Staff Profile

@article{Sprague2021a,

title = {Changes in Mammography Use by Women's Characteristics During the First 5 Months of the COVID-19 Pandemic.},

author = {Brian L. Sprague and Kathryn Lowry and Diana L. Miglioretti and Nila Alsheik and Erin J. A. Bowles and Anna N. A. Tosteson and Garth Rauscher and Sally D. Herschorn and Janie Lee and Amy Trentham-Dietz and Davis Weaver and Natasha K. Stout and Karla Kerlikowske},

url = {https://pubmed.ncbi.nlm.nih.gov/33778894/},

doi = {10.1093/jnci/djab045},

issn = {1460-2105},

year  = {2021},

date = {2021-09-01},

journal = {Journal of the National Cancer Institute},

volume = {113},

pages = {1161--1167},

abstract = {The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics. We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic stratified by age, race and ethnicity, breast density, and family history of breast cancer. Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of the April 2019 prepandemic volumes, respectively, but by July 2020 had rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of the July 2019 prepandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of the July 2019 prepandemic volume, respectively. Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women, and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lee2021,

title = {Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016.},

author = {Janie Lee and Laura E Ichikawa and Karen J Wernli and Erin Bowles and Jennifer M Specht and Karla Kerlikowske and Diana L Miglioretti and Kathryn Lowry and Anna N A Tosteson and Natasha K Stout and Nehmat Houssami and Tracy Onega and Diana S M Buist},

url = {https://pubmed.ncbi.nlm.nih.gov/34003059/},

doi = {10.1148/radiol.2021204581},

issn = {1527-1315},

year  = {2021},

date = {2021-08-01},

journal = {Radiology},

volume = {300},

number = {2},

pages = {290-300},

abstract = {Background Since 2007, digital mammography and digital breast tomosynthesis (DBT) replaced screen-film mammography. Whether these technologic advances have improved diagnostic performance has, to the knowledge of the authors, not yet been established. Purpose To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. Materials and Methods In this observational cohort study, five Breast Cancer Surveillance Consortium registries provided prospectively collected mammography data linked with tumor registry and pathologic outcomes. This study identified asymptomatic women with American Joint Committee on Cancer anatomic stages 0-III primary breast cancer who underwent surveillance mammography from 2007 to 2016. The primary outcome was a second breast cancer diagnosis within 1 year of mammography. Performance measures included the recall rate, cancer detection rate, interval cancer rate, positive predictive value of biopsy recommendation, sensitivity, and specificity. Results Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. Conclusion In transitioning from screen-film to digital mammography and digital breast tomosynthesis, surveillance mammography performance demonstrated minimal improvement over time and remained inferior to the performance of screening mammography benchmarks. © RSNA, 2021 See also the editorial by Moy and Gao in this issue.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lowry2020,

title = {Screening Performance of Digital Breast Tomosynthesis vs Digital Mammography in Community Practice by Patient Age, Screening Round, and Breast Density.},

author = {Kathryn Lowry and Rebecca Yates Coley and Diana L. Miglioretti and Karla Kerlikowske and Louise M. Henderson and Tracy Onega and Brian L. Sprague and Janie Lee and Sally Herschorn and Anna N. A. Tosteson and Garth Rauscher and Christoph I. Lee},

