Estimating and Mitigating Thyroid Cancer Overdiagnosis: A Mathematical Modeling Approach

项目概要/摘要 该提案将为减少美国甲状腺癌的过度诊断提供证据。 过度诊断是指识别出一种疾病，如果没有被发现，就不太可能引起 患者一生中的症状或死亡。过度诊断会产生严重后果，例如 过度治疗会带来相关的副作用和并发症、患者焦虑以及医疗费用增加。 尽管自 20 世纪 80 年代末以来，甲状腺癌的诊断增加了三倍，但死亡率仍然很高 稳定。小甲状腺乳头状癌很少致命，但几乎是全部增加的原因 在发病率中。然而，假设所有小型甲状腺癌都被过度诊断是不安全的。一些小 甲状腺癌可能具有侵袭性，确实需要治疗。迫切需要有效的方法 了解导致甲状腺癌过度诊断的关键因素，以便有针对性的解决方案 制定和实施以减少过度诊断。我们提出系统工程的创新运用 和模拟建模来解决这一知识差距并提供对自然的细致入微的理解 甲状腺肿瘤病史。我们将使用我们的模型来确定减少甲状腺转诊和使用的效果 过度诊断的影像学检查；改变活检大小阈值对过度诊断的影响；和 减少过度诊断对治疗的危害和益处的下游影响。这种做法也 随着时间的推移，解释了超声的不同使用和精度的提高。我们的目标是创建和验证 量化甲状腺癌过度诊断的模拟模型。我们将让利益相关者参与各个阶段 开发，从模型概念到验证，以获得临床指导并为我们的模型输入提供信息， 成果和传播策略。我们的研究团队由一名工业系统工程师组成 癌症建模方面的专业知识，以及甲状腺癌、癌症流行病学、卫生服务方面的专家 研究、交流。多学科团队非常有资格完成三个具体任务 目标：(1) 开发并验证一个模拟模型，以量化美国甲状腺癌的过度诊断； (2) 确定使患者接触的医疗保健利用模式（例如，提供者接触和转诊决定） 甲状腺成像、活检和甲状腺癌过度诊断的增加； (3) 吸引关键利益相关者 在整个项目期间确保模型具有表面有效性，并且输出可以 适用于对临床医生和政策制定者都很重要的问题。拟议的研究符合 美国国家癌症研究所的使命是帮助人们活得更长久、更健康。这项创新的成果 模型将有助于为临床实践指南和转诊实践建议提供信息，以改善 医疗保健的质量，同时减少不适当的检测，以尽量减少过度诊断和 过度治疗。

Project Summary/Abstract This proposal will generate evidence to reduce the overdiagnosis of thyroid cancer in the United States. Overdiagnosis is the identification of a disease that, had it not been detected, would be unlikely to cause symptoms or death during a patient’s lifetime. Overdiagnosis has significant consequences, such as overtreatment with associated side effects and complications, patient anxiety, and increased healthcare costs. Despite a three-fold increase in thyroid cancer diagnoses since the late 1980s, the mortality rate remains stable. Small papillary thyroid cancers, which are rarely lethal, are responsible for virtually the entire increase in incidence. However, it is not safe to assume that all small thyroid cancers are overdiagnosed; some small thyroid cancers can be aggressive and do need treatment. Effective methods are urgently needed to understand the key factors contributing to thyroid cancer overdiagnosis, so that directed solutions can be developed and implemented to reduce overdiagnosis. We propose the innovative use of systems engineering and simulation modeling to address this knowledge gap and provide a nuanced understanding of the natural history of thyroid tumors. We will use our model to identify the effect of reducing referrals for and use of thyroid imaging on overdiagnosis; the effect of changing the size threshold for biopsy on overdiagnosis; and the downstream impact of reducing overdiagnosis on harms and benefits of treatment. This approach also accounts for differential use and improved precision of ultrasound over time. Our goal is to create and validate a simulation model that quantifies overdiagnosis in thyroid cancer. We will engage stakeholders at all stages of development, from model conception to validation, to elicit clinical guidance and inform our model inputs, outcomes, and dissemination strategies. Our research team comprises an industrial-systems engineer with expertise in cancer modeling, as well as experts in thyroid cancer, cancer epidemiology, health services research, and communication. The multidisciplinary team is highly qualified to complete the three specific aims: (1) Develop and validate a simulation model to quantify overdiagnosis of thyroid cancer in the US; (2) Identify healthcare utilization patterns (e.g., provider encounters and referral decisions) that expose patients to increased thyroid imaging, biopsies, and the overdiagnosis of thyroid cancer; (3) Engage key stakeholders throughout the duration of the project to ensure that the model has face validity, and that the output can be applied to questions important to both clinicians and policy makers. The proposed research aligns with the National Cancer Institute’s mission to help people live longer and healthier lives. Results from this innovative model will help to inform clinical practice guidelines and referral practice recommendations to improve the quality of health care, while reducing inappropriate testing, to minimize overdiagnosis and overtreatment.