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Detection and selection decisions in the practice of screening mammography
Author(s) -
Stewart Thomas R.,
Mumpower Jeryl L.
Publication year - 2004
Publication title -
journal of policy analysis and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.898
H-Index - 84
eISSN - 1520-6688
pISSN - 0276-8739
DOI - 10.1002/pam.20055
Subject(s) - citation , selection (genetic algorithm) , mammography , computer science , library science , state (computer science) , artificial intelligence , medicine , algorithm , breast cancer , cancer
A large class of problems in society requires detection or selection decisions. Examples include: Who should receive extra scrutiny in airport screening? What personal characteristics, if any, should patrolling police attend to? What blood alcohol levels constitute driving while intoxicated? What thresholds should be used for issuing severe weather warnings or terrorist-related security alerts? At what age, if any, should men routinely receive PSA testing for prostate cancer, and what thresholds should be established for treatment? In this paper we focus on an important member of this class-the practice of screening mammography. Substantial uncertainty and disagreement persist concerning the value of regular mammogram screenings for women, particularly those between the ages of 40 and 49. For example, the National Breast Cancer Coalition (2003) has concluded that there is insufficient evidence to recommend for or against screening mammography for any age group of women. Conversely, the U.S. Preventive Services Task Force (2002) has recommended screening mam-mography, with or without clinical breast examination, every 1 to 2 years for women aged 40 and older.' The results of seven controlled clinical trials on the effectiveness of screening mam-mography remain controversial (e g , de Koning, 2003; Olsen and Gotzsche, 2001). Critics argue that the studies are flawed and inconclusive. Taken as a whole, data from these trials indicate a 24 percent decline in breast cancer mortality associated with ' As an anonymous reviewer noted, the Task Force was rather tepid in its endorsement. Their summary of recommendations concluded: "For women age 40-49, the evidence that screening mammography reduced mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller than it is for older women."