings after being shown to ‘work’ in research projects Confronting corporate, ideological and special interest disease vectors • the tobacco industry • the gun lobby • the sunbed industry • hard right libertarians ideologically opposed to state regulation Many of the interest groups Chapman spotlighted as endangering public health sought to discredit him and diminish his impact. A final chapter in the memoir Growing rhino hide, covers attacks on him and his responses.

Breast density notification trial

Tue, 07 Oct 2025 00:00:00 GMT

Breast density notification trial Nickel, Brooke; Ormiston-Smith, Nick; Cvejic, Erin; Isautier, Jennifer; Hammerton, Lisa; Baker, Karen; Legerton, Paula; Vardon, Paul; McInally, Zoe; Robertson, Sandy; McCaffery, Kirsten; Houssami, Nehmat Dataset.

What do editors of medical journals think about opportunities and barriers to advancement in the publication of plain language summaries? A qualitative analysis

Mon, 15 Sep 2025 00:00:00 GMT

What do editors of medical journals think about opportunities and barriers to advancement in the publication of plain language summaries? A qualitative analysis Gainey, Karen Deidentified transcripts from semi-structured qualitative interviews by Karen Gainey as part of her PhD.

Coaching for Healthy AGEing (CHAnGE) dataset

Tue, 29 Apr 2025 00:00:00 GMT

Coaching for Healthy AGEing (CHAnGE) dataset Anne, Tiedemann This dataset includes 605 participants (aged 60+ years, 180 males /425 females) living in the community, recruited from metropolitan Sydney and regional Orange community (NSW), Australia) via direct contact with established community-based organisations for older people. Baseline data includes demographics, physical activity, fall history, health related quality of life, mobility, BMI, affect, dietary habits. Follow-up data was collected at 3, 6 and 12 months and includes self-reported falls, wellbeing, mobility, health-related quality of life, BMI, dietary habits, falls efficacy, gait efficacy, risk taking behaviour, self-report physical activity and device-measured physical activity. The file type is .XLS.

A technology-enabled collaborative learning model (Project ECHO) to upskill primary care providers in best practice pain care

Mon, 01 Jan 2024 00:00:00 GMT

A technology-enabled collaborative learning model (Project ECHO) to upskill primary care providers in best practice pain care De Morgan, Simone; Walker, Pippy; Blyth, Fiona M.; Daly, Anne; Burke, Anne L. J.; Nicholas, Michael K. Background. The South Australian (SA) Chronic Pain Extension for Community Healthcare Outcomes (ECHO) Network was established to upskill primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach using didactic and case-based virtual mentoring sessions. The aims of this study were to assess: (a) participation, satisfaction (relevance, satisfaction with format and content, perceptions of the mentorship environment), learning (perceived knowledge gain, change in attitudes), competence (self-confidence) and performance (intention to change practice, perceived practice change) of the ECHO Network clinician participants; and (b) self-perceived barriers at the clinical, service and system level to applying the learnings. Methods. A mixed methods, participatory evaluation approach was undertaken. Data sources included analysis of program records (learning needs assessment, enrolment survey data, program participation data and online surveys of healthcare professionals including a satisfaction survey after each ECHO session (n = 106 across the ECHO series of 10 sessions; average response rate = 46%), a case presenters survey (n = 7, response rate = 78%) and an outcome survey after all 10 ECHO sessions (n = 11, response rate = 25%). Results. Forty-four healthcare professionals participated in the ECHO Network from a range of career stages and professional disciplines (half were general practitioners). One-third of participants practised in regional SA. Participants reported that the ECHO sessions met their learning needs (average = 99% across the series), were relevant to practice (average = 99% across the series), enabled them to learn about the multidisciplinary and biopsychosocial approach to pain care (average = 97% across the series) and provided positive mentorship (average = 96% across the series). Key learnings for participants were the importance of validating the patient experience and incorporating psychological and social approaches into pain care. More than one-third of participants (average = 42% across the series) identified barriers to applying the learnings such as limited time during a consultation and difficulty in forming a multidisciplinary team. Conclusions. The ECHO Network model was found to be an acceptable and effective interdisciplinary education model for upskilling primary care providers in best practice pain care aligned to a patient-centred, biopsychosocial approach to pain managment. However, participants perceived barriers to translating this knowledge into practice at the clinical, service and system levels.

Framework for Social Media Health Communication to Young People

Fri, 22 Nov 2024 00:00:00 GMT

Framework for Social Media Health Communication to Young People Taba, Melody A framework for using social media for health communication to young people, co-designed by young people and professional health communicators.

Characteristics and post-metastasis survival of recurrent metastatic breast cancer over time - An Australian population-based record linkage study, 2001-2016

Mon, 01 Jan 2024 00:00:00 GMT

Characteristics and post-metastasis survival of recurrent metastatic breast cancer over time - An Australian population-based record linkage study, 2001-2016 Lord, Sally J; Kiely, Belinda E; O'Connell, Diane L; Daniels, Benjamin; Beith, Jane; Smith, Andrea L; Pearson, Sallie-Anne; Chiew, Kim-Lin; Bulsara, Max K; Houssami, Nehmat The aim of this study was to assess population-level characteristics and post-metastasis survival of people with recurrent metastatic breast cancer (rMBC) during a period when new publicly-subsidised adjuvant and metastatic systemic therapies became available. Record linkage study of females in NSW Cancer Registry (NSWCR) diagnosed with non-metastatic breast cancer (BC) in 2001-2002 (C1) and 2006-2007 (C2). We identified first rMBC from NSWCR, administrative hospital records, dispensed medicines and radiotherapy services (2001-2016). We used death registrations to estimate cumulative incidence of BC death.

Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study.

Sun, 01 Jan 2023 00:00:00 GMT

Preoperative breast MRI positively impacts surgical outcomes of needle biopsy–diagnosed pure DCIS: a patient-matched analysis from the MIPA study. Cozzi, Andrea; Di Leo, Giovanni; Houssami, Nehmat; Gilbert, Fiona J.; Helbich, Thomas H.; Álvarez Benito, Marina; Balleyguier, Corinne; Bazzocchi, Massimo; Bult, Peter; Calabrese, Massimo; Herrero, Julia; Cartia, Francesco; Cassano, Enrico; Clauser, Paola; de Lima Docema, Marcos; Depretto, Catherine; Dominelli, Valeria; Forrai, Gábor; Girometti, Rossano; Harms, Steven; Hilborne, Sarah; Ienzi, Raffaele; Lobbes, Marc; Losio, Claudio; Mann, Ritse; Montemezzi, Stefania; Obdeijn, Inge-Marie; Ozcan, Umit; Pediconi, Federica; Pinker, Katja; Preibsch, Heike; Raya Povedano, José; Saccarelli, Carolina; Sacchetto, Daniela; Scaperrotta, Gianfranco; Schlooz, Margrethe; Szabó, Botond; Taylor, Donna; Ulus, Sila; Van Goethem, Mireille; Veltman, Jeroen; Weigel, Stefanie; Wenkel, Evelyn; Zuiani, Chiara; Sardanelli, Francesco The objective of the study was to investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). The MIPA observational study database (7245 patients) was searched for patients aged 18–80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs).

