Estimating the cumulative risk of a false-positive screening mammogram.

描述（由申请人提供）：摘要/项目摘要。癌症筛查的目标是通过早期发现疾病来降低发病率和死亡率;但筛查的益处必须与潜在危害进行权衡，例如假阳性（FP）结果，这可能导致医疗费用增加，患者焦虑以及与诊断随访程序相关的其他不良结果。本研究的总体目标是开发统计方法，用于估计多轮筛查后假阳性（FP）结果的累积风险，以促进各种筛查方案的比较有效性研究。我们的工作将解决三个具体的目标：（1）描述现有的统计方法的操作特点，估计累积FP风险的情况下，可能发生在筛查乳腺X线摄影;（2）开发新的统计方法，估计FP风险的依赖下的历史FP结果和筛查方案，同时纳入随时间变化的协变量，并允许放射科医生之间的差异;（3）应用新的统计学方法，利用乳腺癌监测联盟（BCSC）13年的数据分析FP风险。在这一目标下，我们将使用目标2下开发的统计方法分析BCSC的数据，并将对40岁和50岁开始筛查的女性进行10年的年度筛查与两年一次筛查后的累积FP风险进行比较有效性分析。这项工作将使我们能够比较拟议的乳腺癌筛查方案的潜在危害。通过提供有关筛查性乳房X光检查潜在危害的信息，这项工作将告知政策制定者，并促进患者和提供者之间就各种筛查方案的风险和益处进行沟通。这将有助于个人决策者和循证指南的制定。 公共卫生相关性：职务名称：项目叙述：我们提出了一种新的统计方法来估计筛查性乳腺X光检查假阳性的累积风险。通过提供有关筛查性乳房X光检查潜在危害的信息，这项工作将告知政策制定者，并促进患者和提供者之间就各种筛查方案的风险和益处进行沟通。这将有助于个人决策者和循证指南的制定。

DESCRIPTION (provided by applicant): Abstract/Project Summary. The goal of cancer screening is to reduce morbidity and mortality through the early detection of disease; but the benefits of screening must be weighed against potential harms, such as false-positive (FP) results, which may lead to increased healthcare costs, patient anxiety, and other adverse outcomes associated with diagnostic follow-up procedures. The overall goal of this research is to develop statistical methods for estimating the cumulative risk of a false-positive (FP) result after multiple rounds of screening in order to facilitate comparative effectiveness research for a variety of screening regimens. Our work will address three specific aims: (1) To describe operating characteristics of existing statistical methods for estimating the cumulative FP risk under scenarios likely to occur in screening mammography; (2) To develop new statistical methods for estimation of the FP risk under dependence of the history of FP results and the screening regimen while incorporating time-varying covariates and allowing for variability among radiologists; (3) To apply new statistical methods to analysis of the FP risk using 13 years of data from the Breast Cancer Surveillance Consortium (BCSC). Under this aim we will analyze data from the BCSC using statistical methods developed under Aim 2 and will carry out comparative effectiveness analyses of the cumulative FP risk after 10 years of annual versus biennial screening, for women beginning screening at age 40 versus 50. This work will allow us to compare the potential harms of proposed breast cancer screening regimens. By contributing information about the potential harms of screening mammography, this work will inform policy-makers and facilitate communication between patients and providers about the risks and benefits of various screening regimens. This will aid both individual decision makers and development of evidence-based guidelines. PUBLIC HEALTH RELEVANCE: Title: Estimating the cumulative risk of a false-positive screening mammogram Project narrative: We propose new statistical methods for estimating the cumulative risk of a false-positive screening mammogram. By contributing information about the potential harms of screening mammography, this work will inform policy-makers and facilitate communication between patients and providers about the risks and benefits of various screening regimens. This will aid both individual decision makers and development of evidence-based guidelines.