Abstract
Mammography screening has been shown in randomized trials to reduce breast cancer mortality by at least 20%, though it has risks as well due to radiation exposure and overtreatment of benign conditions. However, mammography technology and breast cancer treatment have improved since these trials were conducted and it is unlikely that large scale trials will ever be conducted again. Therefore, prospective observational data need to be used to continuously assess improvements in the screening process. We consider the successive steps for a woman undergoing screening and attempt to measure and improve each step in that process to maximize benefits while monitoring harms of screening. A large population-based study entitled PROSPR is assessing longitudinal performance of screening mammography and showing areas where improvements in follow-up of positive mammograms need to be made. In this assessment we consider sources of bias in evaluation of observational data when assessing efficacy of screening. We also propose a chained statistical model to look at steps in the overall process from screening participation to mortality.
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Barlow, W.E. (2017). Contemporary Evaluation of Breast Cancer Screening. In: Matsui, S., Crowley, J. (eds) Frontiers of Biostatistical Methods and Applications in Clinical Oncology. Springer, Singapore. https://doi.org/10.1007/978-981-10-0126-0_20
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DOI: https://doi.org/10.1007/978-981-10-0126-0_20
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