Communicating Heart Disease Risk: Development and testing of a health-literate decision aid for people with low health literacy dataset

Tue, 16 Jul 2024 00:00:00 GMT

Communicating Heart Disease Risk: Development and testing of a health-literate decision aid for people with low health literacy dataset Bonner, Carissa This dataset includes 859 participants aged 45-74 years (52.8% females and 47.2% males) randomised to see one of six different versions of the results page: either a version aimed at lower health literacy, a standard version, or one as the Heart Foundation present it, and each of those three either with percentage risk of having heart attack or stroke, or percentage risk plus heart age. Baseline data includes demographics (age, heart age, sex, education and health literacy), clinical characteristics (cholesterol, HDL, blood pressure, BMI), behaviour and lifestyle characteristics (dietary, exercise and smoking habits) and risk results. Outcome data includes prevention intentions and behaviours, gist and verbatim knowledge of risk, credibility, emotional response, and decisional conflict. The file type is .XLS.

Optimising COVID-19 testing intentions and behaviour with enhanced messaging dataset

Fri, 28 Jun 2024 00:00:00 GMT

Optimising COVID-19 testing intentions and behaviour with enhanced messaging dataset Bonner, Carissa This dataset includes 1314 adults (equal groups above and below the age of 40 years, equal groups for male and female and equal groups for education). Participants were recruited from New South Wales, Australia into this randomised controlled trial to test the efficacy of providing health literacy-sensitive written information (ie, adapted for people with lower health literacy) for all capability and motivation barriers, where individuals could view information to plan for their top 3 barriers to COVID-19 testing. Anonymous quantitative data on outcomes for each group including the intention to undergo testing for COVID-19 if symptomatic, intentions about other prevention behaviours (self-isolation if symptomatic, social distancing of 1.5 m, washing hands regularly, and wearing masks in crowded indoor areas), understanding of messaging, risk perceptions, social stigma, and self-efficacy (ie, confidence in overcoming perceived barriers to testing) is included in this dataset. The file type is .XLS.

The effect of enhanced messaging on COVID-19 testing intentions and behaviour dataset

Tue, 25 Jun 2024 00:00:00 GMT

The effect of enhanced messaging on COVID-19 testing intentions and behaviour dataset Bonner, Carissa This dataset includes 1527 participants (from 18 to 39 years old, both males and females) receiving 2 audio-visual interventions addressing common COVID-19 testing barriers for people with lower health literacy. Participants were recruited from New South Wales, Australia into this randomised controlled trial. Anonymous quantitative data on outcomes for each group including the intention to undergo testing for COVID-19 if symptomatic, intentions about other prevention behaviours (self-isolation if symptomatic, social distancing of 1.5 m, washing hands regularly, and wearing masks in crowded indoor areas), understanding of messaging, risk perceptions, social stigma, and self-efficacy (ie, confidence in overcoming perceived barriers to testing) is included in this dataset. The file type is .XLS.

Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial

Sun, 01 Jan 2023 00:00:00 GMT

Psychosocial outcomes and health service use after notifying women participating in population breast screening when they have dense breasts: a BreastScreen Queensland randomised controlled trial Nickel, Brooke; Ormiston-Smith, Nick; Hammerton, Lisa; Cvejic, Erin; Vardon, Paul; Mcinally, Zoe; Legerton, Paula; Baker, Karen; Isautier, Jennifer; Larsen, Emma; Giles, Michelle; Brennan, Meagan E; McCaffery, Kirsten J; Houssami, Nehmat Robust evidence regarding the benefits and harms of notifying Australian women when routine breast screening identifies that they have dense breasts is needed for informing future mammography population screening practice and policy. The objective of this study was to assess the psychosocial and health services use effects of notifying women participating in population-based breast cancer screening that they have dense breasts; to examine whether the mode of communicating this information about its implications (print, online formats) influences these effects.

Breast cancer highlights from 2023: Knowledge to guide practice and future research

Mon, 01 Jan 2024 00:00:00 GMT

Breast cancer highlights from 2023: Knowledge to guide practice and future research Cardoso, Maria-Joao; Poortman, Philip; Senkus, Elżbieta; Gentilini, Oreste D.; Houssami, Nehmat This narrative work highlights a selection of published work from 2023 with potential implications for breast cancer practice. We feature publications that have provided new knowledge immediately relevant to patient care or for future research. We also highlight guidelines that have reported evidence-based or consensus recommendations to support practice and evaluation in breast cancer diagnosis and treatment. The scope of selected highlights represents various domains and disciplines in cancer control, from prevention to treatment of early and advanced breast cancer.

Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data.

Mon, 20 May 2024 00:00:00 GMT

Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data. Farber, Rachel; Houssami, Nehmat; McGeechan, Kevin; Barratt, Alexandra; Bell, Katy J.L. Digital mammography has replaced film mammography in breast-screening programs globally, including Australia. This led to an increase in the rate of detection, but whether there was increased detection of clinically important cancers is uncertain. We found increased detection of in situ cancer (3.36 per 10,000 screens), localized invasive, and smaller-sized breast cancers attributable to the change in mammography technology, whereas screen-detected intermediate-sized and metastatic breast cancers decreased. Rates of early-stage and intermediate-sized interval cancers increased, and late-stage (−1.62 per 10,000 screens) and large interval cancers decreased. In unscreened women, there were small increases in the temporal trends of cancers across all stages.

