Table 2 Characteristics of decision analysis studies identified.
Author, year | Modelled population | Design/screening intervals | Strategies | Parameters | Years of screening | Outcomes of interest |
|---|---|---|---|---|---|---|
Non-individual based models | ||||||
Gunsoy, 2014 [20] | United Kingdom | Markov-cohort simulation model. -Healthy, preclinical non-progressive in situ, preclinical progressive in situ, preclinical invasive, diagnosed in situ, and diagnosed invasive breast cancer by NPI category, death from BC, and death from other causes. | Six strategies defined by: -Starting age: 40, 47, 50 years. -Interval: triennial, annual, and hybrid (annual for 40–47, triennial thereafter) -Screening scenarios stopped at 70 or 73 years. | -(F): up to 85 years old -(SA): on uptake, sensitivity, and sojourn time. -(O): difference in the cumulative incidence of invasive in situ cancer. -(MA): NHS breast cancer program. | 40–73 | -Breast cancer deaths averted -Overdiagnosis- |
Tsunematsu, 2015 [23] | Japan, United States. | Transition cohort model to simulate impact of screening for the Japanese and US population. The source of stage distributions were data from the Japanese Breast Cancer Society and the BCSC and National Cancer Data BASE respectively. | Twelve strategies defined by: -Starting age: 40, 50 years -Intervals: annual, biennial -Screening stopping at 69, 74, and 79 years. | -(F): NR -(O): NR -(SA:): mortality rate of undetected BC -(MA): SE: 81.5%; SP 90.4–94.7% (Japan) | 40–79 | -Breast cancer deaths averted -FP results |
Vilaprinyo, 2014 [27]* | Spain | Stochastic transition model. Extension of the Lee and Zelen model to estimate incidence and prevalence, | Twenty strategies defined by: -Starting ages: 40, 45, 50. -Intervals: annual, biennial -Screening stopping at 69, 70, 74 and 79. | -(C): born from 1948 to 1952 -(F): time horizon was 40–79 years -(O): NR (SA): not provided by authors -(MA): SE: 0.55 for 40–45 years, 0.70 for 45–50 years, 0.75 for 50–70 years and 0.80 for >70 year -(Q): includes anxiety, and FP results | 40–79 | -Breast cancer deaths averted -Overdiagnosis -QALYS -FP results -Benign breast bx |
Yaffe, 2011 [25] | Canada | Model by Preston (excess absolute risk of radiation induced BC). Applied to Canadian population of 2002. Digital mammography. | Six strategies defined by: -Starting ages: 40, 50 -Intervals: annual, biennial (hybrid annually in 40 s, biennial thereafter). -Screening stopping at 49, 59 years. | -(F): screening began up to 109 years -(SA): using relative model instead of absolute model, latency years, survival rates. | 40–74 | - Radiation induced BC - Radiation induced BC deaths |
Individual based models | ||||||
Arnold, 2019 [29] | Germany N = 3,000,000 women | A microsimulation-Markov model included 6 health states: healthy (no breast cancer); ductal carcinoma in situ (DCIS); localized, regional, or distant invasive breast cancer; and death. | Three regular screening strategies and additional strategies based on individual risk assessment (not shown) -Interval: annual, biennial, triennial -Starting age: 50 years -Screening stopping: 69 years | -(F): from age of 50, until the end of life or 100 years. -(T): specific treatment based on hormone receptors -(MA): digital mammography sensitivity based in BCSC. -(O): -(SA): univariate and probabilistic sensitivity analysis (e.g. DCIS incidence, invasive cancer incidence, invasive cancer morality) | -QALY -Biopsy after false positive screening | |
Mandelblatt, 2016 [7] | United States N = 1000 women | Six micro simulation models developed within the CISNET collaboration: model D, model E, model GE, model M, model S and model W. Updating of models include 1) portrayal of molecular subtypes based on ER and HER2 status, current population incidence, digital screening, and update therapies. | Eight strategies defined by: -Starting age: 40, 45, or 50 years -Interval: annual, biennial and hybrid (annual in 40 s, biennial thereafter). -All strategies stop screening at 74. | -(C): born in 1970 of average-risk and average breast density. -(F): from age 25 years until death or age 100 -(O): models assume proportions of DCIS non-progressive; models M and W assumed some non-progressive invasive cancers -(T): specific treatment based on hormone receptors -(MA): digital mammography sensitivity based in BCSC. -(ME): RR 0.72 (95%CI 0.65–0.75) | 40–74 | Reported as median across models: -BC deaths averted -Overdiagnosis -QALYS (includes overdiagnosis) -FP results -Benign breast bx |
