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Source publication
To assess the acceptability of new non-invasive breast cancer diagnostic tests intended to triage women in need of biopsy.
Women who had abnormal screening tests and had been recommended to have a biopsy were invited to receive digital mammography, magnetic resonance imaging (MRI), and nuclear medicine evaluation (Tc-99m-sestamibi scanning) before...
Context in source publication
Similar publications
Background:
Overflow breast disease (OBD), also known as breast nipple discharge, refers fluid or liquid that comes out of nipple. Many patients with breast cancer experience such condition. However, it is not easy to detect it at early stage, especially for pathological OBD. Previous study found low-dose CT combined mammography (LDCTMG) could hel...
Citations
... Although the former one often indicates the need for a 6-month follow-up visit, anxiety related to uncertainty usually leads to biopsy. It is well known how the biopsy procedure afflict the patients psychologically and even sometimes financially, and in order to lessen these unnecessary costs, better differentiation between benign and malignant pathologies is required [5,6]. Breast imaging using the dynamic contrast-enhanced MRI (DCE-MRI) had been introduced and has become an important tool in the workup of breast lesions. ...
Background
We aimed to evaluate the unenhanced MRI of the breast (UE-MRI) as an effective substitute for dynamic contrast-enhanced breast MRI (DCE-MRI) in both detecting and characterizing breast lesions. We enrolled in our retrospective study 125 females (232 breasts, as 18 patients had unilateral mastectomy) with breast mass at MRI of variable pathologies. Routine DCE-MRI protocol of the breast was conducted. We compared the conventional unenhanced images including STIR, T2, and DWIs to the DCE-MRI by two blinded radiologists, to detect and characterize breast lesions, and then we compared their results with the final reference diagnoses supplied by the histopathology or serial negative follow-ups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for UE-MRI and DCE-MRI were calculated. UE-MRI results of each observer were also compared with DCE- MRI.
Results
The calculated UE-MRI sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for the first observer were 95%, 80%, 83%, 94%, and 89% respectively, and for the second observer, they were 94%, 79%, 81%, 93%, and 86%. On the other hand, those for the DCE-MRI by the first observer were 98%, 82%, 84%, 98%, and 90% and were 97%, 81%, 84%, 97%, and 89% by the second observer. The intraobserver agreement between the UE-MRI and DCE-MRI results of each observer was 94% and 95%, while the interobserver agreement for each section was 97.4% for UE-MRI and 98.3% for DCE-MRI.
Conclusion
UE-MRI of the breast can be a reliable and effective substitute for breast DCE-MRI. It can be used with comparable accuracy to DCE-MRI whenever contrast administration is not feasible or contraindicated.
... carried out. With over 1 million biopsies performed each year in the United States costing on average between $290 and $380 each [4], and 80% resulting in benign diagnosis [5] [6], it is clear that this presents an unacceptable and unnecessary burden on the secondary care system. ...
Objective: This paper presents a novel soft tissue elasticity measurement technique based on the fusion of Magnetic, Angular Rate, and Gravity (MARG) sensors and fixed tactile sensors. This work is intended both as a stand-alone technology, and as an extension of traditional tactile imaging of the breast to allow for accurate diagnosis of breast lesions. Methods: A series of artificial silicone materials known to imitate soft biological breast tissues are characterised using the proposed system and compared against an Instron® universal testing machine to determine system accuracy and repeatability. Results: Comparing the characteristics of 10 distinct materials, with elasticities in the range 9kPa to 90kPa, determined by the proposed system to those from the Instron® yields accuracy within 4% over the full-scale range. Interexperimental repeatability is within 1.5%. Conclusion: The proposed system delivers absolute elasticity of materials to within 4% which, when combined with its lack of moving parts and low implementation cost, can significantly improve the diagnostic capability of tactile imaging in the clinical environment. Significance: By applying this technique, to determine the background elasticity of breast tissue, in conjunction with the relative lesion elasticity result from tactile arrays, the full non-invasive diagnostic potential of tactile imaging can be realised with the effect of reducing benign biopsy rates, secondary care costs, and patient stress.
... Improved specificity could diminish distress as a result of false-positive (mammographic) result. Biomarkers detectable in body fluids could be valuable as this allows for minimally invasive screening and repetitive monitoring [4]. ...
Background
MicroRNAs (miRs) are small RNA molecules, influencing messenger RNA (mRNA) expression and translation, and are readily detectable in blood. Some have been reported as potential breast cancer biomarkers. This study aimed to identify and validate miRs indicative of breast cancer.