OPTimising IMmunisation Using Mixed schedules (OPTIMUM): comparing allergic outcomes in infants following pertussis vaccination dataset

Fri, 15 Mar 2024 00:00:00 GMT

OPTimising IMmunisation Using Mixed schedules (OPTIMUM): comparing allergic outcomes in infants following pertussis vaccination dataset Snelling, Tom OPTIMUM is an investigator-initiated phase IV, two-stage, multisite, parallel, double-blind, adaptive, randomised controlled trial of a single dose of DTwP given at the age of 6 to <12 weeks, followed by DTaP at 4 and 6 months, versus three aP doses only, for the prevention of IgE-mediated food allergy. The primary objective of the study is to assess the allergy protective benefits of the addition of DTwP into the infant schedule. The study population will be up to 1500 Australian infants recruited at 6-10 weeks of age and randomised to receive either a combined Diphtheria-Tetanus-whole cell Pertussis, Hepatitis B, and Haemophilus influenzae type B vaccine (DTwP) OR a combined Diphtheria-Tetanus-acellular Pertussis, Hepatitis B, Inactivated Poliovirus and Haemophilus influenzae type B vaccine (DTaP) as their first vaccine dose at 6- <12 weeks of age as part of the infant vaccine schedule. The dataset includes demographics, birth history, vaccine history, allergic outcomes to 18 months, including SPT and food challenge data at 12 months of age. The file type is .CSV

Engaging Australian men in disease prevention - Supplementary tables

Thu, 28 Sep 2023 00:00:00 GMT

Engaging Australian men in disease prevention - Supplementary tables Smith, Ben J Supplementary tables showing the demographic and health factors associated with preventive health priorities, attitudes and information sources among Australin men.

Transplant recipients and Anal Neoplasia (TAN) study dataset

Wed, 23 Aug 2023 00:00:00 GMT

Transplant recipients and Anal Neoplasia (TAN) study dataset Rosales, Brenda; Hillman, Richard; Webster, Angela This dataset includes up to 125 kidney transplant recipients recruited from Westmead Hospital, New South Wales, Australia. Baseline data includes demographics, risk factors of HPV-associated anal squamous cell cancer, cigarette smoking, sexual behaviours, history of anogenital warts and previous abnormal cervical cytology, concurrent but unrelated anal conditions and sexual practices. Clinical data such as date of transplantation, time on waiting list and current immunosuppression treatment were obtained from patients' clinical records. Anal swab test results for HPV detection and genotyping and cytopathology were collected.

Women’s views about current and future management of Ductal Carcinoma in Situ (DCIS): a mixed-methods study

Sun, 01 Jan 2023 00:00:00 GMT

Women’s views about current and future management of Ductal Carcinoma in Situ (DCIS): a mixed-methods study Nickel, Brooke; McCaffery, Kirsten; Jansen, Jesse; Barratt, Alexandra; Houssami, Nehmat; Saunders, Christobel; Spillane, Andrew; Rutherford, Claudia; Stuart, Kristy; Robertson, Geraldine; Dixon, Ann; Hersch, Jolyn Management of low-risk ductal carcinoma in situ (DCIS) is controversial, with clinical trials currently assessing the safety of active monitoring amidst concern about overtreatment. Little is known about general community views regarding DCIS and its management. We aimed to explore women's understanding and views about low-risk DCIS and current and potential future management options. This mixed-method study involved qualitative focus groups and brief quantitative questionnaires. Participants were screening-aged (50-74 years) women, with diverse socioeconomic backgrounds and no personal history of breast cancer/DCIS, recruited from across metropolitan Sydney, Australia. Sessions incorporated an informative presentation interspersed with group discussions which were audio-recorded, transcribed and analysed thematically. Fifty-six women took part in six age-stratified focus groups. Prior awareness of DCIS was limited, however women developed reasonable understanding of DCIS and the relevant issues. Overall, women expressed substantial support for active monitoring being offered as a management approach for low-risk DCIS, and many were interested in participating in a hypothetical clinical trial. Although some women expressed concern that current management may sometimes represent overtreatment, there were mixed views about personally accepting monitoring. Women noted a number of important questions and considerations that would factor into their decision making. Our findings about women's perceptions of active monitoring for DCIS are timely while results of ongoing clinical trials of monitoring are awaited, and may inform clinicians and investigators designing future, similar trials. Exploration of offering well-informed patients the choice of non-surgical management of low-risk DCIS, even outside a clinical trial setting, may be warranted.

SHeLL Health Literacy Editor screenshot

Wed, 05 Jul 2023 00:00:00 GMT

SHeLL Health Literacy Editor screenshot Ayre, Julie This image depicts the SHeLL Health Literacy Editor. The Editor provides multiple automated health literacy assessments of a text, including readability, complex language, and passive voice.

Let’s talk about U=U: seizing a valuable opportunity to better support adolescents living with HIV

Sun, 01 Jan 2023 00:00:00 GMT

Let’s talk about U=U: seizing a valuable opportunity to better support adolescents living with HIV Bernays, Sarah; Lariat, Joni; Ameyan, Wole; Willis, Nicola The clinical knowledge that people living with HIV who maintain an undetectable viral load and therefore cannot transmit HIV sexually, known as Undetectable equals Untransmittable (U=U), has reached a critical mass of adults, but it is relatively silenced within adolescent HIV care and support. We argue that understanding the full range of opportunities enabled by viral suppression, including the elimination of transmission risk, could transform adolescents’ understanding of living with HIV, incentivise optimal treatment engagement and support and sustain their positive mental health. However, the reluctance to discuss U=U with adolescents means that we are not providing them with adequate access to the information and tools that would help them to succeed. We need to recognise, value, and invest in the mediating role of building viral load literacy, illustrated by conveying U=U in ways that are meaningful for adolescents, to accelerate viral suppression. Rather than protect, rationing access to information on U=U only increases their vulnerability and risk to poor HIV and mental health outcomes.

Towards consensus on managing high mammographic density in population breast screening?

Sun, 01 Jan 2023 00:00:00 GMT

Towards consensus on managing high mammographic density in population breast screening? Tagliafico, Alberto S; Houssami, Nehmat In Medicine and in Radiology, impact on societal and health outcomes of a diagnostic pathway or methodology should be comprehensively investigated before implementing a screening approach for disease ...

Two-year follow-up of participants in the BreastScreen Victoria pilot trial of tomosynthesis versus mammography: breast density-stratified screening outcomes

Sun, 01 Jan 2023 00:00:00 GMT

Two-year follow-up of participants in the BreastScreen Victoria pilot trial of tomosynthesis versus mammography: breast density-stratified screening outcomes Houssami, Nehmat; Lockie, Darren; Giles, Michelle; Noguchi, Naomi; Marr, Georgina; Marinovich, M Luke This follow-up study of BreastScreen Victoria’s pilot trial of digital breast tomosynthesis aimed to report interval cancer rates, screening sensitivity, and density-stratified outcomes for tomosynthesis vs mammography screening. Prospective pilot trial [ACTRN-12617000947303] in Maroondah BreastScreen recruited females ≥ 40 years presenting for screening (August 2017–November 2018) to DBT; concurrent screening participants who received mammography formed a comparison group. Follow-up of 24 months from screen date was used to ascertain interval cancers; automated breast density was measured.

Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study

Sun, 01 Jan 2023 00:00:00 GMT

Screening and diagnostic breast MRI: how do they impact surgical treatment? Insights from the MIPA study Cozzi, Andrea; Di Leo, Giovanni; Houssami, Nehmat; Et, al To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/non-referral and other covariates in driving surgical outcomes. The MIPA observational study enrolled women aged 18–80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis.

Reply: Understanding the Impact of Blood Pressure Guidelines and Variability on Hypertension Diagnoses

Fri, 01 Jan 2021 00:00:00 GMT

Reply: Understanding the Impact of Blood Pressure Guidelines and Variability on Hypertension Diagnoses Bell, Katy J.L.; Doust, Jenny; McGeechan, Kevin; Horvath, AR; Barratt, Alexandra; Hayen, Andrew; Semsarian, Caitlin R; Irwig, Les n/a

Supporting adults with Chronic Kidney Disease to engage in shared decision making successfully (SUCCESS) dataset

Mon, 15 May 2023 00:00:00 GMT

Supporting adults with Chronic Kidney Disease to engage in shared decision making successfully (SUCCESS) dataset Muscat, Danielle This dataset will include up to 384 participants receiving in-center or home-based hemodialysis or peritoneal dialysis recruited from six local health districts in the Greater Sydney region, New South Wales, Australia. Baseline data will include demographics, dialysis history, cognitive status, health literacy and self-efficacy scores. Follow-up data will be collected at 3, 6 and 12 months and will include patient reported outcomes (quality of life, knowledge, confidence, health behaviour and self-management) and clinical outcomes (symptom burden (Palliative care Outcome Scale) and nutritional status (Patient-generated Subjective Global Assessment).

“I haven’t had that information, even though I think I’m really well-informed about most things”: a qualitative focus group study on Australian women’s understanding and views of potentially modifiable risk factors for breast cancer

Sun, 01 Jan 2023 00:00:00 GMT

“I haven’t had that information, even though I think I’m really well-informed about most things”: a qualitative focus group study on Australian women’s understanding and views of potentially modifiable risk factors for breast cancer Nickel, Brooke; Armiger, Josephine; Saunders, Christobel; Vincent, Wendy; Dodd, Rachael H; Temple, Anthea; Bhola, Nalini; Verde, Angela; Houssami, Nehmat This study aimed to explore current knowledge, understanding and experience of potentially modifiable risk factors for breast cancer, and views on current and future communication strategies for this information and related interventions.

Diagnostic accuracy and outcomes of digital breast tomosynthesis (DBT) compared to digital mammography (DM) in identifying breast cancer in women at increased risk of breast cancer due to symptoms and/or family history.

Sun, 01 Jan 2023 00:00:00 GMT

Diagnostic accuracy and outcomes of digital breast tomosynthesis (DBT) compared to digital mammography (DM) in identifying breast cancer in women at increased risk of breast cancer due to symptoms and/or family history. Houssami, Nehmat; Noguchi, Naomi; Boroumand, Farzaneh; Teixeira-Pinto, Armando; Zeng, Aileen; Bell, Katy J.L. Aims: 1. To examine the diagnostic accuracy and outcomes of DBT, in women with symptoms or signs of breast cancer and/or family history of breast cancer, in comparison with DM. 2. To examine the diagnostic accuracy and outcomes of DBT in the subgroup of women with dense breasts who have symptoms or signs of breast cancer and/or family history of breast cancer, in comparison with DM. 3. To examine the additional diagnostic value of breast ultrasound, used in addition to either DBT or DM in the above-described populations including the subgroup with dense breasts.

Low-risk prostate lesions: An evidence review to inform discussion on losing the "cancer" label

Sun, 01 Jan 2023 00:00:00 GMT

Low-risk prostate lesions: An evidence review to inform discussion on losing the "cancer" label Semsarian, Caitlin R; Ma, Tara; Nickel, Brooke; Barratt, Alexandra; Varma, Murali; Delahunt, Brett; Millar, Jeremy; Parker, Lisa; Glasziou, Paul; Bell, Katy J.L. Background: Active surveillance (AS) mitigates harms from overtreatment of low-risk prostate lesions. Recalibration of diagnostic thresholds to redefine which prostate lesions are considered "cancer" and/or adopting alternative diagnostic labels could increase AS uptake and continuation. Methods: We searched PubMed and EMBASE to October 2021 for evidence on: (1) clinical outcomes of AS, (2) subclinical prostate cancer at autopsy, (3) reproducibility of histopathological diagnosis, and (4) diagnostic drift. Evidence is presented via narrative synthesis. Results: AS: one systematic review (13 studies) of men undergoing AS found that prostate cancer-specific mortality was 0%-6% at 15 years. There was eventual termination of AS and conversion to treatment in 45%-66% of men. Four additional cohort studies reported very low rates of metastasis (0%-2.1%) and prostate cancer-specific mortality (0%-0.1%) over follow-up to 15 years. Overall, AS was terminated without medical indication in 1%-9% of men. Subclinical reservoir: 1 systematic review (29 studies) estimated that the subclinical cancer prevalence was 5% at <30 years, and increased nonlinearly to 59% by >79 years. Four additional autopsy studies (mean age: 54-72 years) reported prevalences of 12%-43%. Reproducibility: 1 recent well-conducted study found high reproducibility for low-risk prostate cancer diagnosis, but this was more variable in 7 other studies. Diagnostic drift: 4 studies provided consistent evidence of diagnostic drift, with the most recent (published 2020) reporting that 66% of cases were upgraded and 3% were downgraded when using contemporary diagnostic criteria compared to original diagnoses (1985-1995) Conclusions: Evidence collated may inform discussion of diagnostic changes for low-risk prostate lesions.

Technical aspects of breast MRI—do they affect outcomes?

