Biennial CEM in Women With a Personal History of Breast Cancer
Study Details
Study Description
Brief Summary
This is a prospective clinical trial that will examine if biennial contrast-enhanced mammography added to annual 3D mammography (tomosynthesis) substantially improves breast cancer detection with minimal increase in false-positives, in women with a personal history of breast cancer.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
The investigators seek to determine if improved breast cancer detection is maintained with biennial contrast-enhanced mammography (CEM) added to annual digital breast tomosynthesis (DBT) with overall fewer false positives than from annual DBT plus CEM. The investigators will offer biennial CEM exams for eligible patients. Enrolled participants will have a baseline CEM exam with their routine DBT exam, and then have another CEM exam 24 months after their baseline CEM exam and then again at 48 months. Participants will continue to have their annual DBT exams during this time as a part of their usual care. Two radiologists (one primary) will evaluate each pair of examinations by sequentially interpreting each of DBT and CEM in opposing order (primary reader DBT then CEM and secondary reader CEM then DBT), initially blinded to the other modality. We expect that with biennial screening, at least a similar number of cancers will be detected with CEM (and possibly more that were occult on the DBT-only screen 12 months prior), with a similar incremental false-positive rate and at least similar (if not improved) overall PPV1.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: contrast-enhanced mammography Enrolled participants will receive a baseline contrast-enhanced mammography exam for breast cancer screening, along with their scheduled 3D mammography exam, then they will recieve another CEM exam for breast cancer screening at 24 months after their baseline CEM exam, and then again at 48 months. All the while, participants will still receive their annual 3D mammography exam as per their usual routine care. |
Device: contrast-enhanced mammography
Contrast-enhanced mammography (CEM) is a new FDA-approved exam that is similar to magnetic resonance imaging (MRI) in depicting breast cancers due to increased and leaky blood vessels. Contrast-enhanced mammography is used as an adjunct following mammography and/or ultrasound examinations to localize a known or suspected lesion.
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Outcome Measures
Primary Outcome Measures
- Incremental Cancer Detection Rate [at 24 months, 48 months, and 62 months]
CEM cancer detection rate for first observer vs usual care (annual DBT)
- False-positive recall rate [at 24 months, 48 months, and 62 months]
CEM false-positive findings for first observer vs usual care (annual DBT)
- Positive-predictive values [at 24 months, 48 months, and 62 months]
CEM positive-predictive values for first observer vs usual care (annual DBT)
Eligibility Criteria
Criteria
Inclusion Criteria:
- Asymptomatic women, ages 30-79, with a personal history of breast cancer who are at least one year out from any breast cancer surgery and/or treatment and are scheduled to have a routine annual mammogram with tomosynthesis (DBT).
Exclusion Criteria:
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Women with a history of prior moderate or severe iodinated contrast reaction [only those with a prior mild reaction that can be managed by pre-medication AND with and a strong desire to participate will be allowed to participate. However, among these women with a mild sensitivity, if they are allergic to Benadryl (one of the premedications), they will be excluded].
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Women with implant(s) in the breasts to be screened (as this creates artifacts and diagnostic performance of imaging in women with implants likely does not generalize to those without implants, and the sample size with implants would be too small to infer conclusions.
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Women who have had bilateral mastectomy
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Women with a history of kidney failure or estimated glomerular filtration rate (eGFR) < 45 mL/min
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Pregnancy or lactation
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Women actively being treated for cancer of any type with chemotherapy
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Having only one kidney
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Women with stage 4 metastasis to visceral areas or brain
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Women who have a screening breast MRI exam within 24 months prior to the current round of CEM.
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Women who had a CEM exam within the prior 23 months
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | UPMC Magee-Womens Imaging - Bethel Park | Bethel Park | Pennsylvania | United States | 15102 |
| 2 | UPMC Magee at the Lemieux Sports Complex | Cranberry Township | Pennsylvania | United States | 16066 |
| 3 | Magee Womancare Monroeville | Monroeville | Pennsylvania | United States | 15146 |
| 4 | Magee-Womens Hospital | Pittsburgh | Pennsylvania | United States | 15213 |
| 5 | UPMC West Mifflin Outpatient Center | West Mifflin | Pennsylvania | United States | 15236 |
Sponsors and Collaborators
- Wendie Berg
- Breast Cancer Research Foundation
Investigators
- Principal Investigator: Wendie Berg, MD, PhD, University of Pittsburgh
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- STUDY23080183