BREAST CANCER: EARLY DETECTION, TREATMENT AND PREVENTION

该提案的主要目标是开发和扩展统计模型，这些模型在预测美国乳腺癌未来的发病率和死亡率方面非常重要。 女性乳腺癌的诊断、治疗和预防在过去十年中发生了迅速变化，并显示出继续变化的各种证据。 我们的主要目标是估计干预措施对国家统计的影响。这些干预措施不仅将反映当前的卫生行为实践，而且将反映如果公共卫生实践发生变化的各种情况。 将考虑的问题包括：（1）评估早期发现和最终死亡率之间的关系，考虑竞争风险;预测如果更多的妇女参加常规筛查计划，发生率模式的变化;比较最佳筛查计划和推荐政策之间的收益和成本;为高危亚人群制定最佳筛查计划;估计如果对更高比例的人群常规给予现代癌症治疗，死亡率的变化;使用东部肿瘤协作组（ECOG）和哈佛朝圣者健康计划作为资源，收集目前无法获得的诊断和分期数据;调查筛查政策及其对年轻女性的益处;评估改进的诊断方法对发病率和死亡率的影响。

The major goals of this proposal are to develop and extend statistical models which are important in predicting the future incidence and mortality associated with breast cancer in the United States. The diagnosis, treatment and prevention of female breast cancer has been rapidly changing in the decade and shows every evidence of continuing to change. Our main thrust will be to estimate the impact of interventions on national statistics. The interventions will not only reflect current health behavior practice, but will reflect various scenarios if public health practices were to change. Among the problems which will be considered are: (1) to evaluate the relation between early detection and eventual mortality which considers competing risks; to predict the changing incidence patterns if more women participate in routine screening programs; to compare the trade- offs pertaining to both benefit and cost between optimal screening programs and recommended policies; to develop optimal screening programs for high risk sub-populations; to estimate the change in mortality if modern cancer treatment was routinely given to a higher proportion of the population; to use the Eastern Cooperative Oncology Group (ECOG) and the Harvard Pilgrim Health Plan as a resource to gather data on diagnosis and staging currently not available; to investigate screening policies and their benefit for younger women; to estimate the impact of improved methods of diagnosis on incidence and mortality.