Assessing Dynamic Breast Cancer Screening Policies
Assessing Dynamic Breast Cancer Screening Policies
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DOI：
10.1287/opre.1080.0614
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发表时间：
2008-11-01
影响因子：
2.7
通讯作者：
Diehl, Kathleen
中科院分区：
文献类型：
--
作者：
Maillart, Lisa M.;Ivy, Julie Simmons;Diehl, Kathleen
关于绝经前妇女与绝经后妇女乳房X线摄影筛查的相对价值和频率的问题仍然是开放的，因为疾病的年龄动态（发病率增加，攻击性降低）和测试结果的准确性（增加灵敏度和特异性）相互冲突。为了研究这些问题，我们制定了一个部分观察到的马尔可夫链模型，捕捉这些基于年龄的动态，以前没有同时考虑。使用样本路径枚举，我们评估了广泛的政策，以产生一组“有效”的政策，衡量一生的乳腺癌死亡率风险指标和预期的乳房X光检查计数，从患者可以选择基于个人情况的政策。我们证明了鲁棒性方面的小变化的输入数据，并得出结论，在一般情况下，有效地实现终身风险相当于目前的风险之间的美国。S.对于女性，筛查应在生命的相对早期开始，并在生命的相对晚期继续，无论采用的筛查间隔。边境也表现出有趣的模式，就政策类型，其中政策类型的定义之间的关系规定的筛选间隔在年轻的几年，并规定在以后的生活。
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.