Abstract
Mathematical models and decision analyses based on microsimulations have been shown to be useful in evaluating relative merits of various screening strategies in terms of cost and mortality reduction. Most investigations regarding the balance between mortality reduction and costs have focused on a single modality, mammography. A systematic evaluation of the relative expenses and projected benefit of combining clinical breast examination and mammograpphy is not at present available. The purpose of this report is to provide methodologic details including assumptions and data used in the process of modeling for complex decision analyses, when searching for optimal breast cancer screening strategies with the multiple screening modalities. To systematic evaluate the relative expenses and projected bene- fit of screening programmes that combine the two modalities, we build a simulation model incorporating age-specific incidence of the disease, age-specific pre-clinical duration of the disease, age-specific sensitivities of the two screening modalities, and competing causes of mortality. Using decision models, we can integrate information from different sources into the modeling processes, and assess the cost-effectiveness of a variety of screening strategies while incorporating uncertainties.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Weir HK, Thun MJ, Hankey BF, Ries LA, Lowe HL, Wingo PA, Jemal A, Ward E, Anderson RN, Edwards B.: Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst, 95(17):1276–1299, 2003
National Cancer Institute: The surveillance, epidemiology, and end results (seer) program. www.seer.cancer.gov, 1998.
Research on Cancer (IARC) IA. The cancer-mondial website. www.dep.iarc.fr, 1999.
Fletcher SW; Elmore JG. Mammographic screening for breast cancer. N Engl J Med, 348(17):1672–1680, 2003.
Wang L. Mammography and beyond: Building better breast cancer screening tests. J Natl Cancer Inst, 94(18):1346–1347, 2002.
Berry DA. Benefits and risks of screening mammography for women in their forties: A statistical appraisal. J Natl Cancer Inst, 90:1431–1439, 1998.
Gordis L; Berry D; Chu S; et al. Breast cancer screening for women ages 40–49. J Natl Cancer Inst, 89:1015–1026, 1997.
Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: screening mammography among women aged 40–49 years at average risk of breast cancer. CMAJ, 164(4):469–476, 2001.
Parmigiani G. Measuring uncertainty in complex decision analyses models. Statistical Methods in Medical Research, 11(6):513–37, 2002.
van Oortmarseen G; Boer R; Habbema J. Modeling issues in cancer screening. Statistical Methods in Medical Research, 4:33–54, 1995.
Parmigiani G. Modeling in Medical Decision Making. Wiley, Chichester, 2002.
Parmigiani G. On optimal screening ages. J Amer Stat Assoc, 88:622–628, 1993.
De Koning H. Breast cancer screening; cost-effectiveness in practice. Eur J Radiol, 33:32–7, 2000.
Lindfors KK; Rosenquist CJ. The cost-effectiveness of mammographic screening strategies. J Am Med Assoc, 274:881–884, 1995.
Brown ML. Sensitivity analysis in the cost-effectiveness of breast cancer screening. Cancer, 69(7 Suppl):1963–1967, 1992.
Mushlin AI; Fintor L. Is screening for breast cancer cost-effective? Cancer, 69(7 Suppl):1957–1962, 1992.
van Ineveld BM; van Oortmarssen GJ; de Koning HJ; Boer R; van der Maas PJ. How cost-effective is breast cancer screening in different EC countries? European Journal of Cancer, 29:1663–1668, 1993.
Brown ML; Fintor L. Cost-effectiveness of breast cancer screening: preliminary results of a systematic review of the literature. Breast Cancer Res Treat, 25:113–118, 1993.
Elixhauser A. Costs of breast cancer and the cost-effectiveness of breast cancer screening. Int J Technol Assess Health Care, 7:604–615, 1991.
Clark RA. Economic issues in screening mammography. Am J of Roentgenology, 158:527–534, 1992.
Parmigiani G; Kamlet M. Cost-utility analysis of alternative strategies in screening for breast cancer. In C Gatsonis; J Hodges; RE Kass; N Singpurwalla, eds., Case Studies in Bayesian Statistics, 390–402. Springer, New York, 1993.
Eddy DM; Hasselblad V; McGivney W; Hendee W. The value of mammography screening in women under age 50 years. J Am Med Assoc, 259:1512–1519, 1989.
Carter R; Glasziou P; van Oortmarssen G; de Koning H; Stevenson C; Salkeld G; Boer R. Cost-effectiveness of mammographic screening in Australia. Austr J Pub Health, 17:42–50, 1993.
Saltzmann P; Kerlikowske K; Phillips K. Cost-effectiveness of extending screening mammography guidelines to include women 40 to 49 years of age. Ann Intern Med, 127:955–965, 1997.
Burnside E; Belkora J; Esserman L. The impact of alternative practices on the cost and quality of mammographic screening in the United States. Clinical Breast Cancer, 2(2):145–152, 2001.
Fett M. Computer modelling of the Swedish two country trial of mammographic screening and trade offs between participation screening interval. J Med Screen, 8(1):39–45, 2001.
Yasmeen S; Romano P; Pettinger M; Chlebowski R; Robbins J; Lane D; Hendrix S. Frequency and predictive value of a mammographic recommendation for short-interval follow-up. J Natl Cancer Inst, 95(6):429–436, 2003.
Kerlikowske K; Smith-Bindman R; Sickles E. Short-interval follow-up mammography: Are we doing the right thing? J Natl Cancer Inst, 95(6):418–419, 2003.
Barton MB; Harris R; Fletcher SW. Does this patient have breast cancer? The screening clinical breast examination: Should it be done? How? J Am Mec Assoc, 282:1270–80, 1999.
Baines CJ; Miller AB; Bassett AA. Physical examination. its role as a single screening modality in the canadian national breast screening study. Cancer, 63:1816–22, 1989.