Thu, 01 Jan 2009 00:00:00 GMT

Technical aspects of breast MRI—do they affect outcomes? Warren, Ruth; Ciatto, Stefano; Macaskill, Petra; Black, Richard; Houssami, Nehmat In a systematic review of breast MRI for assessing ipsilateral breast cancer to detect additional lesions, technical details were extracted from publications to assess their effect on diagnostic performance. Where technical parameters were complete, we examined their effect on summary ROC models, and the TP:FP ratio and PPV, using random-effects logistic regression. A total of 2,801 breasts in 19 publications underwent statistical analysis for year of study, slice thickness, and repetitions after contrast-medium injection. None were associated with TP/FP ratio. Summary ROC analysis provided weak evidence (P = 0.09) of an association between diagnostic performance and time period, however no trend over time. Tesla strength was reported in 2,801 cases. Other key information was omitted including whether both breasts were examined for 1683 (60%), position of the patient in 1,375 (49%), and imaging planes used in 688 (25%). Contrast agent and dose were reported for 2,646 (95%) breasts. Reporting technique was inconsistently reported. Single radiology reports were found in 1,637 (58%) cases, double in 347 (12.4%), and in 960 (34%) knowledge of mammography or ultrasound findings was not stated. Slice thickness, number of sequences after contrast medium, and year of study did not show significant performance differences. Other technical information was deficient. There is an urgent need to improve the quality of reporting of breast MRI studies.

“It’s about our bodies… we have the right to know this stuff”: a qualitative focus group study on Australian women’s perspectives on breast density

Sat, 01 Jan 2022 00:00:00 GMT

“It’s about our bodies… we have the right to know this stuff”: a qualitative focus group study on Australian women’s perspectives on breast density Brooke, Nicole; Dolan, Hankiz; Carter, Stacy; Houssami, Nehmat; Brennan, Meagan; Hersch, Jolyn; Verde, Angela; Vaccaro, Lisa; McCaffery, Kirsten Objective: This study aimed to explore Australian women's current knowledge, perspectives and attitudes about breast density (BD); and information needs to inform effective evidence-based communication strategies. Methods: Fourteen online focus group sessions with a total of 78 women in New South Wales and Queensland, Australia aged 40-74 years without a personal diagnosis of breast cancer were conducted. Audio-recorded data was transcribed and analysed thematically. Results: Women had a very limited knowledge of BD. Overall, women expressed a preference for more frequent mammograms and/or supplemental screening should they be told they had dense breasts, despite being presented with information on potential downsides of additional testing. The majority of women were supportive of the notion of BD notification, often suggesting they had a 'right to know' and they would prefer to be educated and informed about it. Conclusion: The potential of being informed and notified of BD is found to be of interest and importance to Australian women of breast screening age despite lacking current knowledge.

The Effect of Supplemental Imaging on Interval Cancer Rates in Mammography Screening: Systematic Review

Sat, 01 Jan 2022 00:00:00 GMT

The Effect of Supplemental Imaging on Interval Cancer Rates in Mammography Screening: Systematic Review Zheng, Aileen; Brennan, Meagan E; Young, Sharon; Mathieu, Erin; Houssami, Nehmat Supplemental screening with MRI or ultrasound increases cancer detection rate (CDR) in women with standard screening mammography. Whether it also reduces interval cancer rate (ICR) is unclear. This study reviewed the evidence evaluating the effect of supplemental imaging on ICR in women undergoing screening mammography. This systematic review included studies that reported both CDR and ICR in women undergoing screening mammography alone compared to those undergoing screening mammography with supplemental imaging. Five studies (3 randomized trials) were eligible. These reported on 142,153 women undergoing mammography screening alone or mammography with supplemental imaging (3 ultrasound and 2 MRI studies). Two studies included a general screening population and 3 included special populations (young, high genetic risk and/or dense breasts). The incremental CDR for supplemental MRI was 14.2 to 16.5/1000 screens and for ultrasound was 0 to 4.4/1000 screens. Effect on ICR was variable but evidence of a reduced ICR was more consistent for studies using supplemental MRI (ICR 0.3 to 0.8 per 1000 screens) than those using ultrasound (ICR 0.49 to 1.9 per 1000 screens). The higher CDR and lower ICR with supplemental screening were associated with higher recall and biopsy rates particularly with supplemental MRI (9.5%-15.9%, up to 69/1000 screens). Cancers detected with supplemental imaging modalities were generally smaller and earlier stage. Mammography with supplemental MRI or ultrasound increases detection of cancers (versus mammography only) in some sub-groups but also increases recall and biopsy rates and may have a relatively modest effect in reducing ICR.

The financial implications of investigating false-positive and true-positive mammograms in a national breast cancer screening program

Sat, 01 Jan 2022 00:00:00 GMT

The financial implications of investigating false-positive and true-positive mammograms in a national breast cancer screening program Soon, Jason; Houssami, Nehmat; Clemson, Michelle; Lockie, Darren; Farber, Rachel; Barratt, Alexandra; Elshaug, Adam; Howard, Kirsten ObjectivesTo determine the total annual screening and further-investigation costs of investigating false-positive and true-positive mammograms in the Australian population breast-screening program.MethodsThis economic analysis used aggregate-level retrospective cohort data of women screened at a breast-screening clinic. Counts and frequencies of each diagnostic workup-sequence recorded were scaled up to national figures and costed by estimating per-patient costs of procedures using screening clinic cost data. Main outcomes and measures estimated were percentage share of total annual screening and further-investigation costs for the Australian population breast-screening program of investigating false-positive and true-positive mammograms. Secondary outcomes determined were average costs of investigating each false-positive and true-positive mammogram. Sensitivity analyses involved recalculating results excluding subgroups of patients below and above the screening age range of 50-74 years.ResultsOf 8235 patients, the median age was 60.35 years with interquartile range of 54.17-67.17 years. A total of 15.4% (ranging from 13.4 to 15.4% under different scenarios) of total annual screening and further-investigation costs were from investigating false-positive mammograms. This exceeded the share of costs from investigating true-positives (13%).ConclusionsWe have developed a transparent and non-onerous approach for estimating the costs of false-positive and true-positive mammograms associated with the national breast-screening program. While determining an optimal balance between false-positives and true-positive rates must rely primarily on health outcomes, costs are an important consideration. We recommend that future research adopts and refines similar approaches to facilitate better monitoring of these costs, benchmark against estimates from other screening programs, and support optimal policy development.

