Breast Cancer Screening: Paper: Overcoming '97 Policy Crisis; Too Many Montreal Centers Spurs Study

April 16, 1998

Maximizing the effectiveness of breast cancer detection is the subject of two papers, one on the difficulties of setting policy for screening women in their forties, the other devoted to optimally locating screening centers in the Montreal area. The papers are being delivered at the Montreal conference of the Institute for Operations Research and the Management Sciences (INFORMS) and the Canadian Operations Research Society (CORS) at 1:30 PM on Tuesday, April 28.

Why Can't We Agree On Policy? Researcher Asks

Dr. Eric Wolman, who studies the special difficulties of screening for breast cancer in women under 50, examines the long-lasting inability of experts to reach an agreed-upon set of guidelines for mammographic screening of women in their forties. He maintains that the policy question hinges mainly on human values - namely, weighing the value of one life against many hundreds of false-positive tests leading to fear, expense, and many unnecessary surgical procedures. He says that direct interference by the U.S. Congress has decreased the credibility of recent expert recommendations, which seem to be heading for more agreement as new scientific evidence accumulates. In January of 1997, the National Cancer Institute sponsored a Consensus Conference on whether to screen women in their forties for breast cancer using mammography. The conference, he says, was astonishing for its disorder, level of conflict, and angry outbursts.

In his discussion, Dr. Wolman examines the natural progression of breast cancer; aspects of a screening-test that make it useful; general characteristics of medical screening tests; the interpretation - and misinterpretation -of data from clinical trials of screening tests; and current knowledge in this field.

Dr. Wolman formerly directed community cancer services at the Karmanos Cancer Institute in Detroit, and later taught at the Wayne State University School of Medicine. Currently a Visiting Research Professor at George Mason University in Fairfax, Virginia, he is a specialist in cancer screening policy and the mathematical modeling of hormonal exposures as risk factors for breast cancer.

Math Models Find Best Montreal Locations

An unusual problem led to a paper about situating breast cancer screening centers throughout Montreal: The current number of Montreal centers offering mammograms is actually too large, according to the report. To ensure that radiologists maintain high standards, says the report, every center should perform at least 4,000 mammograms a year. With 48 centers currently operating in the city, many practitioners are not doing enough tests to maintain professional excellence. Eliminating screening centers haphazardly, however, would make access more difficult for many women.

Using a mathematical model grounded in operations research techniques, the researchers were able to present options for 15, 18, or 22 centers that guarantee medical excellence and geographic accessibility. The researchers employed a sophisticated Geographic Information System (GIS) and considered criteria such as equipment quality, accreditation, and information about the radiologists at the centers under consideration.

The study was conducted by Dr. Sophie LaPierre, Center for Research on Transportation and Ecole Polytechnique, Montreal; and Dr. Vedat Verter, McGill University. It was commissioned by the Montreal Ministry of Health.

Operations Research Convention in Montreal

The papers are being presented during a convention of INFORMS and CORS in Montreal. It takes place at the Montréal Bonaventure Hilton and Queen Elizabeth Hotel from Sunday, April 26 to Wednesday, April 29. The convention will include sessions on topics applied to a wide number of fields, including aviation, health care, information technology, the Internet, energy, marketing, package delivery, pharmaceuticals, securities, and telecommunications. More than 1,600 papers are scheduled to be delivered at the four-day conference.

Operations researchers and management scientists are little known but indispensable experts who use science to improve decision-making, management, and operations. They work throughout business, government, and academia.

Additional information on the conference, including a full list of workshops, is available at

The Institute for Operations Research and the Management Sciences (INFORMS) is an international scientific society with 12,000 members, including Nobel Prize laureates, dedicated to applying scientific methods to help improve decision-making, management, and operations. Members of INFORMS work primarily in business, government, and academia. They are represented in fields as diverse as airlines, health care, law enforcement, the military, the stock market, and telecommunications.

The Canadian Operations Research Society (CORS), founded in 1958, works to advance the theory and practice of operations research. Its primary purpose is to stimulate and promote contacts between those interested in operations research. CORS members are employed across Canada in various industries, government, and academia.

Institute for Operations Research and the Management Sciences

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