ORCID Profile
0000-0002-6650-1639
Current Organisations
Royal College of Physicians of Edinburgh
,
University of Manchester
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Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.EJCA.2019.09.026
Abstract: Mammographic screening reduces breast cancer mortality but may lead to the overdiagnosis and overtreatment of low-risk breast cancers. Conservative management may reduce the potential harm of overtreatment, yet little is known about the impact upon quality of life. To quantify women's preferences for managing low-risk screen detected ductal carcinoma in situ (DCIS), including the acceptability of active monitoring as an alternative treatment. Utilities (cardinal measures of quality of life) were elicited from 172 women using visual analogue scales (VASs), standard gambles, and the Euro-Qol-5D-5L questionnaire for seven health states describing treatments for low-risk DCIS. Sociodemographics and breast cancer history were examined as predictors of utility. Both patients and non-patients valued active monitoring more favourably on average than conventional treatment. Utilities were lowest for DCIS treated with mastectomy (VAS: 0.454) or breast conserving surgery (BCS) with adjuvant radiotherapy (VAS: 0.575). The utility of active monitoring was comparable to BCS alone but was rated more favourably as progression risk was reduced from 40% to 10%. Disutility for active monitoring was likely driven by anxiety around progression, whereas conventional management impacted other dimensions of quality of life. The heterogeneity between in idual preferences could not be explained by sociodemographic variables, suggesting that the factors influencing women's preferences are complex. Active monitoring of low-risk DCIS is likely to be an acceptable alternative for reducing the impact of overdiagnosis and overtreatment in terms of quality of life. Further research is required to determine subgroups more likely to opt for conservative management.
Publisher: Informa UK Limited
Date: 27-01-2021
Publisher: Royal College of General Practitioners
Date: 26-03-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2021
DOI: 10.29337/IJSP.136
Publisher: Elsevier BV
Date: 06-2020
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-2018
DOI: 10.1200/JGO.18.67900
Abstract: Background: Controversy persists about the overdiagnosis of low risk breast cancers identified by breast cancer screening programs. Low risk ductal carcinoma in situ (DCIS) is a noninvasive breast condition with an uncertain risk of invasive progression. Standard management consists of immediate surgical treatment, with or without radiotherapy and adjuvant therapy. Active monitoring of low risk DCIS via annual mammography is proposed as an alternative strategy to immediate surgery to reduce the harm of overdiagnosis, whereby the disease is only treated upon disease progression. However, the costs and benefits of active monitoring are not well researched in the breast cancer setting. Aim: To assess the cost-effectiveness of active monitoring versus immediate surgical management in women diagnosed with low grade ductal carcinoma in situ (DCIS). Methods: A Markov state transition model was constructed for a theoretical cohort of women aged 50 years and over with low risk DCIS over a lifetime horizon. A cost-utility analysis was performed to compare a strategy of observation (active monitoring) versus immediate surgical treatment using an annual time cycle. Transition probabilities, costs and utilities were obtained from national mortality and cost data, published meta-analyses, primary data collection of utilities and expert opinion. A healthcare perspective was adopted to present the results. Primary outcomes were assessed in terms of cost per quality-adjusted-life-year (cost per QALY). Multiple sensitivity analyses were undertaken to determine effect of parameter uncertainty on results. Results: The cumulative costs and QALYs for each age cohort are presented. Active monitoring is a cost-effective strategy for the management of low risk breast cancer in older women with comorbid conditions. Sensitivity analyses revealed the ICERs for all women to be affected by baseline probability of disease progression, age, cost of surgery and utility. Conclusion: Conservative management of ductal carcinoma in situ via active monitoring may be cost-effective compared with immediate surgical treatment in a selected cohort of older women with low risk disease.
Publisher: Springer Science and Business Media LLC
Date: 02-2017
Publisher: Elsevier BV
Date: 05-2021
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-2018
DOI: 10.1200/JGO.18.50800
Abstract: Background: Breast cancer screening is effective in reducing breast cancer mortality, but there is increasing concern that it may also lead to overdiagnosis the detection and treatment of a cancer that would never have presented symptomatically during the woman's lifetime. Conservative management of low-risk breast cancer may reduce the harm of overdiagnosis resulting from mammographic screening programs, yet little is known about how such strategies might impact upon quality of life. Aim: To quantify women's preferences for managing low risk breast cancers identified by breast cancer screening. Methods: Utilities (measures of preference) were obtained from women with and without a history of breast cancer for seven health states reflecting low risk screen detected ductal carcinoma in situ (DCIS) using standard gambles. Demographics and a history of prior screening participation or breast cancer diagnosis were examined as predictors of screening and treatment pathway preferences. Results: Utilities were lower for breast cancers treated with mastectomy or invasive adjuvant treatment. The impact of active monitoring on quality of life was comparable to breast conserving surgery, although women in both patient and general population groups rated active monitoring more favorably as the risk of disease spread was decreased. There was some variation in ratings across patients suggesting that in idual risk aversion does affect preferences for the type of conservative management valued. Conclusion: Overdiagnosis remains a challenge for improving the current breast cancer screening program. Active monitoring of low risk ductal carcinoma in situ may provide an acceptable solution for reducing the impact of overdiagnosis and overtreatment resulting from breast cancer screening on quality of life.
