Kenneth Young research projects
OPTIMAM2: Optimisation of breast cancer detection using digital X-ray technologyFunding period: 01 December 2013 to 30 November 2018
Funding scheme: Science Committee - Programme Award
Funding committee: Science Committee
X-ray mammography is used for breast screening programmes worldwide and over two million women are screened in the UK each year. However, although screening achieves earlier detection leading to improved survival there are also associated harms. One harm is the number of women unnecessarily recalled for further assessment. Currently there are about 100,000 recalls per year in England of which only about 15,000 result in cancer detection. In the UK concern has also been raised about over-diagnosis leading to the Marmot independent review into the benefits and harms of breast screening. The review concluded that for every life saved by screening there were three cases of over-diagnosis. Specifically there was concern about the natural history and treatment of the increasing number of cases of ductal carcinoma in situ (DCIS) found in screening.
This project aims to improve the detection and characterisation of breast cancer during screening and diagnosis and to reduce harm by optimising the use of existing and optimal adoption of new X-ray imaging technologies including: digital breast tomosynthesis (DBT), new image reconstruction methods for DBT, and tissue characterisation by computerised image analysis.
We will evaluate and optimise imaging technology by virtual clinical trials. These mimic clinical trials but widen the range of factors evaluated by using mathematical modelling techniques followed by very specific observer performance studies. The characterisation of microcalcifications and DCIS by quantitative analysis of new and existing cases, together with serial digital mammograms from collaborating studies (Low Risk DCIS trial (LORIS) and the Sloane project) will also be studied as this may correlate with pathology and disease progression enabling better management of the disease.
How the results of this research will be used
Over the next five years key decisions will be made on how and whether to introduce new imaging technology into breast screening and assessment. The nationwide adoption of such enhanced imaging is expected to lead to a reduction in the number of unnecessary recalls from screening, earlier breast cancer detection and improved survival. Currently there is a lack of evidence on which to base strategic decisions about screening technology, which this project will address. Correlating our characterisation of serial DCIS images with pathology and disease progression may help to reduce overdiagnosis and enable improved management of this disease.