. The goal of cancer screening is to reduce morbidity and mortality through the early detection of disease;but the benefits of screening must be weighed against potential harms, such as false-positive (FP) results, which may lead to increased healthcare costs, patient anxiety, and other adverse outcomes associated with diagnostic follow-up procedures. The overall goal of this research is to develop statistical methods for estimating the cumulative risk of a false-positive (FP) result after multiple rounds of screening in order to facilitate comparative effectiveness research for a variety of screening regimens. Our work will address three specific aims: (1) To describe operating characteristics of existing statistical methods for estimating the cumulative FP risk under scenarios likely to occur in screening mammography;(2) To develop new statistical methods for estimation of the FP risk under dependence of the history of FP results and the screening regimen while incorporating time-varying covariates and allowing for variability among radiologists;(3) To apply new statistical methods to analysis of the FP risk using 13 years of data from the Breast Cancer Surveillance Consortium (BCSC). Under this aim we will analyze data from the BCSC using statistical methods developed under Aim 2 and will carry out comparative effectiveness analyses of the cumulative FP risk after 10 years of annual versus biennial screening, for women beginning screening at age 40 versus 50. This work will allow us to compare the potential harms of proposed breast cancer screening regimens. By contributing information about the potential harms of screening mammography, this work will inform policy-makers and facilitate communication between patients and providers about the risks and benefits of various screening regimens. This will aid both individual decision makers and development of evidence-based guidelines.

Public Health Relevance

Title: Estimating the cumulative risk of a false-positive screening mammogram Project narrative: We propose new statistical methods for estimating the cumulative risk of a false-positive screening mammogram. By contributing information about the potential harms of screening mammography, this work will inform policy-makers and facilitate communication between patients and providers about the risks and benefits of various screening regimens. This will aid both individual decision makers and development of evidence-based guidelines.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Small Research Grants (R03)
Project #
5R03CA150007-02
Application #
8034829
Study Section
Special Emphasis Panel (ZCA1-SRLB-D (J1))
Program Officer
Divi, Rao L
Project Start
2010-06-01
Project End
2013-05-31
Budget Start
2011-06-01
Budget End
2013-05-31
Support Year
2
Fiscal Year
2011
Total Cost
$77,600
Indirect Cost
Name
Group Health Cooperative
Department
Type
DUNS #
078198520
City
Seattle
State
WA
Country
United States
Zip Code
98101
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Hubbard, Rebecca A; Miglioretti, Diana L (2013) A semiparametric censoring bias model for estimating the cumulative risk of a false-positive screening test under dependent censoring. Biometrics 69:245-53
Kerlikowske, Karla; Zhu, Weiwei; Hubbard, Rebecca A et al. (2013) Outcomes of screening mammography by frequency, breast density, and postmenopausal hormone therapy. JAMA Intern Med 173:807-16
Braithwaite, Dejana; Zhu, Weiwei; Hubbard, Rebecca A et al. (2013) Screening outcomes in older US women undergoing multiple mammograms in community practice: does interval, age, or comorbidity score affect tumor characteristics or false positive rates? J Natl Cancer Inst 105:334-41
Hubbard, Rebecca A; Johnson, Eric; Hsia, Raymond et al. (2013) The cumulative risk of false-positive fecal occult blood test after 10 years of colorectal cancer screening. Cancer Epidemiol Biomarkers Prev 22:1612-9
Kerlikowske, Karla; Hubbard, Rebecca A; Miglioretti, Diana L et al. (2011) Comparative effectiveness of digital versus film-screen mammography in community practice in the United States: a cohort study. Ann Intern Med 155:493-502
Hubbard, Rebecca A; Kerlikowske, Karla; Flowers, Chris I et al. (2011) Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med 155:481-92