Assessing Dynamic Breast Cancer Screening Policies
成果类型：
Article
署名作者：
Maillart, Lisa M.; Ivy, Julie Simmons; Ransom, Scott; Diehl, Kathleen
署名单位：
Pennsylvania Commonwealth System of Higher Education (PCSHE); University of Pittsburgh; North Carolina State University; University of North Texas System; University of North Texas Health Science Center; University of Michigan System; University of Michigan
刊物名称：
OPERATIONS RESEARCH
ISSN/ISSBN：
0030-364X
DOI：
10.1287/opre.1080.0614
发表日期：
2008
页码：
1411-1427
关键词：
摘要：
Questions regarding the relative value and frequency of mammography screening for premenopausal women versus postmenopausal women remain open due to the conflicting age-based dynamics of both the disease (increasing incidence, decreasing aggression) and the accuracy of the test results (increasing sensitivity and specificity). To investigate these questions, we formulate a partially observed Markov chain model that captures several of these age-based dynamics not previously considered simultaneously. Using sample-path enumeration, we evaluate a broad range of policies to generate the set of efficient policies, as measured by a lifetime breast cancer mortality risk metric and an expected mammogram count, from which a patient may select a policy based on individual circumstance. We demonstrate robustness with respect to small changes in the input data and conclude that, in general, to efficiently achieve a lifetime risk comparable to the current risk among U. S. women, screening should start relatively early in life and continue relatively late in life regardless of the screening interval(s) adopted. The frontier also exhibits interesting patterns with respect to policy type, where policy type is defined by the relationship between the screening interval prescribed in younger years and that prescribed later in life.