Abstract for: Our Walk to the “End of Cancer”: Understanding the Trade-Offs and Feedback in Mammography Screening Decision

Implications of widespread mammography screening remain controversial, and major health organizations in the US adopt different guidelines reflecting significant variations in actual practice. Literature suggests that implementation of routine screening over the past 30 years has incurred less benefit and more harms than is formerly believed. The classical approach to setting guidelines is based on the statistical paradigm of TypeI and TypeII errors, seeking to find an evidence-based balance between sensitivity and specificity, given the costs and benefits of different outcomes. However, a wide range of considerations play important roles in determining both the formal guidelines and how these are interpreted and acted upon by providers, payers, and advocacy groups. Science and evidence, including the processes that generate evidence, are embedded in a sociopolitical system. In this study we develop the first explicit feedback theory around the dynamics of health screening. The theory we develop includes core issues around costs and benefits of screening including the fundamental tradeoff between sensitivity and specificity. However it also includes some of the sociopolitical feedbacks that condition formal guidelines and the actual practice. We use the mammography case as the motivating example, but our model is generic enough to be applicable to other contexts.