Should she have a mammogram?

40 yr old woman
non smoker
2 children (10 and 16 yrs)
pre-menopausal
aunt developed breast cancer at 63 yrs

what evidence is needed to inform decision?

1. proportion of women like her who have breast cancer (i.e.
prior to having a mammogram)
2. accuracy of mammograms for detecting cancer

Rod Jackson, University of Auckland

What evidence is needed to inform decision?
1. proportion of women like her who have breast cancer (i.e.
prior to having a mammogram)
2. accuracy of mammograms for detecting cancer

40 year-old
women:
~ 0.1% will have
breast cancer
test accuracy
= 9 (if positive)

only ~ 1% of 40
year old women with
a positive
mammogram have
breast cancer
 40 year-old 0%
0.1 ✖
women:
~ 0.1% will have
breast cancer
1

proportion of 5
Fagan
population 10 nomogram
being tested
who have %
condition 50

95

100%
 40 year-old 0% ∞
0.1 ✖
women:
~ 0.1% will have
breast cancer
1

proportion of 100
Fagan
population 5
10
being tested 10 ✖ nomogram
who have 1
condition % .5

50 .05

.005
test accuracy
= 9 (if positive) 95

100% 0
 40 year-old 0% ∞ 100%
women: 0.1 ✖
~ 0.1% will have
breast cancer proportion of those
who test positive /
Prevalence/pre- 1 90 negative who have the
test probability condition
100
proportion of 5 Post-test
population being 10
✖ 50
probability
10
tested who have
condition % 1
.5 %
50 10
.05
5 only ~ 1% of 40
.005 year old women
Likelihood ratio with a positive
✖1
test accuracy mammogram
95
= 9 (if positive) have breast
cancer
0.1
100% 0 0%
 40 year-old 0% ∞ 100%
0.1 ✖
women:
~ 0.1% will have
breast cancer
1 90
100

5
10
10 50
1
.5
% ✖ %
50 10 Only ~ 0.01%
.05
5 of 40 year old
test accuracy .005 women with a
= 0.1 (if negative) 1 negative
95 mammogram
have breast
✖ 0.01 cancer
100% 0 0%