title: Simulation models in population breast cancer screening: A systematic review.
abstract: 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.
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands. Electronic address: r.koleva-kolarova@umcg.nl.
authors.forename: Rositsa G
authors.initials: RG
authors.lastname: Koleva-Kolarova
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands. Electronic address: z.zhan01@umcg.nl.
authors.forename: Zhuozhao
authors.initials: Z
authors.lastname: Zhan
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Radiology, PO Box 30.001, 9700RB Groningen, The Netherlands. Electronic address: m.j.w.greuter@umcg.nl.
authors.forename: Marcel J W
authors.initials: MJ
authors.lastname: Greuter
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands; RIVM, PO Box 1, 3720BA Bilthoven, The Netherlands. Electronic address: t.l.feenstra@umcg.nl.
authors.forename: Talitha L
authors.initials: TL
authors.lastname: Feenstra
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands. Electronic address: g.h.de.bock@umcg.nl.
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: De Bock
mesh_terms: D000465:Algorithms; D015982:Bias; D001943:Breast Neoplasms / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000592:standards*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D008962:Models, Theoretical; D012680:Sensitivity and Specificity
keywords: Breast neoplasms; Computer simulation; Cost–benefit analysis; Mass screening; Mortality