Quantifying performance thresholds for recommending screening mammography: A revealed preference analysis of USPSTF guidelines Journal Article


Authors: Narayan, A. K.; Elkin, E. B.; Lehman, C. D.; Morris, E. A.
Article Title: Quantifying performance thresholds for recommending screening mammography: A revealed preference analysis of USPSTF guidelines
Abstract: Purpose: During ongoing controversies about mammography screening, many investigators have stated that performance improvements in screening mammography may mitigate concerns about harms. However, there have been few attempts to quantify performance improvements required to recommend mammography screening. Based on USPSTF benchmarks, we utilized revealed preference methods to ascertain quantitative thresholds at which screening mammography would be recommended beyond biennial screening in women 50 and older. Methods: Benefits of routine screening mammography (breast cancer deaths averted) were from published USPSTF meta-analyses. Potential harms (10-year cumulative probability of at least one false-positive) were from published Breast Cancer Surveillance Consortium estimates. We identified the implicit threshold (benefit/harm ratio) to recommend biennial screening starting at age 50. Using this threshold, we ascertained reductions of false-positives required to recommend more frequent screening and screening initiation under age 50 using revealed preference analyses. Results: Using USPSTF implied benefit/harm ratio, routine biennial screening would be recommended starting at 40 if false-positives declined by at least 62%. Reductions of false-positive proportions of 74% would be required to recommend annual screening starting at 40 and reductions of false-positive proportions of 31% would be required to support annual screening starting at 50. Conclusions: Using USPSTF revealed preferences, 31–74% reductions in false-positives would be required to recommend mammography screening beyond biennial screening starting at age 50. Widespread implementation of tomosynthesis and reducing recall rates to the lower end of recommended recall rates (5–12%) would provide support for expanding screening beyond biennial screening in women age 50. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: breast cancer; economics; screening; guidelines; revealed preferences
Journal Title: Breast Cancer Research and Treatment
Volume: 172
Issue: 2
ISSN: 0167-6806
Publisher: Springer  
Date Published: 2018-11-01
Start Page: 463
End Page: 468
Language: English
DOI: 10.1007/s10549-018-4917-5
PUBMED: 30128821
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 November 2018 -- Source: Scopus
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MSK Authors
  1. Elizabeth A Morris
    248 Morris
  2. Elena B Elkin
    151 Elkin