Results
Based on the discovery and literature, 18 potentially informative miRs were quantified in the validation cohort. Irrespective of patient and tumour characteristics, hsa-miR-652-5p was significantly upregulated in the malignant compared to benign patients (1.26 fold, P = 0.005) and therefore validated as potential biomarker. In the validation cohort literature-based hsa-let-7b levels were higher in malignant patients as well (1.53 fold, P = 0.011). Two miRs differentiated benign wildtype from benign BRCA1 mutation carriers and an additional 8 miRs differentiated metastastic (n = 8) from non-metastatic (n = 41) cases in the validation cohort.
Methods
Pre-treatment plasma samples were collected of patients with benign breast disease and breast cancer and divided over a discovery (n = 31) and validation (n = 84) cohort. From the discovery cohort miRs differentially expressed between benign and malignant cases were identified using a 2,000-miR microarray. Literature-based miRs differentiating benign from malignant disease were added. Using RT-qPCR, their expression was investigated in a validation cohort consisting of pre-treatment benign, malignant and metastatic samples. Additionally, benign and malignant cases were compared to benign and malignant cases of BRCA1-mutation carriers.
Conclusions
Plasma microRNA levels differed between patients with and without breast cancer, between benign disease from wildtype and BRCA1-mutation carriers and between breast cancer with and without metastases. Hsa-miR-652-5p was validated as a potential biomarker for breast cancer.
... Following a literature review of factors affecting the perceived acceptability of health interventions, four factors that contribute to the perceived acceptability of health interventions were identified. These were comfort during the health intervention [11,12], the intervention Volunteer trials of a novel improvised dry decontamination protocol being quick to undertake [13], the intervention being easy to undertake [13,14], and the intervention being perceived as effective [12]. From these four identified factors, five questionnaire items designed to measure perceived acceptability were developed, as follows: two items measured how comfortable participants felt using the dry decontamination product (e.g. ...
... Following a literature review of factors affecting the perceived acceptability of health interventions, four factors that contribute to the perceived acceptability of health interventions were identified. These were comfort during the health intervention [11,12], the intervention Volunteer trials of a novel improvised dry decontamination protocol being quick to undertake [13], the intervention being easy to undertake [13,14], and the intervention being perceived as effective [12]. From these four identified factors, five questionnaire items designed to measure perceived acceptability were developed, as follows: two items measured how comfortable participants felt using the dry decontamination product (e.g. ...
Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely.
... identifying relevant attributes and levels from the literature Because no studies from low-income countries have explored breast cancer detection preferences, we relied on studies from high-income countries, which examined characteristics of mammography screening services. 25 32 but none about CBE. We identified common conceptual domains, including attributes about the invitation or reminder to participate in screening, convenience, facility setting, privacy, accuracy and frequency of the intervention, and how results were relayed. ...
Background
In Malawi, routine breast cancer screening is not available and little is known about women’s preferences regarding early detection services. Discrete choice experiments are increasingly used to reveal preferences about new health services; however, selecting appropriate attributes that describe a new health service is imperative to ensure validity of the choice experiment.
Objective
To identify important factors that are relevant to Malawian women’s preferences for breast cancer detection services and to select attributes and levels for a discrete choice experiment in a setting where both breast cancer early detection and choice experiments are rare.
Methods
We reviewed the literature to establish an initial list of potential attributes and levels for a discrete choice experiment and conducted qualitative interviews with health workers and community women to explore relevant local factors affecting decisions to use cancer detection services. We tested the design through cognitive interviews and refined the levels, descriptions, and designs.
Results
Themes that emerged from interviews provided critical information about breast cancer detection services, specifically, that breast cancer interventions should be integrated into other health services because asymptomatic screening may not be practical as an individual service. Based on participants’ responses, the final attributes of the choice experiment included travel time, health encounter, health worker type and sex, and breast cancer early detection strategy. Cognitive testing confirmed the acceptability of the final attributes, comprehension of choice tasks, and women’s abilities to make trade-offs.
Conclusion
Applying a discrete choice experiment for breast cancer early detection was feasible with appropriate tailoring for a low-income, low-literacy African setting.
... . The development, content, and administration of each measure are described below. Q U E S T I O N N A I R E S While patients have made direct comparisons of different diagnostic procedures in previous studies (Liang et al., 2003; Sparrow et al., 2004 ...
