Risk-specific optimal cancer screening schedules: an application to breast cancer early detection.
Risk-specific optimal cancer screening schedules: an application to breast cancer early detection.
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DOI：
10.1007/s12561-011-9032-7
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发表时间：
2011-12
影响因子：
1
通讯作者：
Shen, Yu
中科院分区：
文献类型：
--
作者：
Ahern, Charlotte Hsieh;Cheng, Yi;Shen, Yu
根据检查频率和检查年龄确定乳腺癌筛查的最佳时间表具有实际意义。探索决策理论方法来寻找最佳的癌症筛查计划，该计划应实现最大的生存效益，同时平衡医疗保健系统的相关成本。我们提出了一类效用函数，用于解释与筛查检查相关的成本和不稳定疾病模型下的生存获益价值。我们考虑两种不同的优化标准：优化筛查检查的数量，检查之间的筛查间隔相等，但没有预先固定的总成本；并优化固定总成本下应进行筛查的年龄。我们证明了两个框架下都存在最优解决方案。所提出的方法可能会考虑处于不同乳腺癌风险水平的女性，以便根据女性患乳腺癌的风险制定最佳筛查策略。给出了数值研究的结果，并用各种数据输入说明了所提出的模型。我们还使用纽约健康保险计划 (HIP) 和加拿大国家乳房筛查研究 (CNBSS) 的数据输入来说明所提出的模型，并比较 HIP 和 CNBSS 试验中最佳计划与实际计划之间的效用值。这里，效用被定义为在给定筛查时间表下，在考虑检查成本的情况下，筛查检查中发现的病例与筛查检查之间发现的病例之间的治愈率差异。
The optimal schedules for breast cancer screening in terms of examination frequency and ages at examination are of practical interest. A decision-theoretic approach is explored to search for optimal cancer screening programs which should achieve maximum survival benefit while balancing the associated cost to the health care system. We propose a class of utility functions that account for costs associated with screening examinations and value of survival benefit under a non-stable disease model. We consider two different optimization criteria: optimize the number of screening examinations with equal screening intervals between exams but without a pre-fixed total cost; and optimize the ages at which screening should be given for a fixed total cost. We show that an optimal solution exists under each of the two frameworks. The proposed methods may consider women at different levels of risk for breast cancer so that the optimal screening strategies will be tailored according to a woman’s risk of developing the disease. Results of a numerical study are presented and the proposed models are illustrated with various data inputs. We also use the data inputs from the Health Insurance Plan of New York (HIP) and Canadian National Breast Screening Study (CNBSS) to illustrate the proposed models and to compare the utility values between the optimal schedules and the actual schedules in the HIP and CNBSS trials. Here, the utility is defined as the difference in cure rates between cases found at screening examinations and cases found between screening examinations while accounting for the cost of examinations, under a given screening schedule.