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- Title
Optimal Policies for Reducing Unnecessary Follow-Up Mammography Exams in Breast Cancer Diagnosis.
- Authors
Alagoz, Oguzhan; Chhatwal, Jagpreet; Burnside, Elizabeth S.
- Abstract
Mammography is the most effective screening tool for early diagnosis of breast cancer. Based on the mammography findings, radiologists need to choose from one of the following three alternatives: (1) take immediate diagnostic actions including prompt biopsy to confirm breast cancer; (2) recommend a follow-up mammogram; (3) recommend routine annual mammography. There are no validated structured guidelines based on a decision-analytical framework to aid radiologists in making such patient-management decisions. Surprisingly, only 15-45% of the breast biopsies and less than 1% of short-interval follow-up recommendations are found to be malignant, resulting in unnecessary tests and patient anxiety. We develop a finite-horizon discrete-time Markov decision process (MDP) model that may help radiologists make patient-management decisions to maximize a patient's total expected quality-adjusted life years. We use clinical data to find the policies recommended by the MDP model and also compare them to decisions made by radiologists at a large mammography practice. We also derive the structural properties of the MDP model, including sufficiency conditions that ensure the existence of a double control limit-type policy.
- Subjects
BREAST cancer diagnosis; MAMMOGRAMS; MEDICAL screening; FOLLOW-up studies (Medicine); MEDICAL decision making; QUALITY of life
- Publication
Decision Analysis, 2013, Vol 10, Issue 3, p200
- ISSN
1545-8490
- Publication type
Article
- DOI
10.1287/deca.2013.0272