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Breast CancerBCSC-ADVANCENCT02980848

Assessing Breast Density's Value in Imaging - A Comparative Effectiveness Study

An observational study of Breast Cancer, run by University of California, Davis at 7 sites in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This Breast Cancer Surveillance Consortium (BCSC) ADVANCE study is a large, observational pragmatic comparative effectiveness research study using high-quality, prospectively collected data from BCSC registries to generate evidence on how breast density should be integrated into decision making around breast cancer… Read more about this study

Who is it for?
Ages 18 to 89 years, women only
Conditions the study is for
Breast Cancer
What is being tested?
Screening digital mammography, Screening digital breast tomosynthesis and Screening breast magnetic resonance imaging
How many people
1,341,172 participants
Where
7 sitesUnited States
Study dates
Sep 2016to Feb 2022
How long will I take part?
3 Years
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 89 years
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Study population: This study will include women age 40-79 undergoing screening mammography (Aim 1) and women age ≥18 with a first breast cancer diagnosis (Aim 2). We will include women in the BCSC cohort with mammography from 2005-2017. BCSC participants are identified from seven BCSC breast imaging registries. The BCSC prospectively collects data during routine clinical practice through voluntary partnerships with radiology facilities. Women enter the BCSC cohort when they receive a breast-imaging exam at a participating facility.

Who may be able to join

  • Women aged 40-79 undergoing screening mammography from 2010-2017 for comparisons with tomosynthesis and 2005-2017 for comparison with breast MRI at a facility that participates in one of six BCSC breast imaging registries
  • Digital mammography exams performed for screening and performed with or without supplemental screening with digital breast tomosynthesis from 2010-2017 or breast MRI from 2005-2017, at a facility that participates in one of seven BCSC breast imaging registries, and in women who meet inclusion criteria.
  • Women aged 40-74 years undergoing screening mammography, with or without supplemental screening with digital breast tomosynthesis or breast MRI, at selected BCSC facilities
  • Women within 12 months of a digital screening mammogram with known breast density and no known breast cancer diagnosis
  • For MRI subgroup, we will include women with a screening MRI within the prior 24 months
  • Within strata defined by BCSC registry, breast density subgroup (dense vs. not dense), and race/ethnicity, women with supplemental screening with digital breast tomosynthesis or breast MRI will be matched to women without supplemental screening
Show all 29Show fewer
  • Aim 1 Focus Groups
  • Women age 40-74 years undergoing screening mammography, with or without supplemental screening (defined as digital breast tomosynthesis or breast MRI)
  • Women within 12 months post-most recent screening examination with known dense breasts from most recent screening mammogram and no known breast cancer diagnosis
  • Women who are able to speak English and can travel to a nearby location for a discussion
  • Subaim 1
  • Radiologists interpreting digital mammography and/or tomosynthesis for at least one year from 2010-2017 at a facility that participates in the BCSC
  • Digital mammography exams and digital breast tomosynthesis performed for screening and evaluated by a radiologist meeting inclusion criteria from 2010-2017
  • Women at least 18 years of age with a first breast cancer diagnosis (DCIS or invasive) from 2005-2017 for whom there was a mammogram performed within the year prior to breast cancer diagnosis at one of the participating BCSC registry facilities
  • Women for whom we have pathologically-confirmed breast cancer (DCIS or invasive) with a pathology or biopsy record related to the incident cancer diagnosis in the BCSC data
  • MRI and mammography examinations performed for pre-operative work-up from 2005-2017 at one of the participating BCSC registry facilities in women meeting eligibility criteria
  • Aim 2 Patient Reported Outcomes
  • Women at least 18 years of age with a first pathology-confirmed breast cancer diagnosis (DCIS or stage I-III invasive) within 6-18 months
  • Known breast density at the time of breast cancer diagnosis
  • Aim 2 Focus Groups
  • Women age ≥18 with a first breast cancer diagnosis (DCIS or stage I-III invasive cancer) within 1-5 years and after completion of active breast cancer treatment who have undergone mammography or MRI pre-operatively.
  • Women who are able to speak English and can travel to a nearby location for a discussion
  • COVID-19 Enhancement Focus Groups
  • Women age 18-74 who were due for breast imaging services during the COVID pandemic and have either canceled their appointment, delayed their appointment, or kept their appointment
  • Women who are able to speak English and can attend calls virtually through Zoom or over the phone
  • In addition, for focus groups with women who have prior breast cancer:
  • First breast cancer diagnosis (DCIS or stage I-III invasive cancer) within 1-3 years prior to March, 2020.
  • Completed active cancer treatment (ongoing endocrine and Herceptin therapy acceptable)
  • No evidence of a second breast cancer event in cancer registry or pathology data before recruitment.

Who cannot join

  • Exams performed on women with a history of breast cancer, mastectomy, or breast augmentation.
  • Unilateral mammograms and mammograms performed within 9 months of a prior mammogram to avoid classifying diagnostic exams as screening
  • Exams without complete cancer capture during the follow-up period
  • Aim 1 Patient Reported Outcomes
  • Exams performed on women with a history of breast cancer, mastectomy, or breast augmentation
  • Unilateral mammograms and mammograms performed within 9 months of a prior mammogram to avoid classifying diagnostic exams as screening
  • Exams without complete cancer capture during one year following the screening mammogram
  • Aim 2 Clinical Outcomes

Trial locations and contacts

7 sites in 1 country.