url = {https://pubmed.ncbi.nlm.nih.gov/32721031/},

doi = {10.1001/jamanetworkopen.2020.11792},

issn = {2574-3805},

year  = {2020},

date = {2020-07-01},

journal = {JAMA network open},

volume = {3},

pages = {e2011792},

abstract = {Digital mammography (DM) and digital breast tomosynthesis (DBT) are used for routine breast cancer screening. There is minimal evidence on performance outcomes by age, screening round, and breast density in community practice. To compare DM vs DBT performance by age, baseline vs subsequent screening round, and breast density category. This comparative effectiveness study assessed 1 584 079 screening examinations of women aged 40 to 79 years without prior history of breast cancer, mastectomy, or breast augmentation undergoing screening mammography at 46 participating Breast Cancer Surveillance Consortium facilities from January 2010 to April 2018. Age, Breast Imaging Reporting and Data System breast density category, screening round, and modality. Absolute rates and relative risks (RRs) of screening recall and cancer detection. Of 1 273 492 DM and 310 587 DBT examinations analyzed, 1 028 891 examinations (65.0%) were of white non-Hispanic women; 399 952 women (25.2%) were younger than 50 years; and 671 136 women (42.4%) had heterogeneously dense or extremely dense breasts. Adjusted differences in DM vs DBT performance were largest on baseline examinations: for example, per 1000 baseline examinations in women ages 50 to 59, recall rates decreased from 241 examinations for DM to 204 examinations for DBT (RR, 0.84; 95% CI, 0.73-0.98), and cancer detection rates increased from 5.9 with DM to 8.8 with DBT (RR, 1.50; 95% CI, 1.10-2.08). On subsequent examinations, women aged 40 to 79 years with heterogeneously dense breasts had improved recall rates and improved cancer detection with DBT. For example, per 1000 examinations in women aged 50 to 59 years, the number of recall examinations decreased from 102 with DM to 93 with DBT (RR, 0.91; 95% CI, 0.84-0.98), and cancer detection increased from 3.7 with DM to 5.3 with DBT (RR, 1.42; 95% CI, 1.23-1.64). Women aged 50 to 79 years with scattered fibroglandular density also had improved recall and cancer detection rates with DBT. Women aged 40 to 49 years with scattered fibroglandular density and women aged 50 to 79 years with almost entirely fatty breasts benefited from improved recall rates without change in cancer detection rates. No improvements in recall or cancer detection rates were observed in women with extremely dense breasts on subsequent examinations for any age group. This study found that improvements in recall and cancer detection rates with DBT were greatest on baseline mammograms. On subsequent screening mammograms, the benefits of DBT varied by age and breast density. Women with extremely dense breasts did not benefit from improved recall or cancer detection with DBT on subsequent screening rounds.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bahl2020,

title = {Breast Cancer Screening with Digital Breast Tomosynthesis: Are Initial Benefits Sustained?},

author = {Manisha Bahl and Sarah Fletcher Mercaldo and Pragya A. Dang and Anne Marie McCarthy and Kathryn Lowry and Constance D. Lehman},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32255414},

doi = {10.1148/radiol.2020191030},

issn = {1527-1315},

year  = {2020},

date = {2020-04-01},

journal = {Radiology},

pages = {191030},

abstract = {Background Performance metrics with digital breast tomosynthesis (DBT) are based on early experiences. There is limited research on whether the benefits of DBT are sustained. Purpose To determine whether improved screening performance metrics with DBT are sustained over time at the population level and after the first screening round at the individual level. Materials and Methods A retrospective review was conducted of screening mammograms that had been obtained before DBT implementation (March 2008 to February 2011, two-dimensional digital mammography [DM] group) and for 5 years after implementation (January 2013 to December 2017, DBT1-DBT5 groups, respectively). Patients who underwent DBT were also categorized according to the number of previous DBT examinations they had undergone. Performance metrics were compared between DM and DBT groups and between patients with no previous DBT examinations and those with at least one prior DBT examination by using multivariable logistic regression models. Results The DM group consisted of 99 582 DM examinations in 55 086 women (mean age, 57.3 years ± 11.6 [standard deviation]). The DBT group consisted of 205 048 examinations in 76 276 women (mean age, 58.2 years ± 11.2). There were no differences in the cancer detection rate (CDR) between DM and DBT groups (4.6-5.8 per 1000 examinations, = .08 to = .95). The highest CDR was observed with a woman's first DBT examination (6.1 per 1000 examinations vs 4.4-5.7 per 1000 examinations with at least one prior DBT examination, = .001 to = .054). Compared with the DM group, the DBT1 group had a lower abnormal interpretation rate (AIR) (adjusted odds ratio [AOR], 0.85; \< .001), which remained reduced in the DBT2, DBT3, and DBT5 groups ( \< .001 to = .02). The reduction in AIR was also sustained after the first examination ( \< .001 to = .002). Compared with the DM group, the DBT1 group had a higher specificity (AOR, 1.20; \< .001), which remained increased in DBT2, DBT3, and DBT5 groups ( \< .001 to = .004). The increase in specificity was also sustained after the first examination ( \< .001 to = .01). Conclusion The benefits of reduced false-positive examinations and higher specificity with screening tomosynthesis were sustained after the first screening round at the individual level. © RSNA, 2020 See also the editorial by Taourel in this issue.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{JLee2020,