A survey of the use and impact of International Journal of Epidemiology's Education Corner

Sat, 01 Jan 2022 00:00:00 GMT

A survey of the use and impact of International Journal of Epidemiology's Education Corner Medcalf, Ellie; Huang, Jonathan Y; Arah, Oneybuchi A; Harhay, Michael O; Leeder, Stephen R; Bell, Katy J.L. The International Journal of Epidemiology (IJE) Education Corner was introduced in 2012, providing educational articles on epidemiological concepts and methods. We conducted a survey of the use and impact of the IJE Education Corner articles in relation to teaching, research and practice, collating suggestions on how we might increase their utility.

Strategies to Improve Adherence to Skin Self-examination and Other Self-management Practices in People at High Risk of Melanoma: A Scoping Review of Randomized Clinical Trials

Sun, 01 Jan 2023 00:00:00 GMT

Strategies to Improve Adherence to Skin Self-examination and Other Self-management Practices in People at High Risk of Melanoma: A Scoping Review of Randomized Clinical Trials Ackermann, Deonna M; Bracken, Karen; Janda, Monika; Turner, Robin M; Hersch, Jolyn; Drabarek, Dorothy; Bell, Katy J.L. Importance: Adherence, both in research trials and in clinical practice, is crucial to the success of interventions. There is limited guidance on strategies to increase adherence and the measurement and reporting of adherence in trials of melanoma self-management practices. Objective: This scoping review aimed to describe (1) strategies to improve adherence to self-management practices in randomized clinical trials of people at high risk of melanoma and (2) measurement and reporting of adherence data in these trials. Evidence review: Four databases, including MEDLINE, Embase, CENTRAL, and CINAHL, were searched from inception to July 2022. Eligible studies were randomized clinical trials of self-monitoring interventions for early detection of melanoma in people at increased risk due to personal history (eg, melanoma, transplant, dysplastic naevus syndrome), family history of melanoma, or as determined by a risk assessment tool or clinical judgment. Findings: From 939 records screened, 18 eligible randomized clinical trials were identified, ranging in size from 40 to 724 participants, using a range of adherence strategies but with sparse evidence on effectiveness of the strategies. Strategies were classified as trial design (n = 15); social and economic support (n = 5); intervention design (n = 18); intervention and condition support (n = 10); and participant support (n = 18). No strategies were reported for supporting underserved groups (eg, people who are socioeconomically disadvantaged, have low health literacy, non-English speakers, or older adults) to adhere to self-monitoring practices, and few trials targeted provider (referring to both clinicians and researchers) adherence (n = 5). Behavioral support tools included reminders (n = 8), priority-setting guidance (n = 5), and clinician feedback (n = 5). Measurement of adherence was usually by participant report of skin self-examination practice with some recent trials of digital interventions also directly measuring adherence to the intervention through website or application analytic data. Reporting of adherence data was limited, and fewer than half of all reports mentioned adherence in their discussion. Conclusions and relevance: Using an adaptation of the World Health Organization framework for clinical adherence, this scoping review of randomized clinical trials identified key concepts as well as gaps in the way adherence is approached in design, conduct, and reporting of trials for skin self-examination and other self-management practices in people at high risk of melanoma. These findings may usefully guide future trials and clinical practice; evaluation of adherence strategies may be possible using a Study Within A Trial (SWAT) framework within host trials.

Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow up? Statistical analysis plan for the MEL-SELF randomised controlled trial

Sat, 01 Jan 2022 00:00:00 GMT

Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow up? Statistical analysis plan for the MEL-SELF randomised controlled trial Medcalf, Ellie; Taylor, Aiya; Turner, Robin M; Espinoza, David; Bell, Katy J.L. Background: The MEL-SELF trial is a randomised controlled trial of patient-led surveillance compared to clinician-led surveillance in people treated for localised cutaneous melanoma (stage 0, I, II). The primary trial aim is to determine if patient led-surveillance compared to clinician-led surveillance increases the proportion of participants who are diagnosed with a new primary or recurrent melanoma at a fast-tracked unscheduled clinic visit. The secondary outcomes include time to diagnosis of any skin cancer, psychosocial outcomes, acceptability, and resource use. Objective: The objective of this report is to outline and publish the pre-determined statistical analysis plan before the database lock and the start of analysis. Methods/design: The statistical analysis plan describes the overall analysis principles, including how participants will be included in each analysis, the presentation of the results, adjustments for covariates, the primary and secondary outcomes, and their respective analyses. In addition, we present the planned sensitivity and subgroup analyses. A separate analysis plan will be published for health economic outcomes. Results: The MEL-SELF statistical analysis plan has been designed to minimize bias in estimating effects of the intervention on primary and secondary outcomes. By pre-specifying analyses, we ensure the study's integrity and believability while enabling the reproducibility of the final analysis. Conclusion: This detailed statistical analysis plan will help to ensure transparency of reporting of results from the MEL-SELF trial.

General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study

Fri, 01 Jan 2021 00:00:00 GMT

General practitioners’ (GPs) understanding and views on breast density in Australia: a qualitative interview study Nickel, Brooke; Dolan, Hankiz; Carter, Stacy; Houssami, Nehmat; Brennan, Meagan; Hersch, Jolyn; Kaderbhai, Alia; McCaffery, Kirsten Objectives To understand general practitioners’ (GPs’) awareness and knowledge of mammographic breast density (BD) and their perspectives around information and potential notification of BD for women. Design Qualitative study using semistructured telephone interviews. Interviews were audiorecorded, transcribed and analysed using framework analysis. Setting Australia. Participants Australian GPs (n=30). Results GPs had limited knowledge of BD and little experience discussing BD with women. There were mixed views on notification of BD with some GPs believing this information would help informed decision making about breast health and that women have the right to know any information about their bodies. While others were concerned about causing unnecessary anxiety and were worried about the uncertainty about what to advise women to do with this information, particularly in relation to supplemental breast screening. The need for an equitable system where all women are either notified or not, and also provided with publicly funded supplemental screening was raised by GPs. Overall, there was high interest in education, training and support around the topic of BD. Conclusions Australian GPs require education, support and evidence-based guidelines to have discussions with women with dense breasts and help manage their risk, especially if widespread notification is to be introduced in population-based screening programmes.

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA)

Fri, 01 Jan 2021 00:00:00 GMT

Magnetic resonance imaging before breast cancer surgery: results of an observational multicenter international prospective analysis (MIPA) Sardanelli, Francesco; Trimboli, Rubina M; Houssami, Nehmat; Gilbert, Fiona J; Helbich, Thomas H; Benito, Marina A; et, al Objectives Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. Methods This observational study enrolled women aged 18–80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. Results Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). Conclusions Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup.

Improving Breast Density Communication: Does the Provision of Complex Health Information Online Work?

