Diana L. Miglioretti, PhD

“My research is about the risks and benefits of procedures such as cancer screening. I'm working to standardize medical imaging so patients can be confident they're getting the lowest radiation doses necessary for effective imaging.”

Diana L. Miglioretti, PhD

Senior Investigator, Kaiser Permanente Washington Health Research Institute

Areas of focus:

Biography

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.

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.

Research interests and experience

  • Biostatistics

    Clustered and longitudinal data analysis; latent variable modeling; assessment of diagnostic and screening tests

  • Cancer

    Biostatistics; breast cancer screening and  surveillance; mammographic breast density; risk prediction; colorectal cancer screening

  • Radiology

    Imaging trends; radiation exposure from medical  imaging; evaluation of imaging tests

 

Recent publications

Miglioretti DL, Abraham L, Lee CI, Buist SM, Herschorn S, Sprague BL, Henderson LM, Tosteson ANA, Kerlikowske K, Breast Cancer Surveillance Consortium. Digital breast tomosynthesis: radiologist learning curve. Radiology. 2019 Feb 26:182305. doi: 10.1148/radiol.2019182305. [Epub ahead of print]. PubMed

Tice JA, Bissell MCS, Miglioretti DL, Gard CC, Rauscher GH, Dabbous FM, Kerlikowske K. Validation of the Breast Cancer Surveillance Consortium model of breast cancer risk. Breast Cancer Res Treat. 2019 Feb 22. doi: 10.1007/s10549-019-05167-2. [Epub ahead of print]. PubMed

Miglioretti DL, Lee JM, Kerlikowske K. Re: "Linkage of the ACR National Mammography Database to the network of state cancer registries: proof of concept evaluation by the ACR National Mammography Database Committee". J Am Coll Radiol. 2019;16(2):135-136. doi: 10.1016/j.jacr.2018.09.056. PubMed

Arasu VA, Miglioretti DL, Sprague BL, Alsheik NH, Buist DSM, Henderson LM, Herschorn SD, Lee JM, Onega T, Rauscher GH, Wernli KJ, Lehman CD, Kerlikowske K. Population-based assessment of the association between magnetic resonance imaging background parenchymal enhancement and future primary breast cancer risk. J Clin Oncol. 2019 Jan 9:JCO1800378. doi: 10.1200/JCO.18.00378. [Epub ahead of print]. PubMed

 

Researcher profile

Why does Diana Miglioretti study the biostatistics of cancer screening?

Family history sparks interest for KPWHRI senior investigator, UC Davis professor, and co-leader of the BCSC.

Read it in News and Events.

Study results

No need to follow up simple ovarian cysts

New study shows women with simple cysts are not at increased risk of ovarian cancer.

Read it in Healthy Findings.

KPWHRI in the media

Most ovarian cysts may not need surveillance

NIH (National Institutes of Health) Research Matters Newsletter, Dec 4, 2018

Funding News

KPWHRI shares in $17 million grant to improve breast screening

National Cancer Institute support continues nation's largest collection of breast imaging data and funds three studies to personalize screening.

Read it in News and Events

Healthy Findings Blog

Can standardized CT scans improve safety?

Dr. Diana Miglioretti and University of California colleagues are developing and testing a new way to lower radiation doses while still producing sharp images.

Read about it in Healthy Findings

featured video

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Making Medicine Better by Working Together

(YouTube, 5:33)