Publication

Simulation models in population breast cancer screening: A systematic review

Koleva-Kolarova, R. G., Zhan, Z., Greuter, M. J. W., Feenstra, T. L. & De Bock, G. H., Aug-2015, In : The Breast. 24, 4, p. 354-363 10 p.

Research output: Contribution to journalReview articleAcademicpeer-review

The aim of this review was to critically evaluate published simulation models for breast cancer screening of the general population and provide a direction for future modeling. A systematic literature search was performed to identify simulation models with more than one application. A framework for qualitative assessment which incorporated model type; input parameters; modeling approach, transparency of input data sources/assumptions, sensitivity analyses and risk of bias; validation, and outcomes was developed. Predicted mortality reduction (MR) and cost-effectiveness (CE) were compared to estimates from meta-analyses of randomized control trials (RCTs) and acceptability thresholds. Seven original simulation models were distinguished, all sharing common input parameters. The modeling approach was based on tumor progression (except one model) with internal and cross validation of the resulting models, but without any external validation. Differences in lead times for invasive or non-invasive tumors, and the option for cancers not to progress were not explicitly modeled. The models tended to overestimate the MR (11-24%) due to screening as compared to optimal RCTs 10% (95% CI - 2-21%) MR. Only recently, potential harms due to regular breast cancer screening were reported. Most scenarios resulted in acceptable cost-effectiveness estimates given current thresholds. The selected models have been repeatedly applied in various settings to inform decision making and the critical analysis revealed high risk of bias in their outcomes. Given the importance of the models, there is a need for externally validated models which use systematical evidence for input data to allow for more critical evaluation of breast cancer screening. (C) 2015 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)354-363
Number of pages10
JournalThe Breast
Volume24
Issue number4
Publication statusPublished - Aug-2015

    Keywords

  • Breast neoplasms, Mass screening, Computer simulation, Mortality, Cost-benefit analysis, COST-EFFECTIVENESS ANALYSIS, AGE 40 YEARS, HEALTH TECHNOLOGY-ASSESSMENT, RANDOMIZED CONTROLLED-TRIAL, ECONOMIC-EVALUATION, CHINESE WOMEN, COMPUTER-SIMULATION, MORTALITY REDUCTION, NATIONAL BREAST, CATALONIA SPAIN

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