Comparative effectiveness of incorporating a hypothetical DCIS prognostic marker into breast cancer screening

Amy Trentham-Dietz*, Mehmet Ali Ergun, Oguzhan Alagoz, Natasha K. Stout, Ronald E. Gangnon, John M. Hampton, Kim Dittus, Ted A. James, Pamela M. Vacek, Sally D. Herschorn, Elizabeth S. Burnside, Anna N.A. Tosteson, Donald L. Weaver, Brian L. Sprague

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Purpose: Due to limitations in the ability to identify non-progressive disease, ductal carcinoma in situ (DCIS) is usually managed similarly to localized invasive breast cancer. We used simulation modeling to evaluate the potential impact of a hypothetical test that identifies non-progressive DCIS. Methods: A discrete-event model simulated a cohort of U.S. women undergoing digital screening mammography. All women diagnosed with DCIS underwent the hypothetical DCIS prognostic test. Women with test results indicating progressive DCIS received standard breast cancer treatment and a decrement to quality of life corresponding to the treatment. If the DCIS test indicated non-progressive DCIS, no treatment was received and women continued routine annual surveillance mammography. A range of test performance characteristics and prevalence of non-progressive disease were simulated. Analysis compared discounted quality-adjusted life years (QALYs) and costs for test scenarios to base-case scenarios without the test. Results: Compared to the base case, a perfect prognostic test resulted in a 40% decrease in treatment costs, from $13,321 to $8005 USD per DCIS case. A perfect test produced 0.04 additional QALYs (16 days) for women diagnosed with DCIS, added to the base case of 5.88 QALYs per DCIS case. The results were sensitive to the performance characteristics of the prognostic test, the proportion of DCIS cases that were non-progressive in the model, and the frequency of mammography screening in the population. Conclusion: A prognostic test that identifies non-progressive DCIS would substantially reduce treatment costs but result in only modest improvements in quality of life when averaged over all DCIS cases.

Original languageEnglish
Pages (from-to)229-239
Number of pages11
JournalBreast Cancer Research and Treatment
Volume168
Issue number1
DOIs
Publication statusPublished - 1 Feb 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017, Springer Science+Business Media, LLC, part of Springer Nature.

Funding

was supported by the National Cancer Institute Grant P01 CA154292, contract HSN261201100031C, and Grant U54 CA163303. The collection of BCSC cancer and vital status data used in this study was supported in part by several state public health departments and cancer registries throughout the US. For a full description of these sources, please see: http://breastscreening.cancer.gov/work/acknowledgement. html. Funding This work was supported by the National Cancer Institute at the National Institutes of Health for the Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) Program (Grant No. U54 CA163303) and other projects (Grant Nos. U01 CA199218, P30 CA014520, and U54 CA163307). Data collection for model inputs from the Breast Cancer Surveillance Consortium (BCSC)

FundersFunder number
National Institutes of Health
National Cancer InstituteHSN261201100031C, U54 CA163303, P01 CA154292
National Center for Advancing Translational SciencesUL1TR000427

    Keywords

    • Breast cancer
    • Costs
    • Ductal carcinoma in situ
    • Indolent disease
    • Prognosis
    • Quality-adjusted life years

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