title = {Breast cancer risk, worry, and anxiety: Effect on patient perceptions of false-positive screening results.},

author = {Janie Lee and Kathryn Lowry and Jessica Cott Chubiz and J. Shannon Swan and Tina Motazedi and Elkan F. Halpern and Anna N A Tosteson and G. Scott Gazelle and Karen Donelan},

url = {https://www.ncbi.nlm.nih.gov/pubmed/32135458},

doi = {10.1016/j.breast.2020.02.004},

issn = {1532-3080},

year  = {2020},

date = {2020-04-01},

journal = {Breast (Edinburgh, Scotland)},

volume = {50},

pages = {104--112},

abstract = {The impact of mammography screening recall on quality-of-life (QOL) has been studied in women at average risk for breast cancer, but it is unknown whether these effects differ by breast cancer risk level. We used a vignette-based survey to evaluate how women across the spectrum of breast cancer risk perceive the experience of screening recall. Women participating in mammography or breast MRI screening were recruited to complete a vignette-based survey. Using a numerical rating scale (0-100), women rated QOL for hypothetical scenarios of screening recall, both before and after benign results were known. Lifetime breast cancer risk was calculated using Gail and BRCAPRO risk models. Risk perception, trait anxiety, and breast cancer worry were assessed using validated instruments. The final study cohort included 162 women at low (n = 43, 26%), intermediate (n = 66, 41%), and high-risk (n = 53, 33%). Actual breast cancer risk was not a predictor of QOL for any of the presented scenarios. Across all risk levels, QOL ratings were significantly lower for the period during diagnostic uncertainty compared to after benign results were known (p 0.05). In multivariable regression analyses, breast cancer worry was a significant predictor of decreased QoL for all screening scenarios while awaiting results, including scenarios with non-invasive imaging alone or with biopsy. High trait anxiety and family history predicted lower QOL scores after receipt of benign test results (p 0.05). Women with high trait anxiety and family history may particularly benefit from discussions about the risk of recall when choosing a screening regimen.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lowry2018,

title = {Predictors of surveillance mammography outcomes in women with a personal history of breast cancer.},

author = {Kathryn Lowry and Lior Z Braunstein and Konstantinos Economopoulos and Laura Salama and Constance D Lehman and G. Scott Gazelle and Elkan F. Halpern and Catherine S Giess and Alphonse G Taghian and Janie Lee},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29748762},

doi = {10.1007/s10549-018-4808-9},

issn = {1573-7217},

year  = {2018},

date = {2018-08-01},

journal = {Breast cancer research and treatment},

volume = {171},

number = {1},

pages = {209-215},

abstract = {To identify predictors of poor mammography surveillance outcomes based on clinico-pathologic features. This study was HIPAA compliant and IRB approved. We performed an electronic medical record review for a cohort of women with American Joint Committee on Cancer (AJCC) Stage I or II invasive breast cancer treated with breast conservation therapy who developed subsequent in-breast treatment recurrence (IBTR) or contralateral breast cancer (CBC). Poor surveillance outcome was defined as second breast cancer not detected by surveillance mammography, including interval cancers (diagnosed within 365 days of surveillance mammogram with negative results) and clinically detected cancers (diagnosed without a surveillance mammogram in the preceding 365 days). Univariate and multivariate logistic regression were performed to identify predictors of poor mammography surveillance outcome, including patient and primary tumor characteristics, breast density, mode of primary tumor detection, and time to second cancer diagnosis. 164 women met inclusion criteria (65 with IBTR, 99 with CBC); 124 had screen-detected second cancers. On univariate analysis, poor surveillance outcome (n = 40) was associated with age at primary cancer diagnosis 50 years (p 0.0001), AJCC stage II primary cancers (p = 0.007), and heterogeneously or extremely dense breasts (p = 0.04). On multivariate analysis, age 50 years at primary breast cancer diagnosis remained a significant predictor of poor surveillance outcome (p = 0.001). Women younger than age 50 at primary breast cancer diagnosis are at risk of poor surveillance mammography outcomes, and may be appropriate candidates for more intensive clinical and imaging surveillance.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Women’sImaging:2017,