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.SOCSCIMED.2019.03.028
Abstract: Policy decisions regarding breast cancer screening and treatment programmes may be misplaced unless the decision process includes the appropriate utilities and disutilities of mammography screening and its sequelae. The objectives of this study were to critically review how economic evaluations have valued the health states associated with breast cancer screening, and appraise the primary evidence informing health state utility values (cardinal measures of quality of life). A systematic review was conducted up to September 2018 of studies that elicited or used utilities relevant to mammography screening. The methods used to elicit utilities and the quality of the reported values were tabulated and analysed narratively. 40 economic evaluations of breast cancer screening programmes and 10 primary studies measuring utilities for health states associated with mammography were reviewed in full. The economic evaluations made different assumptions about the measures used, duration applied and the sequalae included in each health state. 22 evaluations referenced utilities based on assumptions or used measures that were not methodologically appropriate. There was significant heterogeneity in the utilities generated by the 10 primary studies, including the methods and population used to derive them. No study asked women to explicitly consider the risk of overdiagnosis when valuing the health states described. Utilities informing breast screening policy are restricted in their ability to reflect the full benefits and harms. Evaluating the true cost-effectiveness of breast cancer screening will remain problematic, unless the methodological challenges associated with valuing the disutilities of screening are adequately addressed.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.EJSO.2022.07.014
Abstract: Shared learning is imperative in the assessment and safe implementation of new healthcare interventions. Magnetic seeds (Magseed®) potentially offer logistical benefit over wire localisation for non-palpable breast lesions but few data exist on outcomes comparing these techniques. A national registration study (iBRA-NET) was conducted to collate device outcomes. In order to share learning, thematic analysis was conducted to ascertain early clinical experiences of Magseed® and wire guided localisation and explore how learning events may be applied to improve clinical outcomes. A qualitative study of 27 oncoplastic surgeons, radiologists and physicians was conducted in January 2020 to ascertain the feasibility and challenges associated with Magseed® versus wire breast localisation surgery. Four focus groups were asked to discuss experiences, concerns and shared learning outcomes which were tabulated and analysed thematically. Three key themes were identified comparing Magseed® and wire localisation of breast lesions relating to preoperative, intraoperative and postoperative learning outcomes. Percutaneous Magseed® detection, instrument interference and potential seed or wire dislodgement were the most common issues identified. Clinician experience suggested Magseed® index lesion identification was non-inferior to wire placement and improved the patient pathway in terms of scheduling and multi-site insertion. Prospective shared learning suggested Magseed® offered additional non-clinical benefits over wire localisation, improving the efficiency of the patient pathway. Recommendations for improving breast localisation technique, appropriate patient selection and clinical practice through shared learning are discussed that may aid other surgeons in the adoption of this relatively new technique.
Publisher: Royal College of General Practitioners
Date: 13-12-2021
Abstract: Women with breast pain constitute % of breast clinic attendees. To investigate breast cancer incidence in women presenting with breast pain and establish the health economics of referring women with breast pain to secondary care. A prospective cohort study of all consecutive women referred to a breast diagnostic clinic over 12 months. Women were categorised by presentation into four distinct clinical groups and cancer incidence investigated. Of 10 830 women, 1972 (18%) were referred with breast pain, 6708 (62%) with lumps, 480 (4%) with nipple symptoms, 1670 (15%) with ‘other’ symptoms. Mammography, performed in 1112 women with breast pain, identified cancer in eight (0.7%). Of the 1972 women with breast pain, breast cancer incidence was 0.4% compared with ∼5% in each of the three other clinical groups. Using ‘breast lump’ as reference, the odds ratio (OR) of women referred with breast pain having breast cancer was 0.05 (95% confidence interval = 0.02 to 0.09, P .001). Compared with reassurance in primary care, referral was more costly (net cost £262) without additional health benefits (net quality-adjusted life-year [QALY] loss −0.012). The greatest impact on the incremental cost-effectiveness ratio (ICER) was when QALY loss because of referral-associated anxiety was excluded. Primary care reassurance no longer dominated, but the ICER remained greater (£45 528/QALY) than typical UK National Health Service cost-effectiveness thresholds. This study shows that referring women with breast pain to a breast diagnostic clinic is an inefficient use of limited resources. Alternative management pathways could improve capacity and reduce financial burden.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Hannah Bromley.