This grant provides funding for the development of a mathematical model to examine whether different mammogram screening intervals should be used pre-menopause and post-menopause. Analysis of this model will provide insight into the following questions: how worthwhile is it, in terms of mortality risk, to use different mammogram intervals in the pre- and post-menopausal phases? Should screening be more frequent pre- or post-menopause? How does screening start-age/stop-age affect mortality risk? These questions are particularly interesting given the dynamic nature of breast cancer incidence, breast cancer aggression, and mammogram-efficacy between the pre- and post-menopausal phases. Using a partially observed Markov decision process model, different screening policies will be evaluated, and informative tradeoff curves that plot some measure of "policy effort" versus mortality risk will be constructed. Attention will be restricted to two types of policies: "routine" policies that prescribe the same screening interval over the life of the patient, and "two-phase" policies that prescribe one interval pre-menopause and a different interval post-menopause.
The results of this research will potentially benefit society through patient-empowerment and improved public policy. The tradeoff curves will allow women to tailor their own mammogram screening choices based on individual risk preference, economic status, insurance coverage, incidence propensity, etc.. The tradeoff curves will present the quantitative relationship between screening policy and mortality risk in a format that is both understandable and useful for "non-scientists." If successful, the outcomes of the proposed research may also impact American Cancer Society policy recommendations for breast cancer screening.
