The role of IT in improving breast cancer outcomes

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February was National Cancer Prevention Month, an excellent platform to dispel the many myths about cancer and improve knowledge of the disease. While a great deal of important information was disseminated last month, cancer education is a year-round endeavor, making now as good a time as any to reflect on some of the ways in which information technology can prevent cancer and improve outcomes. Let's begin with cancer prevention in general, then dive a bit deeper into breast cancer in particular.

Benefits of Healthy Living
The old saying, "the best things in life are free," definitely applies to preventive healthcare and is reflected in a classic 2009 publication in the Archives of Internal Medicine entitled, "Healthy Living is the Best Revenge." Exploring the findings of the European Prospect Investigation into Cancer and Nutrition—Potsdam Study, the report used data from over 23,000 adults, age 35-65, to investigate four lifestyle choices:
  • Never smoking
  • Body-mass index <30
  • 3.5 hours/week or more of physical activity
  • Healthy diet (high intake of fruits, vegetables, whole-grain bread and low
    meat consumption)

“Information technology can also play an important role in disease prevention by helping individuals understand their cancer risks and making it easier to adhere to behaviors that reduce them.”

Participants were tracked for a mean follow-up of 7.8 years. Those who adhered to all four choices exhibited a relative risk reduction of 93 percent for developing diabetes, 81 percent for myocardial infarction, 50 percent for stroke, and 36 percent for developing cancer, compared to those without one of these factors. This study highlights the connection between cancer (as well as other chronic diseases) and lifestyle choices. Imagine being able to prevent more than one third of cancers via measures that cost nothing!

IT and Breast Cancer Prevention
Information technology can also play an important role in disease prevention by helping individuals understand their cancer risks and making it easier to adhere to behaviors that reduce them. In fact, one of the reasons why IBM Watson Health recently created a new consumer health business arm is to apply cognitive computing to consumer health. Consider some of the many ways in which information technology can help in this domain:
  • Family History and Electronic Health Records
    Electronic personal health records, including cloud-based systems that provide patients the ability to view their records, track their health activities, and securely communicate with providers, can help women better understand their individual risks, especially when it comes to collecting and recognizing the importance of family history. While most women are aware of the importance of a first or second degree relative with breast cancer, they may often, along with their physicians, overlook the risks associated with a family history of ovarian cancer or other common risk factors such as early menstruation, obesity, dense breasts, alcohol consumption, and certain genetic mutations. Understanding these factors can help women mitigate risk, both for themselves and other family members.

  • Better Screening Compliance
    Early detection leads to better outcomes in properly screened populations. However, mammography screening rates continue to hover between 50-70 percent depending on the screening criteria used.  There are also differences in the screening guidelines recommended by organizations such as the American College of Radiology (ACR) and United States Preventive Services Task Force (USPSTF), which can leave both consumers and their physicians confused. In addition, even though screening with MRI has been recommended by the American Cancer Society for women with a calculated lifetime risk of breast cancer greater than 20 percent, MRI is underutilized as a screening procedure. Information technology can help in two ways: 
    • Electronic notifications reminding women of the need for appropriate screening
    • Helping women and their primary care providers calculate their risk to determine if tests, such as MRI or genetic screening, are recommended

  • Improved Reader Performance
    The variation in mammography reader performance is unacceptably high, according to industry experts. For example, Carney, Sickles, and Monsees et al. evaluated acceptable reader performance in "Identifying Minimally Acceptable Interpretive Performance Criteria for Screening Mammography" (Radiology: Volume 255: Number 2—May 2010).  Based on reader variability of performance, these experts set "cut points" for "acceptable reader performance." They concluded that if underperforming physicians moved into the acceptable range, the impact would be significant. Indeed, based upon the U.S. 2016 volume of approximately 39 million screening mammograms, more ideal reader performance could result in 343,000 fewer false positives and 5,400 more breast cancer diagnoses.

IT on the Horizon
While the impact of IT has shown great potential for cancer – and in particular – breast cancer prevention, in some ways it feels as though we are just scratching the surface. For example, there are solutions, like Image Shuffling (sometimes also called Image Toggling), a Merge patented viewing method that has been found to increase reader speed by 15 percent. In a pilot study, this work-in-progress technology showed a trend toward increased accuracy, and further study is underway to validate the effect of image shuffling on accuracy. Merge is also developing other work-in-progress technologies, such as Marktation, a new method of combining image analytics with reading that aims to increase the speed and clarity of reporting. Other new cognitive capabilities in various stages of development aim to combat known cognitive biases that lead to reading errors and increase the speed and effectiveness of reader training.

We know that often, cancer is preventable and can be successfully treated, especially when caught early.  Innovative new information technology can help in many ways—by improving consumer health literacy, increasing personalized screening, improving reader performance, and helping to find new treatments. Incredible changes and advancements in cancer prevention and care are on the horizon, and we at Merge are proud to be at the forefront of this exciting transformation.

Originally posted on: 3/30/2017 9:06:09 AM

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