Senior Investigator and Biostatistician Diana Miglioretti is committed to helping improve early detection of breast cancer. She pursues a rigorous combination of applied and methodological research, overseeing analyses of the largest and most comprehensive collection of breast cancer screening data in the nation.
Dr. Miglioretti co-leads the Breast Cancer Surveillance Consortium (BCSC)—a network of mammography registries linked to tumor and pathology registries. Established in 1994, the BCSC kicked off a new $20 million Program Project grant from the National Cancer Institute (NCI) in 2011. Dr. Miglioretti serves as the program’s contact principal investigator (PI) and the Director of the Biostatistics and Data Management Core, which houses the Statistical Coordinating Center—the repository and central analysis site for all BCSC data.
The vast BCSC database includes information on more than 9.5 million mammograms, 2.3 million women, and 114,000 breast cancer cases. Dr. Miglioretti leads the SCC in maximizing the value of these data: establishing and evaluating data collection, helping individual sites and outside researchers with analyses, and developing new statistical techniques. Through these efforts, BCSC data play an essential role in formulating national breast cancer screening policy decisions and clinical guidelines. It’s a one-of-a-kind resource that lets researchers worldwide answer timely questions about benefits and risks of breast cancer screening.
For example, Dr. Miglioretti worked with KPWHRI Senior Investigator Diana Buist, PhD, MPH, and colleagues from the University of Sydney in Australia on the first-ever study to rigorously assess screening mammography outcomes for women who’d had breast cancer before. Examining 12 years of information from more than 110,000 mammograms, they found that yearly screening detected second breast cancers at an early stage—results they published February 23, 2011 in the Journal of the American Medical Association (see news release).
Another example comes from Dr. Miglioretti’s collaboration with NCI’s Cancer Intervention and Surveillance Modeling Network (CISNET) and the Oregon Evidence-based Practice Center. Publishing in the May 1, 2012, Annals of Internal Medicine, the team found that women age 40 to 49 with a twofold increase in breast cancer risk who have screening mammograms every two years experience similar benefits and harms as average-risk women who start biennial screening at age 50 (see news release).
BCSC data are also being used to better understand variation in radiologists’ interpretive performance of mammography. In the Assessing and Improving Mammography (AIM) study, Dr. Miglioretti worked with BCSC collaborators to develop mammography test sets to assess individual radiologist's interpretive performance (see news release). She is currently working with international colleagues to expand the test set to compare radiologist performance across many counties as part of the International Cancer Screening Network.
Additionally, Dr. Miglioretti develops statistical methods to more rigorously analyze longitudinal mammography data and is tackling questions related to the rapidly increasing use of diagnostic imaging. As imaging rates trend upward, so does exposure to medical radiation—results she reported June 12, 2012, in the Journal of the American Medical Association with Rebecca Smith-Bindman, MD, of the University of California, San Francisco, and colleagues from the Cancer Research Network (see news release).
These many achievements earned Dr. Miglioretti an appointment as the Dean’s Professor of Biostatistics in the Department of Public Health Sciences, School of Medicine at the University of California, Davis—a position she undertook at the outset of 2013, while still maintaining her leadership role in the BCSC and other key KPWHRI projects. Dr. Miglioretti enthusiastically shares her expertise as an instructor at the Radiological Society of North America's (RSNA) annual workshop in clinical trials methodology, which aims to prepare radiologists to develop clinical research protocols and apply for funding. Among her many professional memberships are the American Association for Cancer Research, the International Biometrics Society Eastern and Western North America regions (ENAR and WNAR), and the American Statistical Association, for whom she served as a Council of Sections representative in Biometrics.
Clustered and longitudinal data analysis; latent variable modeling; assessment of diagnostic and screening tests
Biostatistics; breast cancer screening and surveillance; mammographic breast density; risk prediction; colorectal cancer screening
Imaging trends; radiation exposure from medical imaging; evaluation of imaging tests
Engmann NJ, Golmakani MK, Miglioretti DL, Sprague BL, Kerlikowske K. Population-attributable risk proportion of clinical risk factors for breast cancer. JAMA Oncol. 2017 Feb 2. doi: 10.1001/jamaoncol.2016.6326. [Epub ahead of print]. PubMed
Engmann NJ, Scott C, Jensen MR, Ma L, Brandt KR, Mahmoudzadeh A, Malkov S, Whaley DH, Hruska C, Wu FF, Winham S, Miglioretti DL, Norman AD, Heine J, Shepherd J, Pankratz VS, Vachon CM, Kerlikowske K. Longitudinal changes in volumetric breast density with tamoxifen and aromatase inhibitors. Cancer Epidemiol Biomarkers Prev. 2017 Feb 1. pii: cebp.0882.2016. doi: 10.1158/1055-9965.EPI-16-0882. [Epub ahead of print]. PubMed
Ahern TP, Sprague BL, Bissell MC, Miglioretti DL, Buist DS, Braithwaite D, Kerlikowske K. Family history of breast cancer, breast density, and breast cancer risk in a U.S. breast cancer screening population. Cancer Epidemiol Biomarkers Prev. 2017 Jan 17. pii: cebp.0801.2016. doi: 10.1158/1055-9965.EPI-16-0801. [Epub ahead of print]. PubMed
Kerlikowske K, Gard CC, Tice JA, Ziv E, Cummings SR, Miglioretti DL. Risk factors that increase risk of estrogen receptor-positive and -negative breast cancer. J Natl Cancer Inst. 2016 Dec 31;109(5). pii: djw276. doi: 10.1093/jnci/djw276. Print 2017. PubMed
Breast Cancer Surveillance Consortium receives $7.5 million to investigate supplemental breast MRI and tomosynthesis.
Read it in Healthy Findings.
A new video shows how patient engagement takes center stage in Dr. Karen Wernli’s study of breast cancer imaging for women who’ve had the disease before.
Read it in Healthy Findings.
Sept. 28, 2015—CAD raises screening costs without benefit to patients and may miss cancers, large national BCSC study shows
Seattle Times, Sept. 28, 2015