Optimal Timing for Cancer Screening and Adaptive Surveillance Using Mathematical Modeling.
Optimal Timing for Cancer Screening and Adaptive Surveillance Using Mathematical Modeling.
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DOI：
10.1158/0008-5472.can-20-0335
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发表时间：
2021-02-15
期刊：
影响因子：
11.2
通讯作者：
Luebeck GE
中科院分区：
文献类型：
--
作者：
Curtius K;Dewanji A;Hazelton WD;Rubenstein JH;Luebeck GE
癌症筛查和早期发现努力在降低发病率和死亡率方面取得了部分成功，但还需要许多改进。虽然目前的医疗实践是由流行病学研究和专家提供信息的，但指导方针的决定最终是临时的。我们在这里提出，定量优化方案可以潜在地增加筛查成功率，减少过度诊断。可以使用癌症演变的随机过程的数学建模来推导和优化临床筛查的时间，从而在可以观察到早期癌症发展的情况下，患者在用于干预的特定机会窗口内被筛查的概率是最大的。除了严格的经验方法或对许多可能的情景进行微观模拟之外，基于生物学的机械建模可以用于预测何时进行筛查和开始适应性监测的最佳时机。我们介绍了一种方法，用于优化筛查，评估潜在风险，并使用多尺度模型量化医疗保健的相关成本。作为Barrett‘s食道(BE)的案例研究，这些方法被应用于一个食管腺癌(EAC)模型，该模型之前根据美国癌症登记数据进行了校准。症状性胃食道反流病患者的最佳筛查年龄(男性58岁，女性)高于目前推荐的年龄(50岁)。这些年龄在开始筛查的成本效益范围内，并通过当前指南中使用的数据进行了独立验证。总的来说，我们的框架捕获了BE患者体内癌症演变的关键方面，以进行更个性化的筛查设计。
Cancer screening and early detection efforts have been partially successful in reducing incidence and mortality, but many improvements are needed. Although current medical practice is informed by epidemiological studies and experts, the decisions for guidelines are ultimately ad hoc. We propose here that quantitative optimization of protocols can potentially increase screening success and reduce overdiagnosis. Mathematical modeling of the stochastic process of cancer evolution can be used to derive and optimize the timing of clinical screens so that the probability is maximal that a patient is screened within a certain “window of opportunity” for intervention when early cancer development may be observable. Alternative to a strictly empirical approach or microsimulations of a multitude of possible scenarios, biologically-based mechanistic modeling can be used for predicting when best to screen and begin adaptive surveillance. We introduce a methodology for optimizing screening, assessing potential risks, and quantifying associated costs to healthcare using multiscale models. As a case study in Barrett’s esophagus (BE), these methods were applied for a model of esophageal adenocarcinoma (EAC) that was previously calibrated to US cancer registry data. Optimal screening ages for patients with symptomatic gastroesophageal reflux disease were older (58 for men, 64 for women) than what is currently recommended (age > 50 years). These ages are in a cost-effective range to start screening and were independently validated by data used in current guidelines. Collectively, our framework captures critical aspects of cancer evolution within BE patients for a more personalized screening design.
影响因子：
1
作者：
Ahern, Charlotte Hsieh;Cheng, Yi;Shen, Yu
通讯作者：
Shen, Yu