Sicsic Jonathan, Pelletier-Fleury Nathalie, Moumjid Nora
Centre Léon Bérard, Cancer Environment Team, Lyon, France; CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France; Health Services and Performance Research (HESPER EA 7425), Lyon, France.
CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.
Value Health. 2018 Jan;21(1):78-88. doi: 10.1016/j.jval.2017.07.003. Epub 2017 Aug 18.
Over the past decade, the benefits and harms balance of breast cancer (BC) screening has been widely debated.
To elicit women's trade-offs between the benefits and harms of BC screening and to analyze the main determinants of these trade-offs.
A discrete-choice experiment with seven attributes depicting BC screening programs including varying levels of BC mortality, overdiagnosis, and false-positive result was used. Eight hundred twelve women aged 40 to 74 years with no personal history of BC recruited by a survey institute and representative of the French general population (age, socioeconomic level, and geographical location) completed the discrete-choice experiment. Preference heterogeneity was investigated using generalized multinomial logit models from which individual trade-offs were derived, and their main determinants were assessed using generalized linear models. Screening acceptance rates under various benefits and harms ratios were simulated on the basis of the distribution of individual preferences.
The women would be willing to accept on average 14.1 overdiagnosis cases (median = 9.6) and 47.8 false-positive results (median = 27.2) to avoid one BC-related death. After accounting for preference heterogeneity, less than 50% of women would be willing to accept 10 overdiagnosis cases for one BC-related death avoided. Screening acceptance rates were higher among women with higher socioeconomic level and lower among women with poor health.
Women are sensitive to both the benefits and the harms of BC screening and their preferences are highly heterogeneous. Our study provides useful results for public health authorities and clinicians willing to improve their recommendations of BC screening on the basis of women's preferences.
在过去十年中，乳腺癌筛查的利弊平衡一直备受广泛争议。
探讨女性在乳腺癌筛查的利弊之间的权衡，并分析这些权衡的主要决定因素。
采用离散选择实验，其中七个属性描述了乳腺癌筛查项目，包括不同水平的乳腺癌死亡率、过度诊断和假阳性结果。由一家调查机构招募的812名年龄在40至74岁之间、无乳腺癌个人病史且代表法国普通人群（年龄、社会经济水平和地理位置）的女性完成了离散选择实验。使用广义多项logit模型研究偏好异质性，从中得出个体权衡，并使用广义线性模型评估其主要决定因素。根据个体偏好分布模拟了各种利弊比率下的筛查接受率。
为避免一例与乳腺癌相关的死亡，女性平均愿意接受14.1例过度诊断病例（中位数=9.6）和47.8例假阳性结果（中位数=27.2）。在考虑偏好异质性后，不到50%的女性愿意为避免一例与乳腺癌相关的死亡而接受10例过度诊断病例。社会经济水平较高的女性筛查接受率较高，健康状况较差的女性筛查接受率较低。
女性对乳腺癌筛查的益处和危害都很敏感，且她们的偏好高度异质。我们的研究为公共卫生当局和临床医生提供了有用的结果，他们希望根据女性的偏好改进乳腺癌筛查建议。
