Optimal Policies for Reducing Unnecessary Follow-Up Mammography Exams in Breast Cancer Diagnosis

Oguzhan Alagoz (), Jagpreet Chhatwal () and Elizabeth S. Burnside ()
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Oguzhan Alagoz: Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin 53705
Jagpreet Chhatwal: Department of Health Policy and Management and Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania 15261
Elizabeth S. Burnside: Department of Radiology, University of Wisconsin–Madison, Madison, Wisconsin 53792

Decision Analysis, 2013, vol. 10, issue 3, 200-224

Abstract: Mammography is the most effective screening tool for early diagnosis of breast cancer. Based on the mammography findings, radiologists need to choose from one of the following three alternatives: (1) take immediate diagnostic actions including prompt biopsy to confirm breast cancer; (2) recommend a follow-up mammogram; (3) recommend routine annual mammography. There are no validated structured guidelines based on a decision-analytical framework to aid radiologists in making such patient-management decisions. Surprisingly, only 15–45% of the breast biopsies and less than 1% of short-interval follow-up recommendations are found to be malignant, resulting in unnecessary tests and patient anxiety. We develop a finite-horizon discrete-time Markov decision process (MDP) model that may help radiologists make patient-management decisions to maximize a patient's total expected quality-adjusted life years. We use clinical data to find the policies recommended by the MDP model and also compare them to decisions made by radiologists at a large mammography practice. We also derive the structural properties of the MDP model, including sufficiency conditions that ensure the existence of a double control limit-type policy.

Keywords: Markov decision processes; double control limit policy; medical decision making; breast cancer diagnosis; mammography interpretation; practice; BI-RADS (search for similar items in EconPapers)
Date: 2013
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Citations: View citations in EconPapers (12)

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