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Quantifying performance thresholds for recommending screening mammography: a revealed preference analysis of USPSTF
Anand K Narayan1, Elena B Elkin2, Constance D Lehman3
1Department of Radiology, Massachusetts General Hospital, 55 Fruit St. Wang 219H, Boston, MA, 02114, USA. aknarayan@mgh.harvard.edu.
Breast Cancer Research and Treatment
|August 22, 2018
Summary
Significant reductions in false-positive mammography results are needed to recommend earlier or more frequent screening. A 31% decrease supports annual screening at age 50, while a 74% decrease is needed for annual screening at age 40.
Area of Science:
- Medical Imaging
- Public Health
- Preventive Medicine
Background:
- Mammography screening effectiveness is debated due to potential harms like false positives.
- Quantifying performance improvements needed for expanded screening recommendations is crucial.
Purpose of the Study:
- To determine the quantitative thresholds for mammography screening performance improvements.
- To ascertain when screening should be recommended beyond biennial intervals for women aged 50+ based on U.S. Preventive Services Task Force (USPSTF) benchmarks.
Main Methods:
- Utilized revealed preference methods based on USPSTF benchmarks.
- Calculated benefit/harm ratios using data on breast cancer deaths averted and false-positive probabilities.
- Determined required reductions in false-positives for expanded screening scenarios.
Main Results:
- Biennial screening at age 40 would be recommended if false-positives decreased by at least 62%.
- Annual screening at age 40 requires a 74% reduction in false-positives.
- Annual screening at age 50 requires a 31% reduction in false-positives.
Conclusions:
- A 31-74% reduction in false-positives is necessary to support expanding mammography screening beyond biennial intervals for women aged 50.
- Implementing tomosynthesis and lowering recall rates (5-12%) could justify expanded screening.
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