Analyzing overdiagnosis risk in cancer screening: A case of screening mammography for breast cancer

ABSTRACTOverdiagnosis is defined as the diagnosis of an asymptotic cancer that would not have presented clinically in a patient's lifetime in the absence of screening. Quantifying overdiagnosis is difficult, since it is impossible to distinguish between a cancer that would cause symptoms in the patient lifetime and the ones that would not. In this study, a mathematical framework is developed to estimate the lifetime overdiagnosis and cancer mortality risks associated with cancer screening policies. We also develop an optimization model to extract screening policies with minimum overdiagnosis and lifetime breast cancer mortality risk. The proposed optimization model is highly nonlinear with complex structure. Therefore, we linearize the optimization model by introducing new decision variables and restructuring the equations to solve it optimally. We utilize existing data on breast cancer for average-risk women and evaluated mammography screening policies in terms of their associated lifetime overdiagnosis ...