Adherence Affects the Performance of Mammography Screening Strategies
Which approach works best depends on the probability of a woman following the screening guidelines.
Mammography screening can prevent deaths from breast cancer, but false positive results can lead to unnecessary procedures and distress. Compared with a one-size-fits-all approach, decisions that are individualized based on patients' risk profiles and preferences could maximize the benefits of screening. Simulation models can be used to weigh the pros and cons of personalized screening under various circumstances, but these models typically do not take into account screening guideline adherence, which varies depending on a woman’s perceived risk of breast cancer.
Now a new simulation study, published in the July issue of the journal Value in Health, has evaluated how nonadherence affects the performance of various screening strategies. The three individualized screening approaches recommended different screening intervals (i.e., annual, biennial or triennial) based on age and breast cancer risk. The model took into account the likelihood of adherence to these screening recommendations depending on the risk level. The researchers evaluated performance indicators such as cost, additional lifetime, quality of life and false positive results.
Which strategy performed the best depended on the level of adherence in different risk groups. Even small changes in adherence levels affected the performance of the screening strategy. Under certain adherence conditions, personalized screening strategies may perform as well as biennial routine screening, but save cost. For high-risk women, individualized screening strategies may be more attractive than routine screening if they are more likely to adhere. According to the authors, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best approach.