Stratified Breast Cancer Follow-Up Using a Partially Observable MDP

  • J. W. M. Otten
  • A. WitteveenEmail author
  • I. M. H. Vliegen
  • S. Siesling
  • J. B. Timmer
  • M. J. IJzerman
Part of the International Series in Operations Research & Management Science book series (ISOR, volume 248)


Frequency and duration of follow-up for patients with breast cancer is still under discussion. Current follow-up consists of annual mammography for the first five years after treatment and does not depend on the personal risk of developing a locoregional recurrence (LRR) or second primary tumor. Aim of this study is to gain insight in how to allocate resources for optimal and personal follow-up. We formulate a discrete-time Partially Observable Markov Decision Process (POMDP) with a finite horizon in which we aim to maximize the total expected number of quality-adjusted life years (QALYs). Transition probabilities were obtained from data from the Netherlands Cancer Registry (NCR). Twice a year the decision is made whether or not a mammography will be performed. Recurrent disease can be detected by both mammography or women themselves (self-detection). The optimal policies were determined for three risk categories based on differentiation of the primary tumor. Our results suggest a slightly more intensive follow-up for patients with a high risk and poorly differentiated tumor, and a less intensive schedule for the other risk groups.


Optimal Policy Markov Decision Process Belief State Optimality Equation Partially Observable Markov Decision Process 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • J. W. M. Otten
    • 1
  • A. Witteveen
    • 2
    Email author
  • I. M. H. Vliegen
    • 3
  • S. Siesling
    • 2
    • 4
  • J. B. Timmer
    • 1
  • M. J. IJzerman
    • 2
  1. 1.Department of Stochastic Operations ResearchUniversity of TwenteEnschedeThe Netherlands
  2. 2.Department of Health Technology and Services ResearchUniversity of TwenteEnschedeThe Netherlands
  3. 3.Department of Industrial Engineering and Business Information SystemsUniversity of TwenteEnschedeThe Netherlands
  4. 4.Department of ResearchComprehensive Cancer OrganisationUtrechtThe Netherlands

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