Collaborative Research: Mathematical Modeling of Dynamic Breast Cancer Screening

这笔赠款为开发一个数学模型提供资金，以检查绝经前和绝经后是否应该使用不同的乳房X光检查间隔。对这一模型的分析将提供对以下问题的洞察：就死亡风险而言，在绝经前和绝经后阶段使用不同的乳房X光检查间隔有多大价值？应该在绝经前还是绝经后更频繁地进行筛查？筛查开始年龄/停止年龄如何影响死亡风险？考虑到乳腺癌发病率、乳腺癌侵袭性和绝经前和绝经后乳房X光检查效果的动态性质，这些问题特别有趣。使用部分观察到的马尔可夫决策过程模型，将评估不同的筛查策略，并将构建信息性权衡曲线，该曲线将绘制一些衡量“政策努力”与死亡率风险的指标。人们的注意力将仅限于两种类型的政策：一种是在患者一生中规定相同的筛查间隔的“常规”政策，另一种是“两阶段”政策，即规定绝经前的一个间隔和绝经后的不同间隔。这项研究的结果将通过患者赋权和改进公共政策来潜在地造福社会。权衡曲线将允许妇女根据个人的风险偏好、经济状况、保险范围、发病倾向等量身定做自己的乳房X光检查选择。权衡曲线将以一种对“非科学家”既可理解又有用的形式呈现筛查政策与死亡风险之间的定量关系。如果成功，这项拟议研究的结果也可能影响美国癌症协会关于乳腺癌筛查的政策建议。

This grant provides funding for the development of a mathematical model to examine whether different mammogram screening intervals should be used pre-menopause and post-menopause. Analysis of this model will provide insight into the following questions: how worthwhile is it, in terms of mortality risk, to use different mammogram intervals in the pre- and post-menopausal phases? Should screening be more frequent pre- or post-menopause? How does screening start-age/stop-age affect mortality risk? These questions are particularly interesting given the dynamic nature of breast cancer incidence, breast cancer aggression, and mammogram-efficacy between the pre- and post-menopausal phases. Using a partially observed Markov decision process model, different screening policies will be evaluated, and informative tradeoff curves that plot some measure of "policy effort" versus mortality risk will be constructed. Attention will be restricted to two types of policies: "routine" policies that prescribe the same screening interval over the life of the patient, and "two-phase" policies that prescribe one interval pre-menopause and a different interval post-menopause. The results of this research will potentially benefit society through patient-empowerment and improved public policy. The tradeoff curves will allow women to tailor their own mammogram screening choices based on individual risk preference, economic status, insurance coverage, incidence propensity, etc... The tradeoff curves will present the quantitative relationship between screening policy and mortality risk in a format that is both understandable and useful for "non-scientists." If successful, the outcomes of the proposed research may also impact American Cancer Society policy recommendations for breast cancer screening.