BREAST CANCER: EARLY DETECTION, TREATMENT AND PREVENTION

该提案的主要目标是发展和扩展统计模型，这些模型对于预测美国与乳腺癌相关的未来发病率和死亡率非常重要。女性乳腺癌的诊断、治疗和预防在过去十年中发生了迅速的变化，并且有充分的证据表明这种变化还在继续。我们的主要目的是估计干预措施对国家统计的影响。干预措施将不仅反映当前的健康行为实践，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)在考虑竞争风险的情况下，评估早期发现与最终死亡率之间的关系；如果更多的妇女参加常规筛查项目，预测发病率模式的变化；比较最佳筛查方案和推荐政策之间的收益和成本权衡；为高危亚人群制定最佳筛查方案；估计如果对较高比例的人口常规进行现代癌症治疗，死亡率的变化；利用东部肿瘤合作组织（ECOG）和哈佛朝圣者健康计划作为收集目前无法获得的诊断和分期数据的资源；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.