OR Forum-A POMDP Approach to Personalize Mammography Screening Decisions
OR Forum-A POMDP Approach to Personalize Mammography Screening Decisions
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DOI：
10.1287/opre.1110.1019
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发表时间：
2012-09-01
影响因子：
2.7
通讯作者：
Stout, Natasha K.
中科院分区：
文献类型：
--
作者：
Ayer, Turgay;Alagoz, Oguzhan;Stout, Natasha K.
乳腺癌是最常见的非皮肤癌，也是美国妇女癌症死亡的第二大原因。虽然乳房X光检查是乳腺癌筛查最有效的方式，但它有几个潜在的风险，包括高假阳性率。因此，受益和风险的平衡取决于个人特征，在设计乳房X线摄影筛查计划时至关重要。与考虑基于人群的筛查建议的先前研究和现有指南相反，我们提出了基于先前筛查历史和女性个人风险特征的个性化乳房X线检查筛查政策。我们制定了一个有限的地平线，部分可观察马尔可夫决策过程（POMDP）模型为这个问题。我们的POMDP模型结合了两种检测方法（自我或筛查）、年龄特异性不可观察的疾病进展和年龄特异性乳腺X线摄影检查特征。我们解决这个POMDP最佳后设置转移概率的值估计从一个验证的微观模拟模型。其他已发布的数据用于指定其他模型输入，例如检测结果的灵敏度和特异性。我们的研究结果表明，我们提出的个性化筛查计划在总预期质量调整生命年方面优于现有指南，同时显着减少了乳房X线照片和假阳性的数量。我们还报告了与每种筛查方案相关的未检测到的浸润性癌症的终生风险。
Breast cancer is the most common nonskin cancer and the second leading cause of cancer death in U.S. women. Although mammography is the most effective modality for breast cancer screening, it has several potential risks, including high false-positive rates. Therefore, the balance of benefits and risks, which depend on personal characteristics, is critical in designing a mammography screening schedule. In contrast to prior research and existing guidelines that consider population-based screening recommendations, we propose a personalized mammography screening policy based on the prior screening history and personal risk characteristics of women. We formulate a finite-horizon, partially observable Markov decision process (POMDP) model for this problem. Our POMDP model incorporates two methods of detection (self or screen), age-specific unobservable disease progression, and age-specific mammography test characteristics. We solve this POMDP optimally after setting transition probabilities to values estimated from a validated microsimulation model. Additional published data is used to specify other model inputs such as sensitivity and specificity of test results. Our results show that our proposed personalized screening schedules outperform the existing guidelines with respect to the total expected quality-adjusted life years, while significantly decreasing the number of mammograms and false-positives. We also report the lifetime risk of developing undetected invasive cancer associated with each screening scenario.