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

Group Health Research Institute Senior Investigator

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 GHRI 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 GHRI 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

Lee CI, Cevik M, Alagoz O, Sprague BL, Tosteson AN, Miglioretti DL, Kerlikowske K, Stout NK, Jarvik JG, Ramsey SD, Lehman CD.

Comparative effectiveness of combined digital mammography and tomosynthesis screening for women with dense breasts.

Radiology. 2014 Oct 13:141237 [Epub ahead of print]. PubMed

Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, Wellman RD, Kerlikowske K, Miglioretti DL.

Prevalence of mammographically dense breasts in the United States.

J Natl Cancer Inst. 2014 Sep 12;106(10). pii: dju255. doi: 10.1093/jnci/dju255. Print 2014. PubMed

Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA Jr, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL, Kriesel DR, Ma OJ, Mallin M, Manson W, Melnikow J, Miglioretti DL, Miller SK, Mills LD, Miner JR, Moghadassi M, Noble VE, Press GM, Stoller ML, Valencia VE, Wang J, Wang RC, Cummings SR.

Ultrasonography versus computed tomography for suspected nephrolithiasis.

N Engl J Med. 2014;371(12):1100-10. doi: 10.1056/NEJMoa1404446. PubMed

Lee CI, Ichikawa L, Rochelle MC, Kerlikowske K, Miglioretti DL, Sprague BL, DeMartini WB, Wernli KJ, Joe BN, Yankaskas BC, Lehman CD.

Breast MRI BI-RADS assessments and abnormal interpretation rates by clinical indication in US community practices.

Acad Radiol. 2014 Aug 7. pii: S1076-6332(14)00231-1. doi: 10.1016/j.acra.2014.06.003 [Epub ahead of print]. PubMed