title = {ACR Appropriateness Criteria® Ovarian Cancer Screening},

author = {Pari Pandharipande and Kathryn Lowry and Caroline Reinhold and Mostafa Atri and Carol B Benson and Priyadarshani R Bhosale and Edward D Green and Stella K Kang and Yulia Lakhman and Katherine E Maturen and Refky Nicola and Gloria M Salazar and Thomas D Shipp and Lynn Simpson and Betsy L Sussman and Jennifer Uyeda and Darci J Wall and Bradford Whitcomb and Carolyn M Zelop and Phyllis Glanc},

url = {http://www.ncbi.nlm.nih.gov/pubmed/29101987},

doi = {10.1016/j.jacr.2017.08.049},

issn = {1558-349X},

year  = {2017},

date = {2017-11-01},

urldate = {2017-11-01},

journal = {Journal of the American College of Radiology : JACR},

volume = {14},

number = {11S},

pages = {S490--S499},

abstract = {There has been much interest in the identification of a successful ovarian cancer screening test, in particular, one that can detect ovarian cancer at an early stage and improve survival. We reviewed the currently available data from randomized and observational trials that examine the role of imaging for ovarian cancer screening in average-risk and high-risk women. We found insufficient evidence to recommend ovarian cancer screening, when considering the imaging modality (pelvic ultrasound) and population (average-risk postmenopausal women) for which there is the greatest available published evidence; randomized controlled trials have not demonstrated a mortality benefit in this setting. Screening high-risk women using pelvic ultrasound may be appropriate in some clinical situations; however, related data are limited because large, randomized trials have not been performed in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lowry2015a,

title = {Projected Effects of Radiation-Induced Cancers on Life Expectancy in Patients Undergoing CT Surveillance for Limited-Stage Hodgkin Lymphoma: A Markov Model},

author = {Kathryn Lowry and Ekin Turan and Jonathan Eisenberg and Chung Yin Kong and Jeffrey A. Barnes and Pari Pandharipande},

url = {http://www.ncbi.nlm.nih.gov/pubmed/26001232},

doi = {10.2214/AJR.14.13287},

year  = {2015},

date = {2015-06-01},

urldate = {2015-06-01},

journal = {AJR Am J Roentgenol},

volume = {204},

number = {6},

pages = {1228--33},

institution = {1 Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114.},

abstract = {Patients with limited-stage Hodgkin lymphoma (HL) undergo frequent posttreatment surveillance CT examinations, raising concerns about the cumulative magnitude of radiation exposure. The purpose of this study was to project radiation-induced cancer risks relative to competing risks of HL and account for the differential timing of each.We adapted a previously developed Markov model to project lifetime mortality risks and life expectancy losses due to HL versus radiation-induced cancers in HL patients undergoing surveillance CT. In the base case, we modeled 35-year-old men and women undergoing seven CT examinations of the chest, abdomen, and pelvis over 5 years. Radiation-induced cancer risks and deaths for 17 organ systems were modeled using an organ-specific approach, accounting for specific anatomy exposed at CT. Cohorts of 20-, 50-, and 65-year-old men and women were evaluated in secondary analyses. Markov chain Monte Carlo methods were used to estimate the uncertainty of radiation risk projections.For 35-year-old adults, we projected 3324/100,000 (men) and 3345/100,000 (women) deaths from recurrent lymphoma and 245/100,000 (men, 95% uncertainty interval [UI]: 121-369) and 317/100,000 (women, 95% UI: 202-432) radiation-induced cancer deaths. Discrepancies in life expectancy losses between HL (428 days in men, 482 days in women) and radiation-induced cancers (11.6 days in men, [95% UI: 5.7-17.5], 15.6 days in women [95% UI: 9.8-21.4]) were proportionately greater because of the delayed timing of radiation-induced cancers relative to recurrent HL. Deaths and life expectancy losses from radiation-induced cancers were highest in the youngest cohorts.Given the low rate of radiation-induced cancer deaths associated with CT surveillance, modest CT benefits would justify its use in patients with limited-stage HL.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lowry2015,