7 sites in 1 country

United States7 sites
  • Vermont Breast Cancer Surveillance System

    Burlington, Vermont, 05405

  • Carolina Mammography Registry

    Chapel Hill, North Carolina, 27599

  • Metro Chicago Breast Cancer Registry

    Chicago, Illinois, 60607

  • Sacramento Area Breast Imaging Registry

    Davis, California, 95616

  • New Hampshire Mammography Network

    Lebanon, New Hampshire, 03755

  • San Francisco Mammography Registry

    San Francisco, California, 94143

  • Kaiser Permanente Washington Breast Cancer Surveillance Registry

    Seattle, Washington, 98101

Other trials in United States

About this study

Official title: Comparative Effectiveness of Breast Cancer Screening and Diagnostic Evaluation by Extent of Breast Density

This Breast Cancer Surveillance Consortium (BCSC) ADVANCE study is a large, observational pragmatic comparative effectiveness research study using high-quality, prospectively collected data from BCSC registries to generate evidence on how breast density should be integrated into decision making around breast cancer screening and preoperative diagnostic work-up. We will augment existing BCSC registry infrastructure with additional prospective data collection and collection of patient reported outcomes (PROs), CISNET modeling of long-term screening outcomes, and qualitative data from focus groups with women represented in two aims.

Read the detailed description

Aim 1: Compare the effectiveness of breast cancer screening using digital mammography alone versus digital mammography plus supplemental screening (digital breast tomosynthesis or MRI) by extent of breast density.

Sub aim 1: Evaluate whether the performance of tomosynthesis improves with years of experience, and whether any "learning curve" depends on radiologist specialty (i.e., breast imaging specialist vs. general radiologist).

Aim 2: Compare the effectiveness of preoperative MRI versus no MRI by extent of breast density among women with an initial, pathologically confirmed diagnosis of DCIS or invasive breast cancer.

Covid-19 Enhancement Aim and Hypotheses:

Develop patient-focused messaging content through focus groups that radiology facilities can use when scheduling appointments to inform women of the safety to schedule or postpone breast screening or diagnostic services.

Conditions
Breast Cancer
Being tested
Screening digital mammography, Screening digital breast tomosynthesis, Screening breast magnetic resonance imaging, Diagnostic mammography, Pre-operative breast magnetic resonance imaging
Keywords
digital mammography, digital breast tomosynthesis, breast magnetic resonance imaging, screening, breast density, breast imaging, pre-operative magnetic resonance imaging
Medical subject headings
Breast Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Screening digital mammographyOther

    Screening with digital mammography alone

  • Screening digital breast tomosynthesisOther

    Screening with digital mammography plus digital breast tomosynthesis

  • Screening breast magnetic resonance imagingOther

    Screening with digital mammography plus breast magnetic resonance imaging

  • Diagnostic mammographyOther

    Pre-operative diagnostic work-up with mammography alone

  • Pre-operative breast magnetic resonance imagingOther

    Pre-operative diagnostic work-up with mammography plus breast magnetic resonance imaging

Study groups in NCT02980848
Study groupRoleWhat they receive
Screening groupWomen without a history of breast cancer undergoing screening digital mammography, screening digital breast tomosynthesis, or screening breast magnetic resonance imaging.
Receives: Other: Screening digital mammography; Other: Screening digital breast tomosynthesis; Other: Screening breast magnetic resonance imaging
Women with breast cancerWomen diagnosed with stage 0-III breast cancer undergoing pre-operative work-up with diagnostic mammography alone or diagnostic mammography plus pre-operative breast magnetic resonance imaging.
Receives: Other: Diagnostic mammography; Other: Pre-operative breast magnetic resonance imaging

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Screening Benefits: Rate of early stage invasive cancer detection (Aim 1)

    Number of stage I or IIA cancers diagnosed within 1 year of a positive screen divided by total number of screens

    Measured: Within one year after screen

  2. Screening Failures: Interval or advanced breast cancer rate (Aim 1)

    Number of invasive cancer cases within 1 year of a negative screen divided by total number of screens

    Number of advanced cancers (stage IIB or higher) within 1 year of a screen divided by total number of screens

    Measured: Within one year after screen

  3. Screening Harms: Recall rate (Aim 1)

    Number of positive screens divided by total number of screens

    Measured: Within one year after screen

  4. Screening Harms: False-positive (FP) recall rate (Aim 1)

    Number of positive screens without a cancer diagnosed within 1 year divided by total number of screens

    Measured: Within one year after screen

  5. Screening Harms: FP biopsy recommendation rate (Aim 1)

    Number of screens with a biopsy recommendation and no cancer diagnosed within 1 year divided by total number of screens

    Measured: Within one year after screen

  6. Screening Harms: Other consequences (Aim 1)

    Number of DCIS diagnoses within 1 year of a positive screen divided by total number of screens, reported overall and by grade

