Comparative Modeling: Informing Breast Cancer Control Practice and Policy

 描述(由申请者提供)：CISNET乳腺工作组(BWG)建议进行创新的建模研究，重点关注早期检测和临床管理方面的挑战，预计将重新定义乳腺癌控制的最佳实践。这项研究的具体目标是：1)评估使用多基因风险为筛查策略提供信息的人群影响；2)评估新兴成像技术在人群筛查中的使用；3)评估主动监测在筛查发现的DCIS的临床管理中的使用；4)评估新的分子途径和基因组靶向治疗范式在佐剂和复发环境中的影响；以及5)综合各种方法，以量化这些新的筛查和临床管理范式对普通人群和风险分层亚人群的美国死亡率趋势的相对贡献。这些目标包括四个RFA优先领域，我们已经拨出资金，以解决另外三个新兴领域(国际癌症控制规划、癌症差异和癌症特定优先领域[例如，局部复发试验])。根据独特的特点，调查人员将以3-4人为一组进行工作 解决这些目标的模型，以便可以在项目期间有效地评估这些主题。如果没有六种独特的BWG模式，这一工作范围是不可行的。BWG模型包括：Dana Farber(D)、Erasmus(E)、乔治敦-爱因斯坦(GE)、MD Anderson(M)、斯坦福(S)和威斯康星-哈佛(W)。在过去的14年里，这些模特团队一直得到持续的资助。他们的合作卓有成效，包括发表了162篇研究论文，并进行了建模，为公共卫生政策决策提供信息。对于这项建议，BWG将与以下机构合作：乳腺癌监测联盟(BCSC)；美国放射成像学会(ACRIN)；肿瘤遗传协会和机制(GAME-ON)研究人员；加拿大抗癌伙伴关系；基因组应用在实践和预防中的评估(EGAPP)；雅典娜DCIS登记处；通过个性化方案优化筛查的人口研究计划(PROSPR)；癌症研究网络(CRN)；以及国际团体。经验丰富的协调中心提供支持项目目标的基础设施。这种非常强大的协作环境提供了前所未有的协同作用和利用资源来解决新的研究问题，而这些问题在这种环境之外是不可能的。我们将采用新的统计方法来联合估计DCIS的自然历史参数，并计算无进展生存和进展后生存。一个独特的组成部分包括提供用于现有DCIS临床管理决策辅助的模型结果。最后，我们包括正式的培训机会。总体而言，这项研究将推进建模研究，并继续指导乳腺癌控制政策。

 DESCRIPTION (provided by applicant): The CISNET Breast Working Group (BWG) proposes innovative modeling research focused on challenges in early detection and clinical management that are expected to re-define breast cancer control best practices. The specific aims of this research are to: 1) evaluate the population impact of using polygenic risk to inform screening strategies; 2) assess use of emerging new imaging technologies for population screening; 3) evaluate use of active surveillance for the clinical management of screen-detected DCIS; 4) evaluate the impact of new molecular pathway- and genomic-targeted treatment paradigms in the adjuvant and recurrence settings; and 5) synthesize the methods to quantify the relative contributions of these new paradigms for screening and clinical management on US mortality trends for the general population and risk-stratified subpopulations. These aims encompass four RFA priority areas, and we have set aside funds to address three additional emerging areas (international cancer control planning, cancer disparities, and cancer-specific priority areas [e.g, trials of local recurrence]). Based on unique features, the investigators will work in teams of 3-4 models to address these aims so that the topics can be evaluated efficiently within the project period. This scope of work would not be feasible without the availability of six distinctive BWG models. The BWG models include: Dana Farber (D), Erasmus (E), Georgetown-Einstein (GE), MD Anderson (M), Stanford (S) and Wisconsin-Harvard (W). These modeling teams have been continuously funded for the past 14 years. Their collaboration has been very productive, including publication of 162 research papers, and conduct of modeling to inform public health policy decisions. For this proposal, the BWG will partner with: the Breast Cancer Surveillance Consortium (BCSC); the American College of Radiology Imaging Network (ACRIN); the Genetic Associations and Mechanisms in Oncology (GAME-ON) researchers; the Canadian Partnership Against Cancer; the Evaluation of Genomic Applications in Practice and Prevention (EGAPP); the Athena DCIS registry; the Population-based Research Optimizing Screening though Personalized Regimens (PROSPR) program; the Cancer Research Network (CRN); and international groups. An experienced Coordinating Center provides the infrastructure to support the project goals. This exceedingly strong collaborative environment provides for unprecedented synergy and leveraging of resources to address new research questions that would not be possible outside of this setting. We will deploy novel statistical approaches to jointly estimate DCIS natural history parameters and calculate progression-free survival and survival post-progression. A unique component includes providing model results for use in an extant DCIS clinical management decision aid. Finally, we include formal training opportunities. Overall, this research will advance modeling research and continue to guide breast cancer control policy.