Fri, 01 Jan 2021 00:00:00 GMT

Improving Breast Density Communication: Does the Provision of Complex Health Information Online Work? Nickel, Brooke; Houssami, Nehmat Breast density (BD) is one of a number of independent risk factors for breast cancer.1 Approximately 40%–50% of women in the breast screening population in the United States are estimated to have dense breasts,2 making it one of the most common risk factors for breast cancer. Apart from this, having dense breasts has also been shown to increase a woman's risk of having an interval cancer diagnosed due to lower sensitivity of mammography in women with dense breast tissue at mammography screening.4 As a result of a largely grass-roots effort, the majority of U.S. states have now enacted laws mandating language in mammography reports, which notifies women if they have dense breasts and informs them of the risks related to dense breast tissue.5,6 However, effecting BD notification has not been straightforward, and has highlighted challenges related to how best to communicate density information and to guide women toward the appropriate management strategy.

Women's conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study

Sat, 01 Jan 2022 00:00:00 GMT

Women's conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study Tsuruda, Kaitlyn M; Veierød, Marit B; Houssami, Nehmat; Waade, Gunvor G; Mangerud, Gunhild; Hofvind, Solveig Objective: To investigate conceptual knowledge about mammographic screening among Norwegian women. Design: We administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia. Setting: Our Norwegian-language survey was open from April to June 2020 and targeted women aged 45-74 years. Participants: 2033 women completed our questionnaire. We excluded 13 women outside the target age range and 128 women with incomplete data. Responses from 1892 women were included in the final study sample. Primary and secondary outcome measures: The questionnaire focused on women's knowledge about the breast cancer mortality reduction, false positive results and overdiagnosis associated with mammographic screening. The primary outcome was the mean number of marks assigned in each of the three themes and overall. There were three potential marks for questions about breast cancer mortality, one for false positives and six for overdiagnosis. Results: Most women (91.7%) correctly reported that screened women are less likely to die of breast cancer than non-screened women. 39.7% of women reported having heard of a 'false positive screening result' and 86.2% identified the term's definition; 51.3% of women had heard of 'overdiagnosis' and 14.8% identified the term's definition. The mean score was 2.59 of 3 for questions about breast cancer mortality benefit and 0.93 of 1 for the question about false positive screening results. It was 2.23 of 6 for questions about overdiagnosis.

Can population breast screening programs be leveraged to reduce the burden of breast cancer?

Sat, 01 Jan 2022 00:00:00 GMT

Can population breast screening programs be leveraged to reduce the burden of breast cancer? Houssami, Nehmat .

Artificial intelligence (AI) to enhance breast cancer screening: protocol for population-based cohort study of cancer detection

Sat, 01 Jan 2022 00:00:00 GMT

Artificial intelligence (AI) to enhance breast cancer screening: protocol for population-based cohort study of cancer detection Marinovich, M Luke; Wylie, Elizabeth Jane; Lotter, William; Pearce, Alison; Carter, Stacy M; Lund, Helen; Waddell, Andrew; Kim, Jiye G; Pereira, Gavin F; Lee, Christoph I; Zackrisson, Sophia; Brennan, Meagan; Houssami, Nehmat Introduction Artiﬁcial intelligence (AI) algorithms for interpreting mammograms have the potential to improve the effectiveness of population breast cancer screening programmes if they can detect cancers, including interval cancers, without contributing substantially to overdiagnosis. Studies suggesting that AI has comparable or greater accuracy than radiologists commonly employ ‘enriched’ datasets in which cancer prevalence is higher than in population screening. Routine screening outcome metrics (cancer detection and recall rates) cannot be estimated from these datasets, and accuracy estimates may be subject to spectrum bias which limits generalisabilty to real-world screening. We aim to address these limitations by comparing the accuracy of AI and radiologists in a cohort of consecutive of women attending a real-world population breast cancer screening programme. Methods and analysis A retrospective, consecutive cohort of digital mammography screens from 109 000 distinct women was assembled from BreastScreen WA (BSWA), Western Australia’s biennial population screening programme, from November 2016 to December 2017. The cohort includes 761 screen-detected and 235 interval cancers. Descriptive characteristics and results of radiologist double-reading will be extracted from BSWA outcomes data collection. Mammograms will be reinterpreted by a commercial AI algorithm (DeepHealth). AI accuracy will be compared with that of radiologist single-reading based on the diﬀerence in the area under the receiver operating characteristic curve. Cancer detection and recall rates for combined AI–radiologist reading will be estimated by pairing the first radiologist read per screen with the AI algorithm, and compared with estimates for radiologist double-reading.

De novo and recurrent metastatic breast cancer - A systematic review of population-level changes in survival since 1995

Sat, 01 Jan 2022 00:00:00 GMT

De novo and recurrent metastatic breast cancer - A systematic review of population-level changes in survival since 1995 Lord, Sarah J.; Bahlmann, K; O'Connell, D L; Kiely, B E; Daniels, B; Pearson, SA; Beith, J; Bulsara, MK; Hou, Nehmat Background: Advances in breast cancer (BC) care have reduced mortality, but their impact on survival once diagnosed with metastasis is less well described. This systematic review aimed to describe population-level survival since 1995 for de novo metastatic BC (dnMBC) and recurrent MBC (rMBC). Methods: We searched MEDLINE 01/01/1995-12/04/2021 to identify population-based cohort studies of MBC reporting overall (OS) or BC-specific survival (BCSS) over time. We appraised risk-of-bias and summarised survival descriptively for MBC diagnoses in 5-year periods from 1995 until 2014; and for age, hormone receptor and HER2 subgroups. Findings: We identified 20 eligible studies (14 dnMBC, 1 rMBC, 5 combined). Potential sources of bias in these studies were confounding and shorter follow-up for the latest diagnosis period.For dnMBC, 13 of 14 studies reported improved OS or BCSS since 1995. In 2005-2009, the median OS was 26 months (range 24-30), a median gain of 6 months since 1995-1999 (range 0-9, 4 studies). Median 5-year OS was 23% in 2005-2009, a median gain of 7% since 1995-1999 (range -2 to 14%, 4 studies). For women ≥70 years, the median and 5-year OS was unchanged (1 study) with no to modest difference in relative survival (range: -1·9% (p = 0.71) to +2·1% (p = 0.045), 3 studies). For rMBC, one study reported no change in survival between 1998 and 2006 and 2007-2013 (median OS 23 months). For combined MBC, 76-89% had rMBC. Three of four studies observed no change in median OS after 2000. Of these, one study reported median OS improved for women ≤60 years (1995-1999 19·1; 2000-2004 22·3 months) but not >60 years (12·7, 11·6 months). Interpretation: Population-level improvements in OS for dnMBC have not been consistently observed in rMBC cohorts nor older women. These findings have implications for counselling patients about prognosis, planning cancer services and trial stratification.

