Breast Cancer Screening Services: - Trade-offs in Quality, Capacity, Outreach, and Centralization

Much research has gone into evaluating the usefulness of mass screening for the early detection of breast cancer in women. Most of this research has been carried out independently across the different perspectives such as operations or statistics. In this Health Care Management Science paper, INSEAD's Stephen Chick, and Koc University's Evrim Gunes and Zeynep Aksin take an integrated approach. How interaction and links between capacity, quality, participation and disease progression, when considered together, can lead to a more holistic approach to breast cancer screening.

by Stephen Chick, Zeynep Aksin,Evrim Didem Günes
Last Updated: 23 Jul 2013

The world's second most common form of cancer after lung cancer, over one million women develop breast cancer every year. This leads to the highest number of cancer-related deaths for women across the planet. The developed world has been actively chasing down breast cancer over a couple of decades, and many countries have national screening programmes. The aim of these programmes is to detect breast cancer in the early stages, when the chances of recovery are higher.

In 2005, the IARC reported that breast cancer accounted for 1 in 8 of the total cancers within Europe and qualified it as one of the big four killers, along with lung, colorectal and stomach cancer. By 2002, research by the International Agency for Research on Cancer (IARC) showed that the reduction in the mortality rate from breast cancer in women between 50-69 who chose to participate in a screening programme was around 35%. And although much progress has been made in reducing mortality through mass breast screening, there is room still for further optimisation.

This research paper: Breast Cancer Screening Services: Trade-offs in Quality, Capacity, Outreach, and Centralization, looks at how efficiency could be augmented through a more integrated approach. INSEAD Professor Stephen Chick of Technology and Operations Management, and Professors Evrim Gunes and Zeynep Aksin of Koc University open up a line of research that is more inclusive, taking into account the interaction between the diverse criteria that make up a screening programme. In particular the study deals with issues within the American and French health systems. Four major simulation experiments are undertaken on two types of service; screening and follow-up diagnostic tests:

1. Cost implications of two approaches to improving early detection, either through outreach, or through increasing quality standards due to increasing the minimum screening volume standards per doctor;

2. Interactions between quality and the effects of waiting due to insufficient capacity;

3/4. Interactions of service decentralisation, access, and screening quality.

The overall results of this detailed study comparing the various parameters and their knock-on effect to a screening programme's success are clear. One of the main issues to come out of the study is the importance of the sensitivity and specificity dimensions of screening test quality.

For instance, low quality leads to higher costs, as the then required unnecessary additional tests due to false positive screening test results waste system capacity. A number of countries are looking at increasing participation in screening programmes, and the study raises the point that such an increase should not be without the availability of sufficient capacity. If this is not in place, an established screening programme may run the risk of actually losing ground in the fight to detect breast cancer in the early stages due to longer waiting lists and the inevitable decrease in service quality due to the increased decentralisation.

Through this study, Chick, Gunes and Aksin bring to the forefront the important interactions between volume, quality, capacity and time-to-screening; not yet so extensively explored in previous studies. The simulations outlined deal with system behaviour and health outcomes for certain aspects of breast screening, and such an approach could well be useful in other applications such as colorectal cancer, another of the 'big four'.

Health Care Management Science No. 4, 2004

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