    Measured: Within one year after screen

  7. Patient Reported Outcomes (Aim 1)

    Patient surveys targeted to determining outcomes of interest to patients

    Measured: Measured within one year post-screening

  8. Rates of additional breast cancers detected (Aim 2)

    Number of women with contralateral breast cancer diagnosed within 6 months of initial diagnosis over total number of women

    Measured: 6 months after initial diagnosis

  9. 3-year rate of 2nd breast cancer events (Aim 2)

    Rate of 2nd breast cancers diagnosed within 3 years of follow-up (starting 6 months after initial diagnosis) calculated separately for ipsilateral and contralateral cancers

    Measured: 3 years after initial diagnosis

  10. Patient Reported Outcomes (Aim 2)

    Patient surveys targeted to determining outcomes of interest to patients

    Measured: Measured 6-18 months post-diagnosis

Secondary outcomes (9)
  1. Performance Measures: Sensitivity (Aim 1)

    Number of cancer cases within 1 year of positive screen divided by number of breast cancer cases

    Measured: Within one year after screen

  2. Performance Measures: Specificity (Aim 1)

    Number of negative screens without cancer diagnosed within 1 year of screen divided by number of screens without breast cancer

    Measured: Within one year after screen

  3. Performance Measures: Positive predictive value (Aim 1)

    Number of cancer cases within 1 year of positive screen divided by number of positive screens

    Measured: Within one year after screen

  4. Definitive surgery type (Aim 2)

    Rates of unilateral mastectomy, or bilateral mastectomy, lumpectomy with reconstruction, lumpectomy without reconstruction

    Measured: 6 months after initial diagnosis

  5. Negative predictive value of work-up with MRI (Aim 2)

    Number of women with a negative pre-operative MRI and no additional cancers diagnosed within 6 months after initial diagnosis over the total number of women with a negative pre-operative MRI

    Measured: 6 months after initial diagnosis

  6. Negative predictive value of work-up without MRI (Aim 2)

    Number of women without a pre-operative MRI with no additional cancers diagnosed within 6 months after initial diagnosis over the total number of women without a pre-operative MRI

    Measured: 6 months after initial diagnosis

  7. Core biopsy rates (Aim 2)

    Number of core biopsies within 6 months of initial diagnosis over number of breast biopsies

    Measured: 6 months after initial diagnosis

  8. Surgical biopsy rate (Aim 2)

    Number of surgical biopsies within 6 months of initial diagnosis over number of breast biopsies

    Measured: 6 months after initial diagnosis

  9. Benign biopsy rate (Aim 2)

    Number of initial benign biopsies over number of breast biopsies

    Measured: 6 months after initial diagnosis

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Dec 2016 (estimated)
  2. Study startSep 2016
  3. Primary completionFeb 2022 (estimated)
  4. Study completionFeb 2022 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
1,341,172 participants (actual)
Target duration
3 Years
IDs, dates and publications
ClinicalTrials.gov ID
NCT02980848
Sponsor's protocol ID
941466
Other IDs
PCS-1504-30370
Acronym
BCSC-ADVANCE
Status last verified
Nov 2021
First submitted
19 Nov 2016
Last updated
17 Nov 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Please visit http://www.bcsc-research.org for information about requesting BCSC data.

Publications

  • Smith RE, Sprague BL, Henderson LM, Kerlikowske K, Miglioretti DL, Wernli KJ, Onega T, diFlorio-Alexander RM, Tosteson ANA. Breast density knowledge and willingness to delay treatment for pre-operative breast cancer imaging among women with a personal history of breast cancer. Breast Cancer Res. 2024 Apr 29;26(1):73. doi: 10.1186/s13058-024-01820-x.

    PubMed 38685119
  • Tosteson ANA, Schifferdecker KE, Smith RE, Wernli KJ, Zhao W, Kaplan CP, Buist DSM, Henderson LM, Sprague BL, Onega T, Budesky J, Jackson-Nefertiti G, Johnson D, Miglioretti DL, Kerlikowske K. Women's Breast Cancer Screening Confidence by Screening Modality and Breast Density: A Breast Cancer Surveillance Consortium Survey Study. J Womens Health (Larchmt). 2022 Nov;31(11):1547-1556. doi: 10.1089/jwh.2021.0649.

    PubMed 36356184
  • Onega T, Zhu W, Kerlikowske K, Miglioretti DL, Lee CI, Henderson LM, Tosteson ANA, Wernli KJ, diFlorio R, Weaver DL, Buist DSM. Preoperative MRI in breast cancer: effect of breast density on biopsy rate and yield. Breast Cancer Res Treat. 2022 Jan;191(1):177-190. doi: 10.1007/s10549-021-06418-x. Epub 2021 Oct 22.

    PubMed 34686934

Questions about this trial

What is this clinical trial studying?

An observational study of Breast Cancer, run by University of California, Davis at 7 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 29 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 17 Nov 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Screening Benefits: Rate of early stage invasive cancer detection (Aim 1) (time frame: Within one year after screen). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02980848, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Nov 2021.

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