Improving the diagnostic accuracy of a stratified screening strategy by identifying the optimal risk cutoff
| Autor: | Deborah H. Glueck, Mieke Kriege, Brandy M. Ringham, R. Edward Hendrick, John T. Brinton |
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| Přispěvatelé: | Medical Oncology |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Risk Cancer Research medicine.medical_specialty Population Breast Neoplasms Article 03 medical and health sciences Breast cancer screening 0302 clinical medicine Breast cancer Cancer screening medicine Humans Mass Screening Mammography Cutoff Medical physics 030212 general & internal medicine education Early Detection of Cancer education.field_of_study Framingham Risk Score medicine.diagnostic_test business.industry Models Theoretical medicine.disease Magnetic Resonance Imaging Oncology 030220 oncology & carcinogenesis Female Risk assessment business |
| Zdroj: | Cancer Causes Control Cancer Causes & Control, 30(10), 1145-1155. Springer Netherlands |
| ISSN: | 1573-7225 0957-5243 |
| Popis: | 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. 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. A risk model with an excellent discriminatory accuracy (c-statistic $$= 0.947$$ ) yielded a reasonable cutoff where only about 20% of women had dual screening. However, the BCSC risk model (c-statistic $$= 0.631$$ ) lacked the discriminatory accuracy to differentiate between women who needed dual screening, and women who needed only mammography. 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. |
| Databáze: | OpenAIRE |
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