Miglioretti, 2016 [21] | United States N = 100,000 women | Two micro simulation modeling approaches for digital mammography. MISCAN-Fadia model and a new model for radiation exposure (which accounts for repeated mammography or radiation exposure and BS). Excess of radiation induced BC using the results from Preston. | Eight strategies defined by: -Starting age: 40, 45, or 50 years -Interval: annual, biennial and hybrid (annual in 40 s, biennial thereafter). -All strategies stop screening at 74. | -(MA): digital mammography sensitivity based in BCSC -(BS): views and compressed thickness from DMIST -(RD): product of half the number of views of both breast by dose per view. | 40–74 | - BC deaths averted - Radiation induced BC - Radiation induced BC deaths |
Mittmann, 2018 [28]** | Canada N = 2,000,000 women | One modified microsimulation, from the perspective of the Ontario public health care system model W developed within the CISNET collaboration. Discrete event, stochastic simulation based on the US population. Model simulated the lives of women at 6-month intervals. | Eleven screening scenarios: -Annual, biennial, triennial, and hybrid of these -Starting age: 40 or 50 years. -Screening stopping at: 49, 69 or 74 years. | -(T): specific treatment based on hormone receptors -(C): all women born in 1960 validated against US data and modified against Canadian data. -(F): lifetime horizon -(SA): input cost varied for key resources in one-way analysis -(MA): digital mammography sensitivity based in BCSC. | 40–74 | -QALYs |
Trentham-Dietz, 2016 [22] | United States N = 1000 | Three micro simulation models developed within the CISNET collaboration: model GE, model W, model E. Model applied to population subgroups based on 4 breast density levels and 4 exemplar relative risk levels: average, postmenopausal obesity, history of benign breast biopsy result, history of lobular carcinoma in situ. | Six screening scenarios: -Annual, biennial, or triennial digital mammography. -Starting age: 50 or 65 (received biennial from 50 to 64). -Stopping age: 74. | -(C): born in 1970 -(F): from age 25 years until death or age 100 -(O): models assume proportions of DCIS non-progressive; models W assumed some non-progressive invasive cancers -(T): specific treatment based in hormone receptors -(MA): digital mammography accuracy based in BCSC. | 40–74 | Reported as median across models (stratified by BD): -BC deaths averted. -Overdiagnosis. -QALYS (includes overdiagnosis). -FP results. -Benign breast bx. |
Van Ravestein, 2012 [24] | United States N = 1000 women | Four micro simulation models developed within the CISNET collaboration: model D, model E, model GE and model W. The models include biennial screening for women 50 to 74 years extended with 4 screening scenarios varying by screening interval (annual and biennial) and screening method (film and digital). | Five screening scenarios: -Interval: annual and biennial -Film or digital mammography -Age group: 40–49 years All scenarios estimated incremental effects compared to 50–74 screening. | -(T): specific treatment based in hormone receptors -(C): born in 1960 of average-risk. -(MA): digital and film mammography accuracy based in BCSC. | 40–49 | -BC deaths averted. -FP results. |
Yaffe, 2015 [26] | Canadian, N = 2,000,000 women | One model from the CISNET collaboration (model W), adapted to the Canadian context. Treatment effectiveness was implemented on a cure/no cure model. The model allowed different proportion of hormone receptors subgroups. | Eleven screening scenarios: -Interval: annual, biennial, triennial (and two hybrid scenarios). -starting age: 40 or 50 years. -stopping age: 69 or 74 years. | -(F): from age 40 years until death or age 99. -(C): born in 1960 of average-risk. | 40–74 | -BC deaths averted. -FP results. |
