Optimal breast cancer risk reduction policies tailored to personal risk level.
Optimal breast cancer risk reduction policies tailored to personal risk level.
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根据个人风险水平量身定做的最佳乳腺癌风险降低政策。
DOI：
10.1007/s10729-022-09596-2
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发表时间：
2022-09
影响因子：
3.6
通讯作者：
Rampurwala, Murtuza
中科院分区：
文献类型：
--
作者：
Ergun, Mehmet A.;Hajjar, Ali;Alagoz, Oguzhan;Rampurwala, Murtuza
根据个人和遗传因素，每个妇女患乳腺癌的风险不同，乳腺癌是妇女死亡的主要原因之一。对于乳腺癌高危女性，可以通过两种主要的治疗方法降低其风险：1）预防性治疗，如激素治疗（即，他莫昔芬、雷洛昔芬、西司坦）;或2）风险降低手术（即，乳房切除术）。现有的国家临床指南在其拟议的风险降低策略中没有纳入或限制使用患乳腺癌的个人风险。因此，他们没有提供足够的解决方案的利益-风险权衡的干预政策作为个人风险的变化。在解决这个问题，我们开发了一个离散时间，有限时域马尔可夫决策过程（MDP）模型的目标是最大限度地提高病人的总预期质量调整生命年。我们发现了一些有用的见解，其中一些与现有的国家乳腺癌风险降低建议相矛盾。例如，我们发现乳房切除术是22岁至38岁之间的边缘高危女性的最佳选择。此外，与国家综合癌症网络的建议相反，我们发现，对于高风险绝经后妇女来说，西美坦是一种合理的，事实上是最好的选择。
Depending on personal and hereditary factors, each woman has a different risk of developing breast cancer, one of the leading causes of death for women. For women with a high-risk of breast cancer, their risk can be reduced by two main therapeutic approaches: 1) preventive treatments such as hormonal therapies (i.e., tamoxifen, raloxifene, exemestane); or 2) a risk reduction surgery (i.e., mastectomy). Existing national clinical guidelines either fail to incorporate or have limited use of the personal risk of developing breast cancer in their proposed risk reduction strategies. As a result, they do not provide enough resolution on the benefit-risk trade-off of an intervention policy as personal risk changes. In addressing this problem, we develop a discrete- time, finite-horizon Markov decision process (MDP) model with the objective of maximizing the patient’s total expected quality-adjusted life years. We find several useful insights, some of which contradict the existing national breast cancer risk reduction recommendations. For example, we find that mastectomy is the optimal choice for the border-line high-risk women who are between ages 22 and 38. Additionally, in contrast to the National Comprehensive Cancer Network recommendations, we find that exemestane is a plausible, in fact, the best, option for high-risk postmenopausal women.
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DOI：
10.1093/jnci/94.18.1365
发表时间：
2002-09-18
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Brose, MS;Rebbeck, TR;Weber, BL
通讯作者：
Weber, BL
DOI：
10.1016/s1470-2045(12)70425-4
发表时间：
2012-11
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Collaborative Group on Hormonal Factors in Breast Cancer
通讯作者：
Collaborative Group on Hormonal Factors in Breast Cancer
DOI：
10.1177/0272989x8500500205
发表时间：
1985-01-01
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
--
作者：
Doubilet, P;Begg, C B;McNeil, B J
通讯作者：
McNeil, B J
影响因子：
45.3
作者：
Anders, Carey K.;Hsu, David S.;Blackwell, Kimberly L.
通讯作者：
Blackwell, Kimberly L.
影响因子：
39.2
作者：
Anderson, K;Jacobson, JS;Grann, VR
通讯作者：
Grann, VR