Positron emission tomography (PET) and single photon emission computed tomography (SPECT) brain imaging are widely used as diagnostic tools for suspected dementia but no studies have directly compared participant views of the two procedures. We used a range of methods to explore preferences for PET and SPECT.
Patients and controls (and accompanying carers) completed questionnaires immediately after undergoing PET and SPECT brain scans. Pulse rate data were collected during each scan. Scan attributes were prioritized using a card sorting exercise; carers and controls additionally answered willingness to pay (WTP) questions.
Few differences were found either between the scans or groups of participants, although carers marginally preferred SPECT. Diagnostic accuracy was prioritized over other scan characteristics. Mean heart rate during both scans was lower than baseline heart rate measured at home (p < 0.001).
Most participants viewed PET and SPECT scans as roughly equivalent and did not have a preference for either scan. Carer preference for SPECT is likely to reflect their desire to be with the patient (routine practice for SPECT but not for PET), suggesting that they should be able to accompany vulnerable patients throughout imaging procedures wherever possible. Pulse rate data indicated that brain imaging was no more stressful than a home visit (HV) from a researcher. The data do not support the anecdotal view that PET is a more burdensome procedure and the use of PET or SPECT scans in dementia should be based on diagnostic accuracy of the technique.
... While risk perception was associated with increased WTP values, it was less clear whether WTP values were influenced by prior test results or prior disease status. For example, Liang et al. [56] reported that women who had prior benign breast diseases were less willing to pay for a test with 95% accuracy than were women without the history. In contrast, Stephens et al. [45] found that while most women (135 of 150 eligible subjects) wanted a prenatal sonogram during pregnancy, their WTP values and the number of sonograms they desired did not vary by prior pregnancy. ...
... One study showed that although parents generally had a high tolerance for false-positive newborn screening results, the median WTP values to avoid a false-positive screening result were significantly lower for parents whose child had experienced a false-positive screening result ($0) than for parents of children with normal screening results ($100) (P o 0.001) [28]. Liang et al. [56] found that women were willing to pay an average of $611 to have a new noninvasive breast cancer diagnostic test instead of a biopsy if the test was as accurate as biopsy; however, WTP values decreased to $308 if the test had only 95% accuracy. In a survey of 175 female patients, Raab et al. [37] estimated an increased median WTP from $50 to $100 as the performance of a new Papanicolaou test increased, regardless of their perceived risk of cervical cancer. ...
... At the disease level, more severe conditions and diseases without a controllable risk factor, such as some cancers and congenital abnormalities, are associated with higher WTP estimates; colon cancer diagnosis [21,22,[24][25][26]50,[60][61][62] and perinatal screening [28,29,35,[63][64][65] are examples. Further, at the technology level, more accurate tests tend to have higher WTP estimates [6,56,60,66], suggesting that they are perceived as having more use for medical decision making and perhaps for greater reductions in diagnostic uncertainty. ...
To understand how people value information from diagnostic technologies, we reviewed and analyzed published willingness-to-pay (WTP) studies on the topic.
We searched PubMed for English-language articles related to WTP for diagnostic laboratory tests published from 1985 through 2011. We characterized methodological differences across studies, examined individual- and technology-level factors associated with WTP, and summarized median WTP values across different diagnostic tests.
We identified 66 relevant WTP studies. Half focused on oncology, while others analyzed infectious diseases (n = 11, 16.1%) and obstetric or gynecological conditions (n = 8, 11.7%), among others. Most laboratory tests included in studies were biological samples/genetic testing (n = 44, 61.1%) or imaging tests (n = 23, 31.9%). Approximately one third of the analyses (n = 20, 30.3%) used discrete-choice questions to elicit WTP values. Higher income, education, disease severity, perceived disease risk, family history, and more accurate tests were in general associated with higher WTP values for diagnostic information. Of the 44 studies with median WTP values available, most reported a median WTP value below $100. The median WTP value for colon or colorectal cancer screening ranged from below $100 to over $1000.
The contingent valuation literature in diagnostics has grown rapidly, and suggests that many respondents place considerable value on diagnostic information. There exists, however, great variation in studies with respect to the type of technologies and diseases assessed, respondent characteristics, and study methodology. The perceived value of diagnostic technologies is also influenced by the study design and elicitation methods.
