CANCER INTERVENTION AND SURVEILLANCE MODELING NETWORK

在过去的十年中，美国乳腺癌死亡率总体下降（SEER 1998）。 这一令人鼓舞的趋势也出现在其他一些国家，包括加拿大和联合王国（IARC）。1999年）。 虽然死亡率下降有各种可能的解释，但两个最可能的原因是早期发现和改善治疗。通过使用筛查性乳房X线照相术，在早期发现方面取得了很大进展。 事实证明，这种方法在早期发现乳腺癌是有效的，随后改变了许多妇女的疾病阶段。 来自国家癌症研究所的监测、流行病学和最终结果（SEER）癌症统计回顾（1998）的数据显示，在过去十年中，I期和原位癌急剧增加。 此外，来自随机试验的结果表明，筛查性乳房X光检查可降低乳腺癌死亡率。 在1990年代，乳房X线检查的普及率急剧增加，临床乳房检查的使用也是如此。在同一时期，化疗治疗的总体使用量和现有细胞毒性药物的数量都有所增加。 目前乳腺癌化疗研究的重点包括开发微调的联合治疗，以更有效的方式利用已建立的药物，并根据其预后特征专门选择患者进行治疗。 20世纪80年代末和90年代，对于肿瘤受体敏感的患者，特别是绝经后患者，他莫昔芬辅助治疗的使用急剧增加。虽然乳腺癌死亡率，筛查的流行率，筛查的有效性，治疗使用模式和治疗效果还不完全清楚，但每一个都可以估计。然而，估计数可能有误差。 该项目的主要目标是提供筛查和治疗（以及相关的不确定性）对观察到的美国乳腺癌死亡率下降的相对贡献的估计。 这一目标的一个必然结果是根据所有可用信息评估筛查性乳腺X射线摄影和治疗的益处。 另一个目标是解决乳腺X线筛查指南的变化以及使用其他干预措施（如他莫昔芬和其他SERM（选择性雌激素受体调节剂）作为预防剂）的潜在影响。 使用的方法包括统计建模和模拟。 在模型开发中将使用各种信息来源。

The last decade has seen an over-all decrease in breast cancer mortality within the United States (SEER 1998). This encouraging trend has also been observed in a number of other countries including Canada and the United Kingdom (IARC. 1999). Whilst there are a variety of possible explanations for this decline in mortality, two of the most likely reasons are earlier detection and improved treatment. Substantial gains have been made in early detection through the use of screening mammography. This procedure has proven effective in identifying breast cancer at an earlier point in its development, subsequently shifting the stage of the disease for many women. Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) cancer statistics review (1998),) shows a dramatic increase in stage-I and in-situ cancer during the last decade. Moreover, results from randomized trials have shown that screening mammography decreases breast cancer mortality. The prevalence of screening mammography has increased dramatically during the 1990s as has the use of clinical breast examination. During the same period, chemotherapy treatments have increased in both overall usage and in the number of cytotoxic agents now available. The focus of current chemotherapy research in breast cancer includes developing fine-tuned combination therapies, utilizing established drugs in more effective ways, and specifically selecting patients for treatment according to their prognostic characteristics. The late 1980s and 1990s have seen a dramatic increase in the use of adjuvant tamoxifen for patients whose tumors are hormone-receptor sensitive, especially for postmenopausal patients in the early part of this period. Although breast cancer mortality, prevalence of screening, effectiveness of screening, therapy use patterns, and therapy effectiveness are not perfectly known, each can be estimated. However, estimates are subject to error. A principal goal of this project is to provide estimates of the relative contributions of screening and therapy (and the associated uncertainty) to the observed decrease in relation to breast cancer mortality in the United States. A corollary of this goal is assessing the benefits of screening mammography and therapy, based upon all of the available information. A further goal is to address the potential impact of changing guidelines for screening mammography and of the use of additional interventions, such as tamoxifen and other SERMs (selective estrogen-receptor modulators) as preventive agents. Methods to be used include statistical modeling and simulation. A variety of sources of information will be used in model development.