Bobo J; Lee N; Thames SF. Findings from 752081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst, 92:971–6, 2000.
Shen Y; Zelen M. Screening sensitivity and sojourn time from breast cancer early detection clinical trials: mammograms and physical examinations. J Clin Oncol, 19:3490–9, 2001.
Shen Y; Parmigiani G. A model-based comparison of breast cancer screening strategies: Mammograms and clinical breast examinations. Cancer Epidemiology, Biomarkers and Prevention, in press, 2005.
Moolgavkar SH; Stevens RG; Lee JAH. Effect of age on incidence of breast cancer in females. J Natl Cancer Inst, 62:493–501, 1979.
Parmigiani G; Skates S. Estimating the age of onset of detectable asymptomatic cancer. Mathematical and Computer Modeling, 33:1347–1360, 2001.
Albert A; Gertman P; Louis T. Screening for the early detection of cancer: I. the temporal natural history of a progressive disease state. Mathematical Biosciences, 40:1–59, 1978.
Day NE; Walter SD. Simplified models of screening for chronic disease: Estimation procedures from mass screening programmes. Biometrics, 40:1–13, 1984.
Brookmeyer R; Day NE; Moss S. Case-control studies for estimation of the natural history of preclinical disease from screening data. Statistics in Medicine, 5:127–138, 1986.
Etzioni RD; Shen Y. Estimating asymptomatic duration in cancer: the AIDS connection. Stat in Med, 16:627–644, 1997.
Straatman H; Peer PG; Verbeek AL. Estimating lead time and sensitivity in a screening program without estimating the incidence in the screened group. Biometrics, 53:217–229, 1997.
Shen Y; Zelen M. Parametric estimation procedures for screening programmes: Stable and nonstable disease models for multimodality case finding. Biometrika, 86:503–515, 1999.
Spratt JS; Greenberg RA; Heuser LS. Geometry, growth rates, and duration of cancer and carcinoma in situ of the breast before detection by screening. Cancer Research, 46:970–974, 1986.
Peer P; van Dijck JAAM; Hendriks J; Holland R; Verbeek ALM. Age-dependent growth rate of primary breast cancer. Cancer, 71:3547–3551, 1993.
Peer P; Verbeek A; Straatman H; Hendriks J; Holland R. Agespecific sensitivities of mammographic screening for breast cancer. Breast Cancer Research and Treatment, 38:153–160, 1996.
National Cancer Institute: Chemoprevention of Estrogen Receptor (ER) Negative Breast Cancer Preclinical Studies. NIH homepage. http://grants1.nih.gov/grants/guide/rfa-files/RFA-CA-03-005.html, 2002.
Wood W; Weiss R; Tormey D; Holland J; Henry P; Leone L; et al. A randomized trial of CMF versus CMFVP as adjuvant chemotherapy in women with node-positive stage ii breast cancer: a CALGB study. World J Surg, 9:714–718, 1985.
Perloff M; Norton L; Korzun A; Wood W; Carey R; Gottlieb A; et al. Postsurgical adjuvant chemotherapy of stage ii breast carcinoma with or without crossover to a non-cross-resistant regimen: a cancer and leukemia group b study. J Clin Oncol, 14:1589–98, 1996.
Wood W; Budman D; Korzun A; Cooper M; Younger J; Hart R; et al. Dose and dose intensity of adjuvant chemotherapy for stage ii, node-positive breast carcinoma. N Engl J Med, 330:1253–1259, 1994.
Parmigiani G; Berry DA; Winer EP; Tebaldi C; Iglehart JD; Prosnitz L. Is axillary lymph node dissection indicated for early stage breast cancer-a decision analysis. J Clin Oncol, 17(5):1465–1473, 1999.
Shen Y; Wu D; Zelen M. Testing the independence of two diagnostic tests. Biometrics, 57:1009–1017, 2001.
Kerlikowske K; Grady D; Barclay J; Frankel SD; Ominsky SH; Sickles EA; Ernster V. Variability and accuracy in mammographic interpretation using the american college of radiology breast imaging reporting and data system. J Natl Cancer Inst, 90(23):1801–1809, 1998.
PREVENTION. Cancer tests worth paying for. http://www.prevention.com/cda/feature/0,1204,876,00.html, 2002.
Matchar DB; Samsa GP. Using outcomes data to identify best medical practice: the role of policy models. Hepatology, Jun; 29(6 Suppl):36S–39S, 1999.
Barratt A; Irwig L; Glasziou P; et al. Users’ guides to the medical literature: XVII. how to use guidelines and recommendations about screening. evidence-based medicine working group. J Am Mec Assoc, 281(21):2029–2034, 1999.
Elmore JG; Barton MB; Moceri VM; Polk S; Arena PJ; Fletcher SW. Ten-year risk of false positive screening mammograms and clinical breast examinations. N Engl J Med, 338:1089–1096, 1998.
Shapiro S. Periodic screening for breast cancer: The HIP randomized controlled trial. Monogr Natl Cancer Inst, 22:27–30, 1997.
Miller A; To T; Baines C; Wall C. The Canadian national breast screening study: Update on breast cancer mortality. Monogr Natl Cancer Inst, 22:37–41, 1997.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Springer Science+Business Media, Inc.
About this paper
Cite this paper
Shen, Y., Parmigiani, G. (2006). Optimization of Breast Cancer Screening Modalities. In: Nikulin, M., Commenges, D., Huber, C. (eds) Probability, Statistics and Modelling in Public Health. Springer, Boston, MA. https://doi.org/10.1007/0-387-26023-4_27
Download citation
DOI: https://doi.org/10.1007/0-387-26023-4_27
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-387-26022-8
Online ISBN: 978-0-387-26023-5
eBook Packages: Mathematics and StatisticsMathematics and Statistics (R0)