Estimating the Cumulative Risk of a False‐Positive Test in a Repeated Screening Program

Abstract

The goal of screening tests for a chronic disease such as cancer is early detection and treatment with a consequent reduction in mortality from the disease. Screening tests, however, might produce false positive and false-negative results. With an increasing number of screening tests, it is clear that the risk of a false-positive screen, a finding with potentially significant emotional, financial, and health costs, also increases. Elmore et al. (1998, New England Journal of Medicine 338, 1089-1096), Christiansen et al. (2000, Journal of the National Cancer Institute 92, 1657-1666), and Gelfand and Wang (2000, Statistics in Medicine 19, 1865-1879) investigated this problem under the somewhat unrealistic assumption that the choice of making the decision to drop out at the kth screen does not depend upon the results of the earlier k - 1 screens. In this article we obtain sufficient and necessary conditions for their assumption to hold and use one of them to provide a method for testing the validity of the assumption. A new model which does not depend on their assumption is introduced. The maximum likelihood estimator of the cumulative risk of receiving a false-positive screen under the new model is derived and its asymptotic normality is proved. The extension of the new model by incorporating covariate information is also considered. We apply our testing method and the new model to data from the breast cancer screening trial of the Health Insurance Plan of Greater New York.

Cumulative Incidence of False-Positive Results in Repeated, Multimodal Cancer Screening

“…The approach applied a model for a single screening test to multiple tests. 27 The model is a type of survival analysis based upon number of tests taken rather than time elapsed. The tests are ordered by appearance and analyzed by tests-to-event rather than by time-to-event; this method allows for appropriate handling of missing tests while enhancing use of available data.…”

Cumulative Probability of False-Positive Recall or Biopsy Recommendation After 10 Years of Screening Mammography

“…They will undergo 17 examinations if they start biennial screening at age 40, 24 if they start annual screening at age 50, and 34 if they start annual screening at age 40. Estimates of the probability that a woman will experience at least one FP recall after 10 screening examinations range from 29% to 77% (10)(11)(12), and are about 8-9% for benign biopsy (12,13). These estimates, however, are based on extrapolations, are limited by statistical methodology that assumes women participating in multiple screening rounds are representative of all women recommended for screening, and do not take into account factors shown in prior studies to be associated with wide variability in FP rates, such as radiologist recall rates (14)(15)(16)(17) and patient age, breast density, hormone therapy use, and screening interval (6,15,18).…”

Solutions of Inverse Problems with Potential Application for Breast Tumour Detection Using Microwave Measurements

“…The microwave signal we use in this application is harmless, because it has a low power and therefore does not damage the normal cells. Screening mammography is the most effective method used at present for breast cancer detection but it suffers from a number of drawbacks such as: high false-positive and falsenegative rates, a possible risk factor, discomfort for the examinee and their difficulty in tolerating breast compression [2,3]. In our approach, the microwave signal applied from the surface of the breast skin requires a minimal compression of the breast for accurate measurements.…”