Optimizing performance of BreastScreen Norway using value of information in graphical models

Abstract

This study proposes a method to optimize the performance of BreastScreen Norway through a stratified recommendation of tests including independent double or single reading of the screening mammograms and additional imaging with or without core needle biopsy. This is carefully evaluated by a value of information analysis. An estimated graphical probabilistic model describing the relationship between a set of risk factors and the corresponding risk of breast cancer is used for this analysis, together with a Bayesian network modeling screening test results conditional on the true (but unknown) breast cancer status of a woman. This study contributes towards evaluating a possibility of improving the efficiency of the screening program, where all women aged 50 to 69 are invited every second year, regardless of individual risk factors. Our stratified recommendation of tests is dependent on the probability that an asymptomatic woman has developed breast cancer at the time she is invited to a screening.

Can breast cancer be stopped? Modifiable risk factors of breast cancer among women with a prior benign or premalignant lesion

“…That HT, in addition to age, appeared as the most influential risk factor for breast cancer among women with a benign or premalignant lesion, is in line with a previous study 45 on stratified screening based on prior screening results, age and self-reported physical activity, BMI, smoking, HT, family history of breast cancer and reproductive history.…”

“…The effect of other types of HT (estrogen not in combination with progestin) and prior HT use was smaller and did not reach statistical significance, however still indicated an increased risk. That HT, in addition to age, appeared as the most influential risk factor for breast cancer among women with a benign or premalignant lesion, is in line with a previous study 45 on stratified screening based on prior screening results, age and self‐reported physical activity, BMI, smoking, HT, family history of breast cancer and reproductive history. However, our results are contrasting a previous study reporting decreased risk of progression to invasive breast cancer among HT users at diagnosis of carcinoma in situ 28 (proposedly through removal of the main etiological driver as the women quit their use of HT).…”