Effectiveness and challenging areas of mammography screening for breast cancer: The application of computer-based simulation approach

The efficacy of mammography screening for breast cancer has been shown in worldwide trials. However, it is unknown how close could be between the efficacy and the effectiveness of mammography screening, i.e., the ratio of benefits of mammography screening under the ideal vs. average conditions of use. It is technically, financially, and ethically difficult to evaluate the effectiveness of mammography screening by traditional medical technology assessment techniques like epidemiological methods. This paper will illustrate how a computer-based simulation approach could be used to resolve the difficulty of assessing the effectiveness of mammography screening. The results show that the issue of what kind of tumors are detected is more critical than the issue of how high the detectability of mammography could be in determining the effectiveness of mammography screening. Without the capability of distinguishing true breast cancers from `limited malignant potential' lesions which may be diagnosed and treated as true breast cancers but actually will not cause breast cancer mortality even if undetected, a `better' mammography in terms of higher sensitivity and specificity might bring more harms than benefits in population. This paper shows the importance of systematic perspective, measurement of effectiveness, and the usefulness of simulation approach for biomedical engineers.