The Athena Breast Health Network: developing a rapid learning system in breast cancer prevention, screening, treatment, and care

Department of Surgery, University of California, San Francisco, Box 1710, San Francisco, CA, 94143-1710, USA.
Breast Cancer Research and Treatment (Impact Factor: 3.94). 07/2013; 140(2). DOI: 10.1007/s10549-013-2612-0


The term breast cancer covers many different conditions, whose clinical course ranges from indolent to aggressive. However, current practice in breast cancer prevention and care, and in breast cancer epidemiology, does not take into account the heterogeneity of the disease. A comprehensive understanding of the etiology and progression of different breast cancer subtypes would enable a more patient-centered approach to breast health care: assessing an individual’s risk of getting specific subtypes of the disease, providing risk-based screening and prevention recommendations, and, for those diagnosed with the disease, tailored treatment options based on risk and timing of progression and mortality. The Athena Breast Health Network is an initiative of the five University of California medical and cancer centers to prototype this approach and to enable the development of a rapid learning system—connecting risk and outcome information from a heterogeneous patient population in real time and using new knowledge from research to continuously improve the quality of care. The Network is based on integrating clinical and research processes to create a comprehensive approach to accelerating patient-centered breast health care. Since its inception in 2009, the Network has developed a multi-site, transdisciplinary collaboration that enables the learning system. The five-campus collaboration has implemented a shared informatics platform, standardized electronic patient intake questionnaires, and common biospecimen protocols, as well as new clinical programs and multi-center research projects. The Athena Breast Health Network can serve as a model of a rapid learning system that integrates epidemiologic, behavioral, and clinical research with clinical care improvements.

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Available from: John Pierce, Feb 11, 2014
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    ABSTRACT: Purpose Practice patterns vary with the planning and delivery of post mastectomy radiation therapy (PMRT). Our investigation examines practice patterns in the use of chest wall bolus and a boost among the Athena Breast Health Network (“Athena”). Methods Athena is a collaboration among the five University of California Medical Centers that aims to integrate clinical care and research [1]. From February 2011 to June 2011, all physicians specializing in the multidisciplinary treatment of breast cancer were invited to take a web-based practice patterns survey. Sixty-two of the 239 questions focused on radiation therapy practice environment, decision making processes, and treatment management, including the use of a bolus or boost in PMRT. Results Ninety-two percent of the radiation oncologists specializing in breast cancer completed the survey. All of the responders use a material to increase the surface dose to the chest wall during PMRT. Materials used included brass mesh, commercial bolus, and custom designed wax bolus. Fifty percent used tissue equivalent superflab bolus. Fifty-five percent of the respondents routinely use a boost to the chest wall in PMRT. Eighteen percent give a boost depending on the margin status, and 3/11 (27%) do not use a boost. Conclusions Our investigation documents practice pattern variation for the use of a PMRT boost and the use of chest wall bolus among the University of California breast cancer radiation oncologists. Further understanding of the practice pattern variation will help guide clinicians in our cancer centers to a more uniform approach in the delivery of PMRT.
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