LBPO.CL02 · 临床研究 · Late-Breaking
MCED检测前后乳腺X线钼靶筛查的高依从性
High adherence to mammography screening before and after MCED testing
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：多癌种早期检测（MCED）检测有望发现那些尚无筛查手段的癌症。然而，人们担心MCED检测的实施可能导致对推荐的单癌种筛查依从性下降。我们在一个符合乳腺癌筛查条件的个体队列中，考察了MCED检测前后的乳腺X线钼靶筛查率。
方法：一个美国女性队列在1年的确认期（2022/07/01—2023/06/30）内接受了阴性（“未检测到癌症信号”）MCED（Galleri®，GRAIL, Inc.）检测，其去标识化数据通过令牌化与Komodo研究数据集进行关联。本分析聚焦于42—72岁、既往未接受过Galleri检测、确认期内无阳性Galleri检测结果、且在指标检测日期具有已结算医疗保险理赔覆盖的女性。为纳入在观察期内符合两个完整乳腺X线钼靶筛查周期条件的女性，构建了要求指标检测前后各有≥24个月连续保险覆盖的最终研究样本。诊断性和筛查性乳腺X线钼靶通过保险理赔记录中的账单代码予以识别。按指标MCED检测之前和/或之后接受乳腺X线钼靶检查的情况，计算了受检者人口学特征的描述性统计。
结果：在6,122名符合条件的女性中，有2,820名（46.1%）纳入最终研究样本。研究样本中的女性与符合条件人群的人口学特征相似，平均年龄57.3岁，61.9%为非西班牙裔白人，80.4%为商业医疗保险。分别有2,317名（82.2%）和2,357名（83.6%）在指标检测前和后的24个月内接受了乳腺X线钼靶检查。2,108名（74.8%）女性在两个时期均接受了乳腺X线钼靶检查，而254名（9.0%）在任一时期均未接受（见表）。
结论：女性在接受阴性MCED检测结果后的24个月内保持了对乳腺X线钼靶检查的高依从性，该时期内超过80%的女性接受了乳腺X线钼靶检查。
无乳腺X线钼靶（前或后）仅指标前乳腺X线钼靶 仅指标后乳腺X线钼靶 指标前后均有乳腺X线钼靶 总体 代表性人群样本 N 254 209 249 2,108 2,820 6,122 指标前乳腺X线钼靶 0（0%）209（100%）0（0%）2,108（100%）2,317（82.2%）指标后乳腺X线钼靶 0（0%）0（0%）249（100%）2,108（100%）2,357（83.6%）保险—商业 202（79.5%）165（78.9%）204（81.9%）1,697（80.5%）2,268（80.4%）4,891（79.9%）保险—其他 52（20.5%）44（21.1%）45（18.1%）411（19.5%）552（19.6%）1,231（20.1%）指标检测时年龄—平均值（SD）57.3（7.7）56.6（7.8）56.2（7.8）57.4（7.4）57.3（7.5）57.4（7.6）种族与族裔 非西班牙裔白人 157（61.8%）118（56.5%）135（54.2%）1,336（63.4%）1,746（61.9%）3,822（62.4%）其他 37（14.6%）35（16.7%）50（20.1%）390（18.5%）512（18.2%）1,128（18.4%）未知 60（23.6%）56（26.8%）64（25.7%）382（18.1%）562（19.9%）1,172（19.1%）
查看英文原文 English abstract
Background : Multi-cancer early detection (MCED) tests have the potential to detect cancers that do not have screening options. However, there is concern that implementation of MCED tests could lead to a lack of adherence to recommended single cancer screening. We examined mammography screening rates before and after MCED testing in a cohort of individuals eligible for breast cancer screening.
Methods : Deidentified data for a US cohort of women with a negative (“no cancer signal detected”) MCED (Galleri®, GRAIL, Inc.) test administered during a 1-year ascertainment period (7/01/2022-6/30/2023) were linked via tokenization to the Komodo Research Dataset. This analysis focused on women aged 42-72 years with no prior Galleri test, no positive Galleri test result during ascertainment, and with closed health insurance claims coverage on the index test date. A final study sample requiring ≥24 months of continuous coverage before and after the index test was created to capture women eligible for two complete cycles of mammography screening across the observation period. Diagnostic and screening mammograms were identified by billing codes on insurance claim records. Descriptive statistics of test recipients' demographic characteristics were calculated by mammogram receipt before and/or after the index MCED test.
Results : Of the 6,122 women in the eligible population, 2,820 (46.1%) were in the final study sample. Women in the study sample had similar demographics as the eligible population, with mean age of 57.3 years, 61.9% white non-Hispanic, and 80.4% commercial health insurance. 2,317 (82.2%) and 2,357 (83.6%) had mammograms in the 24-month pre- and post-index periods, respectively. 2,108 (74.8%) women had mammograms in both periods, while 254 (9.0%) did not have a mammogram in either period (Table).
Conclusions : Women maintained high adherence to mammography at 24 months following receipt of a negative MCED test result, with >80% of women receiving mammograms in that period.
No mammogram (pre or post) Pre-index mammogram only Post-index-mammogram only Pre- and post-index mammograms Overall Representative population sample N 254 209 249 2,108 2,820 6,122 Pre-index mammogram 0 (0%) 209 (100%) 0 (0%) 2,108 (100%) 2,317 (82.2%) Post-index mammogram 0 (0%) 0 (0%) 249 (100%) 2,108 (100%) 2,357 (83.6%) Insurance - Commercial 202 (79.5%) 165 (78.9%) 204 (81.9%) 1,697 (80.5%) 2,268 (80.4%) 4,891 (79.9%) Insurance - Other 52 (20.5%) 44 (21.1%) 45 (18.1%) 411 (19.5%) 552 (19.6%) 1,231 (20.1%) Age at index test - Mean (SD) 57.3 (7.7) 56.6 (7.8) 56.2 (7.8) 57.4 (7.4) 57.3 (7.5) 57.4 (7.6) Race and ethnicity White non-Hispanic 157 (61.8%) 118 (56.5%) 135 (54.2%) 1,336 (63.4%) 1,746 (61.9%) 3,822 (62.4%) Other 37 (14.6%) 35 (16.7%) 50 (20.1%) 390 (18.5%) 512 (18.2%) 1,128 (18.4%) Unknown 60 (23.6%) 56 (26.8%) 64 (25.7%) 382 (18.1%) 562 (19.9%) 1,172 (19.1%)
利益披露 Disclosure
C. H. McDonnell,
Grail, Inc ).
G. M. Stipec,
Grail, Inc ).
A. Chadha,
Medicus Economics Employment, Medicus Economics received funding from GRAIL for this research.
A. R. Kansal,
Grail, Inc Employment, Stock.
C. O'Connell,
Grail, Inc Employment, Stock.
A. Cummings Joyner,
Medicus Economics Employment, Medicus Economics received funding from GRAIL for this research.
A. J. Epstein,
Medicus Economics Employment, Other, Medicus Economics received funding from GRAIL for this research.
E. T. Fung,
Grail, Inc Employment, Stock.
A. M. Fendrick,
Abbvie ).
Centivo ).
EmblemHealth ).
Elektra ).
Exact Sciences ).
Grail Inc ).
Health at Scale Technologies Stock, ).
HealthCorum ).
Johnson & Johnson ).
Medtronic ).
MedZed ).
Merck ).
Mother Goose Health Stock, ).
Phantom Pharmaceuticals ).
Proton Intelligence ).
Sempre Health Stock, ).
Sera Prognostics ).
Silver Fern Healthcare Stock, ).
Teladoc Health ).