Revealed Preferences Analysis and US Preventative Services Task Force Breast Cancer Screening Guidelines

Transcription

1 Revealed Preferences Analysis and US Preventative Services Task Force Breast Cancer Guidelines No Financial Disclosures Contact: Anand Narayan, MD/PhD Elena Elkin, PhD Elizabeth Morris, MD

2 Revealed preference methods have been used in economics to ascertain consumer preferences by quantitatively analyzing consumer choices.

3 Implicit behind breast cancer screening guidelines are the preferences of guideline makers for acceptable trade offs between the benefits and harms of screening mammography, however these preferences are often not explicitly stated in the development of these guidelines.

4 Purpose The purpose of our study was to utilize revealed preference methods to ascertain implicit preferences and thresholds at which screening mammography is recommended.

5 USPSTF Guidelines Recommend Biennial in Women Between Implicit Quantitative Threshold in Recommending Above 50 but not below 50

6 Methods Data Sources Benefits of Mammography Breast Cancer Specific Mortality Reductions From US Preventative Services Task Force Harms of Mammography Number of False Positive Examinations From Breast Cancer Surveillance Consortium

7 Statistical Methods Ratios of harms (false ) to benefits (number of deaths prevented) were calculated using annual and biennial screening strategies above and below 50 years old. Sensitivity analyses were performed to determine the extent to which altering potential harms of screening mammography in women under age 50 would make breast cancer screening acceptable using thresholds using revealed preference thresholds

8 Results: Quantitative Harms of Mammography Cumulative False Positive Proportion over 10 Years Age Group Annual Biennial % 41.6% % 42.0% From: for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. 2016;164(4): doi: /m Date of download: 3/14/2017 Copyright American College of Physicians. All rights reserved.

9 Quantitative Benefits of Breast Cancer Over 10 Years Age years Age years 3 breast cancer deaths avoided per 10,000 women screened 8 breast cancer deaths avoided per 10,000 women screened From: for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. 2016;164(4): doi: /m Date of download: 3/14/2017 Copyright American College of Physicians. All rights reserved.

10 Quantitative Comparison of Harms vs Benefits of False Positive Examinations Required to Prevent 1 Death Age Group Annual 2043 false 766 false Biennial 1400 false 525 false

11 False Positive Examinations Required to Prevent 1 Death Age Group Annual 2043 false Biennial 1400 false false 525 false Quantitative Threshold for Recommending by USPSTF 525 False Positive Examinations per 1 death Prevented from Breast Cancer

12 False Positive Examinations Required to Prevent 1 Death Age Group Annual 2043 false 766 false Biennial 1400 false 525 false Using Threshold of 525 False Positive Examinations, we would need to reduce false by 74 percent to achieve the threshold for annual screening in women 40-49

13 Reductions in False Positives Required to Achieve USPSTF Threshold for Recommending Routine Age Group Annual Biennial percent 63 percent percent Recommended

14 Conclusions Revealed preference analyses of US Preventative Service Task force guideline makers suggest that 525 false positive examinations for every 1 additional death prevented from breast cancer to be an acceptable threshold for recommending routine screening mammography

15 Conclusions Using US Preventative Services Task forces revealed preferences, reductions of false positive proportions between percent would be required to recommend routine screening mammography beyond biennial screening in women beyond age 50.