The preference for new imaging techniques in
breast cancer screening using multiple
performance scenarios
Jasmijn Roelvink MSc, Marjan J.M. Hummel PhD, Janine A. van Til PhD, Ellen M. Ten Tije MSc, Marloes ten
Voorde MSc, Maarten J. IJzerman PhD
1.Department of Health Technology & Services Research, University of Twente, The Netherlands
2. Bevolkingsonderzoek Oost, The Netherlands
Objectives
For the detection of breast cancer, new techniques are in development that are less painful to clients than digital
mammography is.
One of these technologies in development is Photoacoustic Mammography (PAM).
This technique could increase attendance in breast cancer screening programs, and consequently increase health gains of women.
However, the conditions of acceptance of such a technique by clients and health care professionals are still unknown.
Methods
The Analytic Hierarchy Process (AHP), a technique for multi-criteria analysis using pairwise comparisons, is applied.
The AHP supported the elicitation of preferences of 142 clients and 20 health care professionals who work in the population screening.
Three scenarios with a negative , average , and positive
estimation of the diagnostic effectiveness of PAM are included. Preferences for these scenarios of PAM are compared with the preferences for digital mammography.
Conclusion
New techniques to detect breast cancer in screening programs should at least equal the diagnostic effectiveness of X-ray mammography. Additional advantages could slightly increase screening attendance. X-ray mammography has a relatively low diagnostic effectiveness for clients with dense breasts. Therefore, this subpopulation of clients could be the most promising of new, user-friendly detection techniques with a working principle that differs from X-ray mammography.
Results
The sensitivity of a new screening technique is judged to be the most important criterion in accepting a new screening
technology, for both clients and health care professionals. PAM will be slightly preferred over digital mammography only in the positive scenario: to be preferred, its performance on sensitivity and specificity should at least equal the
performance of digital mammography.
Less client discomfort will hardly increase acceptance of new detection techniques by radiologists and radiology
assistants, and slightly increase acceptance by patients.
PAM negative (0,121) PAM average (0,160) PAM positive (0,372) Digital mammography (0,347) Compression Posture Sensitivity Specificity Man power Costs Scan time Ergonomics Radiation Choose the preferred
breast cancer screening technology Comfort (0,117) Effectiveness (0,637) Efficiency (0,151) Risks (0,096) Analytic hierarchy proces Radiologists (n=4) Radiology assistants (n=13) Advisory body (n=2) Manager of screening (n=1) Clients (n=142)
AHP hierarchy Participants in the study
Preferences for the PAM scenarios
0,126 0,169 0,386 0,319 0,182 0,194 0,34 0,281 0 0,05 0,1 0,15 0,2 0,25 0,3 0,35 0,4 0,45 Health care professionals Clients
