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

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.