Modeling Breast Cancer Screening Outcomes

Abstract

There is currently rapid development of imaging technologies for breast cancer screening. In addition there is considerable controversy regarding the optimal screening strategy, including the ages at which screening should begin and end, the interval between screens and the imaging modality or modalities which should be used. Furthermore, there are major economic considerations related to whether screening should be done and how it should be done. Here, we describe the use of the Wisconsin CISNET computer model of breast cancer development to predict key outcomes associated with breast cancer, including incidence, mortality and life-years lost due to breast cancer. The sensitivity and specificity of the detection method and their dependence on factors such as age and breast density are implemented in the model through use of empirical data. Distributions of cancer characteristics are used to determine the type of modern therapy utilized and its effectiveness. Using this framework, the effectiveness of a particular screening strategy can be compared with other scenarios such as not screening at all or following published recommendations. The model can directly inform a cost-effectiveness or cost-utility analysis.