... Another way of increasing the cost-effectiveness is enhancing diagnostic efficacy of screening that would lead to the higher rate of cancer detection. In the United States alone, more than one million breast biopsies are performed annually following mammography findings, and approximately 80% of these findings are benign [24,40]. To evaluate possible impact of TBI supplementing standard screening procedures (mammography alone or combination of mammography and conventional ultrasound) on the benign biopsy rate, one could apply TBI cancer sensitivity and specificity to the patient sample referred for the breast biopsy (20% malignant and 80% benign). ...
... Several dozen WTP studies on a range of diagnostic and predictive tests have been published in a variety of clinical areas and modalities.(Appel et al. 1990;Berwick & Weinstein 1985;Brooks et al. 2005;Carlos et al. 2002;Caughey et al. 2004;Cho et al. 2000;Donaldson et al. 1995;Fauli & Thue 2008;Frew, Wolstenholme, & Whynes 2001;Hirth et al. 1999;Hirth et al. 2000;Lata, Binkley, & Elliott 2002;Liang et al. 2003;Miedzybrodzka et al. 1995;Mushlin et al. 1994b;Mushlin et al. 2005;Neumann et al. 2001;Papatheofanis 1998;Papatheofanis 2000;Phillips et al. 2006;Raab et al. 2002;Ryan et al. 2005;Salkeld et al. 2003;Schiffner et al. 2003;Shih et al. 2007;Tarasiuk et al. 2003;Wagner et al. 2001;Whynes, Frew, & Wolstenholme 2003;Wordsworth, Ryan, & Waugh 2001;Yasunaga et al. 2006a;Yasunaga et al. 2006b;Yasunaga et al. 2007;Yasunaga 2008) They have generally found that people have positive WTP for test information, even in the absence of treatment consequences. However, most of the studies relied on small convenience samples. ...
We assessed how much, if anything, people would pay for a laboratory test that predicted their future disease status. A questionnaire was administered via an internet-based survey to a random sample of adult US respondents. Each respondent answered questions about two different scenarios, each of which specified: one of four randomly selected diseases (Alzheimer's, arthritis, breast cancer, or prostate cancer); an ex ante risk of developing the disease (randomly designated 10 or 25%); and test accuracy (randomly designated perfect or 'not perfectly accurate'). Willingness-to-pay (WTP) was elicited with a double-bounded, dichotomous-choice approach. Of 1463 respondents who completed the survey, most (70-88%, depending on the scenario) were inclined to take the test. Inclination to take the test was lower for Alzheimer's and higher for prostate cancer compared with arthritis, and rose somewhat with disease prevalence and for the perfect versus imperfect test [Correction made here after initial online publication.]. Median WTP varied from $109 for the imperfect arthritis test to $263 for the perfect prostate cancer test. Respondents' preferences for predictive testing, even in the absence of direct treatment consequences, reflected health and non-health related factors, and suggests that conventional cost-effectiveness analyses may underestimate the value of testing.
... Among individuals at average risk for colorectal cancer, 54 per cent identified screening test accuracy as the most important test feature (Ling, Moskowitz, Wachs, Pearson, & Schroy, 2001). When women who had had abnormal mammography screening tests and had been advised to have a biopsy were offered another, noninvasive diagnostic procedure presented either as "accurate as a biopsy at diagnosing cancer" or as "nearly (95%) as accurate as biopsy" (a decrease of 5% accuracy from 100% to 95%), there was a 40 per cent decrease in willingness to pay for the alternative test, suggesting that women prefer to avoid false diagnosis at the cost of an uncomfortable but more accurate test (Liang et al., 2003). However, this study was not conducted in a screening situation and did not specify which types of diagnostic errors were included in the 5 per cent errors: FPs, FNs, or both. ...
Two studies investigated people's motivations for testing, and the influence of awareness of test inaccuracies, on their intentions to undergo cancer screening tests. Study 1 used a between-subjects design in which participants stated their intentions regarding one of several screening tests with equal accuracy but with either false negative, false positive, or unspecified errors. Study 2 used a within-subjects design in which participants indicated their intentions regarding each of those screening tests. In Study 1, intentions for testing were relatively high, affected by instrumental (illness prevention) motivations, and unaffected by type of error acknowledged. Individuals with higher emotional (reassurance seeking) motivations had lower intentions to uptake tests with false positive errors. In Study 2, intentions to uptake all tests were lower compared to Study 1, and were affected by emotional motivations. Participants preferred a test with unspecified errors over tests with specified errors, and, when forced to choose, preferred tests with false negative over false positive errors. Findings are discussed in relation to Error Management Theory and Self-Regulation Theory, emphasising the need to recognise motivations, affect, and framing as important factors in informed screening decisions.
