Integrating Competing Risks into the CISNET DFCI Breast Cancer Model

将竞争风险整合到 CISNET DFCI 乳腺癌模型中

• 批准号: 8753097
• 负责人: ELLEN P MCCARTHY
• 金额: $ 24.5万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8753097
• 关键词: Accounting; Address; Advisory Committees; Age; Anxiety; Breast Cancer Detection; Breast Cancer Early Detection; Breast Cancer Model; Cancer Intervention; Cancer Intervention and Surveillance Modeling Network; Cessation of life; Chronic Disease; Clinical; Comorbidity; Complex; Dana-Farber Cancer Institute; Data; Detection; Diagnosis; Early Diagnosis; Early treatment; Elderly; Elderly woman; Equation; Event; Failure; Gray unit of radiation dose; Guidelines; Health; Incidence; Individual; Indolent; Intervention; Lead; Life; Life Expectancy; Life Table Method; Longevity; Malignant Neoplasms; Mammography; Measures; Methods; Modeling; National Cancer Institute; Natural History; Older Population; Outcome; Population; Preventive; Progressive Disease; Public Health; Randomized Controlled Trials; Recommendation; Research; Research Personnel; Resources; Risk; Schedule; Screening for cancer; Services; Statistical Models; Study models; Time; United States; Woman; aged; aging population; flexibility; improved; insight; malignant breast neoplasm; mortality; network models; older women; prototype; screening; treatment strategy; tumor

DESCRIPTION (provided by applicant): Optimal screening and treatment strategies for breast cancer in older women are uncertain, particularly for those aged e75. Early detection with screening mammography reduces breast cancer mortality in women aged 50-69 and possibly up to age 74, but the benefits of screening are uncertain for women aged e75. The United States Preventive Service Task Force (USPSTF) has concluded there is insufficient evidence to recommend for or against breast cancer screening in women aged e75. Although some women aged e75 may benefit from breast cancer screening, due to exceptionally good health, many have underlying chronic illnesses and may not benefit, due to limited life expectancy resulting from competing mortality risks. The current statistical models used to inform the USPSTF recommendations do not account for competing mortality risks adequately. The statistical research proposed in this application addresses important methodological issues related to competing mortality risks for breast cancer. We will investigate the impact of competing risks on breast cancer mortality using a stochastic model of the natural history of breast cancer. We will integrate Fine and Gray's competing mortality risks directly into equations of the Cancer Intervention and Surveillance Network model developed by Zelen and Lee at Dana-Farber Cancer Institute. The CISNET-DFCI model is one of 7 CISNET breast cancer models used to inform USPSTF breast cancer screening guidelines and the only purely analytic model. We will then examine the impact of competing mortality risks on age-specific breast cancer mortality by comparing mortality estimates derived from the new (FG-CISNET-DFCI) model with the original model and a model using the less robust life table method to account for competing risks. We will then use the FG-CISNET-DFCI model to explore the benefits and harms of breast cancer screening under different scenarios (e.g., stopping ages, screening intervals). These analyses will offer insight into ongoing debate about breast cancer screening in older women by providing data on the mortality benefit and over-diagnosis in populations with different age and clinical (comorbidity) profiles. The new model will also provide a methodological prototype for integrating competing risks into other CISNET models. Our project will not only help inform recommendations for breast cancer screening in specific elderly groups, but also serve as a model to address the appropriateness of cancer screening other preventive health measures in older populations.

描述（由申请人提供）：老年女性乳腺癌的最佳筛查和治疗策略尚不确定，特别是对于年龄在75岁以上的女性。乳腺X线筛查早期发现可降低50-69岁甚至74岁女性的乳腺癌死亡率，但筛查对75岁女性的益处尚不确定。美国预防服务工作组（USPSTF）的结论是，没有足够的证据建议或反对对年龄在75岁以上的女性进行乳腺癌筛查。虽然一些年龄在75岁以上的妇女可能受益于乳腺癌筛查，由于健康状况特别好，许多人有潜在的慢性疾病，可能不会受益，由于竞争性死亡风险导致的预期寿命有限。目前用于告知USPSTF建议的统计模型没有充分考虑竞争性死亡风险。本申请中提出的统计研究解决了与乳腺癌竞争死亡风险相关的重要方法学问题。我们将使用乳腺癌自然史的随机模型研究竞争风险对乳腺癌死亡率的影响。我们将把Fine和Gray的死亡率风险直接整合到由Dana-Farber癌症研究所的Zelen和Lee开发的癌症干预和监测网络模型中。CISNET-DFCI模型是用于告知USPSTF乳腺癌筛查指南的7个CISNET乳腺癌模型之一，也是唯一的纯分析模型。然后，我们将通过比较新模型（FG-CISNET-DFCI）与原始模型和使用不太稳健的生命表方法来考虑竞争风险的模型得出的死亡率估计值，来研究竞争死亡风险对特定年龄乳腺癌死亡率的影响。然后，我们将使用FG-CISNET-DFCI模型来探索乳腺癌筛查在不同情况下的益处和危害（例如，停止年龄、筛选间隔）。这些分析将通过提供不同年龄和临床（合并症）特征人群的死亡率获益和过度诊断数据，深入了解正在进行的关于老年妇女乳腺癌筛查的辩论。新模式还将提供一个方法原型，将相互竞争的风险纳入其他CISNET模式。我们的项目不仅将有助于为特定老年群体的乳腺癌筛查提供信息，而且还将作为一个模型，以解决癌症筛查其他预防性健康措施在老年人群中的适当性。