Assessing Multi-Modality Breast Cancer Screening Strategies for BRCA 1/2 Gene Mutation Carriers and Other High-Risk Populations
Women with certain risk factors such as BRCA 1/2 gene mutations and family history of breast or ovarian cancer are at higher risk for breast cancer. For high-risk women, the existing guidelines suggest intensified screening and the use of ultrasound (US) and magnetic resonance imaging (MRI) to address some of the limitations of mammography, the standard screening modality for average-risk women. Yet, the cost and false positive rates of MRI and operator dependency of US raise concerns about these modalities and their optimal use. Despite being capable of detecting more cancers than mammography, MRI is significantly more expensive and yields higher number of false-positives. US is cheaper but generally less sensitive than MRI, and is an operator dependent technology, causing substantial variability in the number of resulting false- positive readings and the associated costs. Currently there is no consensus on the optimal use of US and MRI in conjunction with, or instead of, mammography in high-risk women. Given the lack of definitive results from comprehensive randomized controlled trials, our objective in this paper is to study the multi-modality breast cancer screening problem in the high-risk population and identify optimal and cost-effective population screening strategies. For this purpose, we first develop a Markov model to capture the disease progression in high-risk women and parameterize it using the best available evidence. Then, we formulate a mixed integer linear program to identify the optimal structured strategies that are practical for implementation. We further study the structure of the optimal strategies, and establish the conditions under which a strategy with more frequent but less sensitive screens yields higher health benefits than a strategy with more sensitive but less frequent screens. Our main findings are as follows: (1) for young women (women aged 25-44 years-old), annual screening with ultrasound alone, despite its high operator dependency, is affordable with moderate budgets, optimal over a wide range of budget levels and is cost-effective, (2) for middle-aged women (women 45-74 years-old), annual mammography screening is robustly optimal and cost-effective and (3) the use of MRI alone or combined with mammogram, a recommended strategy by the current guidelines, leads to outcomes that are not cost-effective. Our findings can be helpful in designing future trials, developing evidence-based guidelines and informing insurance coverage decisions
Year of publication: |
2022
|
---|---|
Authors: | Çağlayan, Çağlar ; Ayer, Turgay ; Ekwueme, Donatus U. |
Publisher: |
[S.l.] : SSRN |
Saved in:
freely available
Extent: | 1 Online-Ressource (73 p) |
---|---|
Type of publication: | Book / Working Paper |
Language: | English |
Notes: | Nach Informationen von SSRN wurde die ursprüngliche Fassung des Dokuments March 13, 2018 erstellt |
Other identifiers: | 10.2139/ssrn.3139779 [DOI] |
Source: | ECONIS - Online Catalogue of the ZBW |
Persistent link: https://www.econbiz.de/10014115423
Saved in favorites
Similar items by person
-
Çağlayan, Çağlar, (2019)
-
Howard, David H., (2009)
-
Trogdon, Justin G., (2014)
- More ...