Improving the diagnostic accuracy of a stratified screening strategy by identifying the optimal risk cutoff.
Background: The American Cancer Society (ACS) suggests using a stratified strategy for breast cancer screening. The strategy includes assessing risk of breast cancer, screening women at high risk with both MRI and mammography, and screening women at low risk with mammography alone. The ACS chose the...
| Publicado en: | Cancer Causes & Control Vol. 30; no. 10; pp. 1145 - 1156 |
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| Autores principales: | , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
Oct2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=138521409&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 138521409 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09575243 ODX jtl: Cancer Causes & Control issn: 09575243 maglogo: N pubinfo: dt: Oct2019 vid: 30 iid: 10 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 138521409 138521409 NLM31377875 10.1007/s10552-019-01208-9 NLM31377875 138521409 ppf: 1145 ppct: 11 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Improving the diagnostic accuracy of a stratified screening strategy by identifying the optimal risk cutoff. aug: au: Brinton, John T. Hendrick, R. Edward Ringham, Brandy M. Kriege, Mieke Glueck, Deborah H. affil: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA sug: subj: Health Screening Methods Breast Neoplasms Diagnosis Early Detection of Cancer Models, Theoretical Female Mammography Relative Risk Magnetic Resonance Imaging Adult Questionnaires Adult: 19-44 years Female ab: Background: The American Cancer Society (ACS) suggests using a stratified strategy for breast cancer screening. The strategy includes assessing risk of breast cancer, screening women at high risk with both MRI and mammography, and screening women at low risk with mammography alone. The ACS chose their cutoff for high risk using expert consensus.Methods: We propose instead an analytic approach that maximizes the diagnostic accuracy (AUC/ROC) of a risk-based stratified screening strategy in a population. The inputs are the joint distribution of screening test scores, and the odds of disease, for the given risk score. Using the approach for breast cancer screening, we estimated the optimal risk cutoff for two different risk models: the Breast Cancer Screening Consortium (BCSC) model and a hypothetical model with much better discriminatory accuracy. Data on mammography and MRI test score distributions were drawn from the Magnetic Resonance Imaging Screening Study Group.Results: A risk model with an excellent discriminatory accuracy (c-statistic [Formula: see text]) yielded a reasonable cutoff where only about 20% of women had dual screening. However, the BCSC risk model (c-statistic [Formula: see text]) lacked the discriminatory accuracy to differentiate between women who needed dual screening, and women who needed only mammography.Conclusion: Our research provides a general approach to optimize the diagnostic accuracy of a stratified screening strategy in a population, and to assess whether risk models are sufficiently accurate to guide stratified screening. For breast cancer, most risk models lack enough discriminatory accuracy to make stratified screening a reasonable recommendation. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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