title = {Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis},

author = {Kathryn Lowry and G. Scott Gazelle and Michael Gilmore and Colden Johanson and Vidit Munshi and Sung Eun Choi and Angela Tramontano and Chung Yin Kong and Pamela M. McMahon},

url = {http://www.ncbi.nlm.nih.gov/pubmed/25652107},

doi = {10.1002/cncr.29225},

year  = {2015},

date = {2015-05-01},

journal = {Cancer},

volume = {121},

number = {10},

pages = {1556-62},

institution = {Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts.},

abstract = {Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds.We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy.Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility.Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population. Cancer 2015. © 2015 American Cancer Society.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{CottChubiz2013,

title = {Cost-effectiveness of alternating magnetic resonance imaging and	digital mammography screening in BRCA1 and BRCA2 gene mutation carriers},

author = {Jessica Cott Chubiz and Janie Lee and Michael Gilmore and Chung Yin Kong and Kathryn Lowry and Elkan F. Halpern and Pamela M. McMahon and Paula D. Ryan and G. Scott Gazelle},

url = {http://www.ncbi.nlm.nih.gov/pubmed/23184400},

doi = {10.1002/cncr.27864},

year  = {2013},

date = {2013-03-01},

journal = {Cancer},

volume = {119},

number = {6},

pages = {1266--1276},

institution = {Institute for Technology Assessment, Massachusetts General Hospital, 

	Boston, Massachusetts.},

abstract = {Current clinical guidelines recommend earlier, more intensive breast 

	cancer screening with both magnetic resonance imaging (MRI) and mammography 

	for women with breast cancer susceptibility gene (BRCA) mutations. 

	Unspecified details of screening schedules are a challenge for implementing 

	guidelines.A Markov Monte Carlo computer model was used to simulate 

	screening in asymptomatic women who were BRCA1 and BRCA2 mutation 

	carriers. Three dual-modality strategies were compared with digital 

	mammography (DM) alone: 1) DM and MRI alternating at 6-month intervals 

	beginning at age 25 years (Alt25), 2) annual MRI beginning at age 

	25 years with alternating DM added at age 30 years (MRI25/Alt30), 

	and 3) DM and MRI alternating at 6-month intervals beginning at age 

	30 years (Alt30). Primary outcomes were quality-adjusted life years 

	(QALYs), lifetime costs (in 2010 US dollars), and incremental cost-effectiveness 

	(dollars per QALY gained). Additional outcomes included potential 

	harms of screening, and lifetime costs stratified into component 

	categories (screening and diagnosis, treatment, mortality, and patient 

	time costs).All 3 dual-modality screening strategies increased QALYs 

	and costs. Alt30 screening had the lowest incremental costs per additional 

	QALY gained (BRCA1, $74,200 per QALY; BRCA2, $215,700 per QALY). 

	False-positive test results increased substantially with dual-modality 

	screening and occurred more frequently in BRCA2 carriers. Downstream 

	savings in both breast cancer treatment and mortality costs were 

	outweighed by increases in up-front screening and diagnosis costs. 

	The results were influenced most by estimates of breast cancer risk 

	and MRI costs.Alternating MRI and DM screening at 6-month intervals 

	beginning at age 30 years was identified as a clinically effective 

	approach to applying current guidelines, and was more cost-effective 

	in BRCA1 gene mutation carriers compared with BRCA2 gene mutation 

	carriers. Cancer 2013. © 2012 American Cancer Society.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}