Breast Cancer Clinical and Population Health

Several studies will be performed (or are in progress) to generate new evidence to fill knowledge gaps regarding the comparative effect of tomosynthesis and mammography on screening outcomes in population screening, and specifically on interval cancer rates.

This MRFF-funded multi-project research program is using a combination of research methods to provide knowledge and best estimates of the comparative effectiveness and cost-effectiveness of the 3D-mammography technology, digital breast tomosynthesis (DBT), compared to other breast imaging, in population groups at increased risk of breast cancer (women with symptoms, family or personal history of breast cancer) including subgroups with dense breasts. Findings from this work will inform the Medical Services Advisory Committee and potentially underpin evidence-based policy decisions for Medicare Benefits Schedule items with regards to DBT.

This multi-institutional, multi-lead collaborative research has two inter-related broad components:

• NHMRC-funded investigation of the Ethical, Legal, and Societal Implications (ELSI) of using Artificial Intelligence (AI) in diagnostics (with a focus on breast cancer screening) led by Prof S. Carter
• NBCF-funded evaluation of the detection metrics of AI in mammography population screening led by Dr ML Marinovich. Several additional projects in this area are also being undertaken in collaboration with international teams in Europe and the US.

An evaluation of temporal changes in the epidemiology of metastatic breast cancer in an Australian cohort to define the risk of metastatic disease after an initial diagnosis of early breast cancer, and to investigate changes in metastatic breast cancer outcomes over time in the context of progressively improved therapeutics led by A/Prof SJ Lord.

The team is investigating the effect of pre- and peri-operative tests on newly diagnosed breast cancer patients to ensure these enhanced outcomes and do not cause harm. It includes original studies conducted with national and international collaborators, and evidence synthesis. An example is an ongoing MRFF-funded prospective trial of the effect of pre-operative MRI on clinical outcomes led by Prof C. Saunders, UWA.