Independent External Validation of Artificial Intelligence Algorithms for Automated Interpretation of Screening Mammography: A Systematic Review

Sat, 01 Jan 2022 00:00:00 GMT

Independent External Validation of Artificial Intelligence Algorithms for Automated Interpretation of Screening Mammography: A Systematic Review Anderson, Anna W; Marinovich, M Luke; Houssami, Nehmat; Lowry, Kathryn P; Elmore, Joann G; Buist, Diana S M; Hofvind, Solveig; Lee, Christoph I Purpose: The aim of this study was to describe the current state of science regarding independent external validation of artificial intelligence (AI) technologies for screening mammography. Methods: A systematic review was performed across five databases (Embase, PubMed, IEEE Explore, Engineer Village, and arXiv) through December 10, 2020. Studies that used screening examinations from real-world settings to externally validate AI algorithms for mammographic cancer detection were included. The main outcome was diagnostic accuracy, defined by area under the receiver operating characteristic curve (AUC). Performance was also compared between radiologists and either stand-alone AI or combined radiologist and AI interpretation. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results: After data extraction, 13 studies met the inclusion criteria (148,361 total patients). Most studies (77% [n = 10]) evaluated commercially available AI algorithms. Studies included retrospective reader studies (46% [n = 6]), retrospective simulation studies (38% [n = 5]), or both (15% [n = 2]). Across 5 studies comparing stand-alone AI with radiologists, 60% (n = 3) demonstrated improved accuracy with AI (AUC improvement range, 0.02-0.13). All 5 studies comparing combined radiologist and AI interpretation with radiologists alone demonstrated improved accuracy with AI (AUC improvement range, 0.028-0.115). Most studies had risk for bias or applicability concerns for patient selection (69% [n = 9]) and the reference standard (69% [n = 9]). Only two studies obtained ground-truth cancer outcomes through regional cancer registry linkage. Conclusions: To date, external validation efforts for AI screening mammographic technologies suggest small potential diagnostic accuracy improvements but have been retrospective in nature and suffer from risk for bias and applicability concerns.

Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer

Sat, 01 Jan 2022 00:00:00 GMT

Evidence from a BreastScreen cohort does not support a longer inter-screen interval in women who have no conventional risk factors for breast cancer Noguchi, Naomi; Marinovich, M Luke; Wylie, Elizabeth Jane; Lund, Helen; Houssami, Nehmat Objectives: To determine screening outcomes in women who have no recorded risk factors for breast cancer. Methods: A retrospective population-based cohort study included all 1,026,137 mammography screening episodes in 323,082 women attending the BreastScreen Western Australia (part of national biennial screening) program between July 2007 and June 2017. Cancer detection rates (CDR) and interval cancer rates (ICR) were calculated in screening episodes with no recorded risk factors for breast cancer versus at least one risk factor stratified by age. CDR was further stratified by timeliness of screening (<27 versus ≥27 months); ICR was stratified by breast density. Results: Amongst 566,948 screens (55.3%) that had no recorded risk factors, 2347 (40.9%) screen-detected cancers were observed. In screens with no risk factors, CDR was 50 (95%CI 48-52) per 10,000 screens and ICR was 7.9 (95%CI 7.4-8.4) per 10,000 women-years, estimates that were lower than screens with at least one risk factor (CDR 83 (95%CI 80-86) per 10,000 screens, ICR 12.2 (95%CI 11.5-13.0) per 10,000 women-years). Compared to timely screens with risk factors, delayed screens with no risk factors had similar CDR across all age groups and a higher proportion of node positive cancers (26.1% vs 20.7%). ICR was lowest in screens that had no risk factors nor dense breasts in all age groups. Conclusions: Majority of screens had no recorded breast cancer risk factors, hence a substantial proportion of screen-detected cancers occur in these screening episodes. Our findings may not justify less frequent screening in women with no risk factors.

Differential detection by breast density for digital breast tomosynthesis versus digital mammography population screening: a systematic review and meta-analysis

Sat, 01 Jan 2022 00:00:00 GMT

Differential detection by breast density for digital breast tomosynthesis versus digital mammography population screening: a systematic review and meta-analysis Li, Tong; Houssami, Nehmat; Noguchi, Naomi; Zeng, Aileen; Marinovich, M Luke Background We examined whether digital breast tomosynthesis (DBT) detects differentially in high- or low-density screens. Methods We searched six databases (2009–2020) for studies comparing DBT and digital mammography (DM), and reporting cancer detection rate (CDR) and/or recall rate by breast density. Meta-analysis was performed to pool incremental CDR and recall rate for DBT (versus DM) for high- and low-density (dichotomised based on BI-RADS) and within-study differences in incremental estimates between high- and low-density. Screening settings (European/US) were compared. Results Pooled within-study difference in incremental CDR for high- versus low-density was 1.0/1000 screens (95% CI: 0.3, 1.6; p = 0.003). Estimates were not significantly different in US (0.6/1000; 95% CI: 0.0, 1.3; p = 0.05) and European (1.9/1000; 95% CI: 0.3, 3.5; p = 0.02) settings (p for subgroup difference = 0.15). For incremental recall rate, within-study differences between density subgroups differed by setting (p < 0.001). Pooled incremental recall was less in high- versus low-density screens (−0.9%; 95% CI: −1.4%, −0.4%; p < 0.001) in US screening, and greater (0.8%; 95% CI: 0.3%, 1.3%; p = 0.001) in European screening. Conclusions DBT has differential incremental cancer detection and recall by breast density. Although incremental CDR is greater in high-density, a substantial proportion of additional cancers is likely to be detected in low-density screens. Our findings may assist screening programmes considering DBT for density-tailored screening.

AI as a new paradigm for risk-based screening for breast cancer

Sat, 01 Jan 2022 00:00:00 GMT

AI as a new paradigm for risk-based screening for breast cancer Houssami, Nehmat; Kerlikowske, Karla AI may represent a new tool in the risk assessment and screening pathway of breast cancer. To realise its potential, the effect of AI-supported decisions on relevant clinical outcomes must be prospectively evaluated.