BREAST CANCER: EARLY DETECTION, TREATMENT AND PREVENTION

这项建议的主要目标是开发和扩展统计模型，这些模型对预测美国未来与乳腺癌相关的发病率和死亡率非常重要。近十年来，女性乳腺癌的诊断、治疗和预防发生了迅速的变化，并显示出所有证据都在继续变化。我们的主旨将是评估干预措施对国家统计数据的影响。这些干预措施不仅将反映当前的健康行为实践，还将反映公共卫生实践发生变化时的各种情景。将考虑的问题包括：(1)评估考虑竞争风险的早期发现和最终死亡率之间的关系；预测如果更多妇女参与常规筛查计划，发病率模式的变化；比较最佳筛查计划和推荐政策在收益和成本方面的权衡；为高危亚群制定最佳筛查计划；估计如果常规地向更高比例的人口提供现代癌症治疗，死亡率的变化；使用东方合作肿瘤学小组(ECOG)和哈佛朝圣者健康计划作为资源，收集目前尚不可用的诊断和分期数据；调查年轻妇女的筛查政策及其益处；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.