Individualization of Decision Making Regarding Mammographic Screening for Breast Cancer in Women 40-49 y.o. with First Degree Relative with Breast Cancer

Individualization of Decision Making Regarding Mammographic Screening for Breast Cancer in Women 40-49 y.o. with First Degree Relative with Breast Cancer

Nikita A. Makretsov (Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada)
Copyright: © 2013 |Pages: 15
DOI: 10.4018/ijudh.2013010106
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Abstract

This paper aims to help health care providers to advise the healthy female patients age of 40-49 y.o. who have one first degree relative with breast cancer, whether she should or should not participate in mammographic screening. The author’s patient is anxious whether she should have her mammogram done and whether it will benefit her. Her sister was most recently diagnosed with breast fibroadenoma. In order to answer their patient’s question the author take into consideration medical aspects of mammography as a screening test, and integrate them with patient values and preferences into a single decision-making model. This paper is based on the modeling of a decision tree, using the information extracted from open sources and peer-reviewed publications. It is based on comprehensive search for each model parameter, but is not an all-inclusive systematic review. The purpose of this work is both educational and practical: the authors try to apply the decision analysis methodology in an attempt to solve this dilemma while trying to avoid or at least minimize biased assumptions regarding usefulness of mammography in this group of patients. Based on their proposed model the decision regarding the participation into mammographic screening in this particular scenario is highly driven by patient values and preferences.
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Introduction

We aim to provide professional advice to our patient Mrs. A, a 45 y.o. healthy female with a family history of breast cancer, regarding whether she should participate in mammographic screening, and if she should, at what intervals.

There is a controversy about effectiveness of the screening, particularly in the younger age group (40-49 y.o.), where the benefits of breast cancer mortality reduction should be evaluated against the risks of overdiagnosis, discomfort caused by diagnostic procedures and psychological stress related to false-positive results and additional tests.

Our goal is to construct the personalized decision-making algorithm which will consider the outcomes of screening for breast cancer, analysis of risks and benefits of screening adjusted to patient values (utility-disutility scale) for a final decision making.

This paper depicts the process of decision making rule construction and involves several steps:

  • Step 1: Search for and analyze the evidence regarding clinical efficiency and accuracy of mammographic screening in the target age group;

  • Step 2: Generate a list of possible breast cancer outcomes in screened and non-screened target age group, necessary for decision making model and perform additional literature search if the sources identified in Step 1 are insufficient;

  • Step 3: Generate a list of patient values (utility-disutility scale) regarding all possible outcomes of screening based on additional literature searches;

  • Step 4: Construct decision tree using extracted or derived parameter values from the available evidence;

  • Step 5: Evaluate decision-making algorithm using the decision tree, considering;

    • A.

      death reduction from breast cancer as the only valued outcome; and

    • B.

      death reduction adjusted to disutilities based on possible patient values;

  • Step 6: Discuss the controversy surrounding breast cancer screening and its potential implications for individual decision making.

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