Improving the diagnostic accuracy of a stratified screening strategy by identifying the optimal risk cutoff

Cancer Causes & Control : CCC
John T BrintonDeborah H Glueck

Abstract

The American Cancer Society (ACS) suggests using a stratified strategy for breast cancer screening. The strategy includes assessing risk of breast cancer, screening women at high risk with both MRI and mammography, and screening women at low risk with mammography alone. The ACS chose their cutoff for high risk using expert consensus. We propose instead an analytic approach that maximizes the diagnostic accuracy (AUC/ROC) of a risk-based stratified screening strategy in a population. The inputs are the joint distribution of screening test scores, and the odds of disease, for the given risk score. Using the approach for breast cancer screening, we estimated the optimal risk cutoff for two different risk models: the Breast Cancer Screening Consortium (BCSC) model and a hypothetical model with much better discriminatory accuracy. Data on mammography and MRI test score distributions were drawn from the Magnetic Resonance Imaging Screening Study Group. A risk model with an excellent discriminatory accuracy (c-statistic [Formula: see text]) yielded a reasonable cutoff where only about 20% of women had dual screening. However, the BCSC risk model (c-statistic [Formula: see text]) lacked the discriminatory accuracy to differentiate betw...Continue Reading

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Citations

Apr 12, 2020·Breast Cancer Research : BCR·Chang MingMaria C Katapodi
Jan 8, 2021·European Radiology·Marta RománXavier Castells

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BETA
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