TMIST Defining Breast Imaging Studies for Years to Come

Amy Curtis MD PhotoThis post is contributed by Amarinthia Curtis, MD, radiation oncologist, site investigator for the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) at the Spartanburg Medical Center in South Carolina.

As I recently told The Cancer Letter, TMIST will not only help tailor future breast cancer screening, but the demographic and socioeconomic information on those who enroll—and choose not enroll — will help us know characteristics of those who take part in clinical trials and what barriers may prevent others from doing so.

This information can help expand representation in future trials and make study results more generalizable across populations.

TMIST is the first large randomized controlled trial (RCT) that seeks to identify women in which digital breast tomosynthesis (DBT) may outpace two-dimensional (2D) digital mammography at reducing advanced breast cancer development. TMIST will also create the world’s largest breast cancer biorepository.

TMIST is not just a technology trial, and many women are excited by that. In 2019, the number of women taking part in TMIST has doubled, and the number of TMIST sites is up 50 percent. We have even opened our first site outside of North America as international providers take notice.

However, even as the number of women and sites participating in TMIST moves higher, we have room for many more of both. If your facility has both DBT and 2D digital mammography, you can do this. Check out this new video for more details on TMIST participation.

My site accrues about 40 women per month (2 to 3 per day, 4 days a week) to TMIST. Our lead coordinator recently outlined to the TMIST E-newsletter how our recruitment program has boosted enrollment. TMIST investigators and staff share ideas that may be of help to one another and to you, should you decide to take part.

On July 24, TMIST Principal Investigator Etta Pisano, MD, FACR, will show AHRA 2019 attendees how TMIST participation enables you to help shape breast cancer screening, strengthen your practice and provide covered screening exams to uninsured women.

TMIST participation also opens the door for you to co-author papers resulting from the data produced by this landmark study.

I strongly encourage you to look into TMIST participation. Together, we can move medicine forward.

Visit acr.org/TMIST for information on how to take part in TMIST.

Email any questions you may have to TMIST@acr.org.

Please share your thoughts in the comments section below.

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Reducing Lung Cancer Deaths with Low-Dose CT

2016-ACR-223Debra S. Dyer, MD, FACR, chair of the American College of Radiology Lung Cancer Screening 2.0 Steering Committee, contributed this post.

On June 28, 2019, the Journal of Thoracic Oncology published an update to the National Lung Screening Trial (NLST). The new study reports a sustained reduction in cancer deaths from low-dose computed tomography (LDCT) lung screening roughly 12 years after the initial screening exam.

This is good news, and adds to the ever-growing body of evidence that lung cancer screening with LDCT is effective.

The study found the incidence of lung cancer to be nearly the same in both the LDCT group and the chest radiograph (CXR) groups. Lung cancer mortality was 3.3 points lower in the LDCT group (42.9 per 1000) compared to the CXR group (46.2 per 1000), which is similar to the 3.1 points noted in the original NLST study results.

A significantly higher proportion of patients in the LDCT group (39.6%) were found to have Stage 1 cancers compared to the CXR group (27.5%). Fewer in the LDCT group (17.5%) were found to have Stage IV cancer compared to CXR group (22.3 %). This shows persistence of a stage shift with CT screening.

The Number Needed to Screen (NNS) to prevent one death was 303, slightly less than the 320 which was reported in the original study. The stability of the difference in NNS over time indicates that LDCT screening did not just delay lung cancer death by a few years, but prevented it.

In addition, the overdiagnosis rate fell to 3.1%, considerably less than 18% in the original study.

By demonstrating a similar and sustained mortality benefit as the original study, the extended follow-up of NLST confirms what the ACR Lung Cancer Screening 2.0 Steering Committee (ACR LCS 2.0) knows: that LDCT is effective, and that more lives can – and will –  be saved by its effective utilization.

To learn more about how ACR LCS 2.0 is addressing the barriers, identifying solutions and empowering radiologists to lead efforts to increase LDCT adoption, register for our free Lung Cancer Screening Boot Camp Web Series and visit the Lung Cancer Screening Resources page on acr.org.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

You Can Help Shape the Future of Patient Care Through Clinical Trials

Dr Saline - UNMJennifer Lynn Saline, MD, chief of mammography and associate professor of radiology, University of New Mexico School of Medicine contributed this post.

Many of us may want to get involved in shaping the future of patient care through clinical research. We just don’t know where to start and what the first steps are once we get involved in a study.

My experience with the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) may help.

In this new video, TMIST Principal Investigator Etta Pisano, MD, FACR, explains what TMIST is about and why you, your practice and your patients can benefit from taking part in TMIST.

This week, my University of New Mexico colleagues and I shared with the TMIST e-news how we started TMIST in our practice. This may provide a clearer picture of what is involved in launching a trial in your department.

On July 24, Dr. Pisano will explain to AHRA 2019 attendees how taking part in TMIST enables your practice to shape breast cancer screening and provide covered screening exams to uninsured women.

Another advantage of taking part in TMIST is that by completing the TMIST enrollment process, which includes becoming a member of a NCI National Clinical Trials Network research group, your site could take part in many other clinical trials.

If you have been thinking about taking part in an imaging or radiation oncology study, now is the time to act!

Visit acr.org/TMIST for information on how to take part in TMIST and general information on taking part in any imaging or radiation oncology study.

Email TMIST@acr.org with any questions you may have about TMIST — or imaging or radiation oncology trial participation in general.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).