title: The influence of disease risk on the optimal time interval between screens for the early detection of cancer: a mathematical approach.
abstract: The intervals between screens for the early detection of diseases such as breast and colon cancer suggested by screening guidelines are typically based on the average population risk of disease. With the emergence of ever more biomarkers for cancer risk prediction and the development of personalized medicine, there is a need for risk-specific screening intervals. The interval between successive screens should be shorter with increasing cancer risk. A risk-dependent optimal interval is ideally derived from a cost-effectiveness analysis using a validated simulation model. However, this is time-consuming and costly. We propose a simplified mathematical approach for the exploratory analysis of the implications of risk level on optimal screening interval. We develop a mathematical model of the optimal screening interval for breast cancer screening. We verified the results by programming the simplified model in the MISCAN-Breast microsimulation model and comparing the results. We validated the results by comparing them with the results of a full, published MISCAN-Breast cost-effectiveness model for a number of different risk levels. The results of both the verification and validation were satisfactory. We conclude that the mathematical approach can indicate the impact of disease risk on the optimal screening interval.
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JFO'M, JvR, FWG, EAMH, EWS, JDFH)|Department of Health Policy and Management, Trinity College Dublin, Dublin, Ireland (JFO'M)
authors.forename: James F
authors.initials: JF
authors.lastname: O'Mahony
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JFO'M, JvR, FWG, EAMH, EWS, JDFH)|Department of Biostatistics, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JvR)
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.affiliation: Statistics Netherlands, Den Haag, the Netherlands (NAM)
authors.forename: Nino A
authors.initials: NA
authors.lastname: Mushkudiani
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JFO'M, JvR, FWG, EAMH, EWS, JDFH)
authors.forename: Frans-Willem
authors.initials: FW
authors.lastname: Goudsmit
authors.affiliation: Department of Biostatistics, UMC-University Medical Centre Utrecht, Utrecht, the Netherlands (MJCE)
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JFO'M, JvR, FWG, EAMH, EWS, JDFH)
authors.forename: Eveline A M
authors.initials: EA
authors.lastname: Heijnsdijk
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JFO'M, JvR, FWG, EAMH, EWS, JDFH)
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, the Netherlands (JFO'M, JvR, FWG, EAMH, EWS, JDFH)
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000191:economics; D008875:Middle Aged; D008962:Models, Theoretical; D057285:Precision Medicine; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013557:Switzerland; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor
keywords: breast cancer; cost-effectiveness analysis; mammography; oncology; simulation methods