title: Optimal Policies for Reducing Unnecessary Follow-up Mammography Exams in Breast Cancer Diagnosis.
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.
authors: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, WI, 53705, alagoz@engr.wisc.edu.
authors: Oguzhan
authors: O
authors: Alagoz
authors: Department of Health Policy and Management and Industrial Engineering, University of Pittsburgh, 130 De Soto Street Pittsburgh, PA, 15261, chhatwal@pitt.edu.
authors: Jagpreet
authors: J
authors: Chhatwal
authors: Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, eburnside@uwhealth.org.
authors: Elizabeth S
authors: ES
authors: Burnside
keywords: Markov decision processes; breast cancer diagnosis; double control-limit policy; mammography interpretation; medical decision making; practice