Combined DES/SD model of breast cancer screening for older women, I: Natural-history simulation

Abstract

Two companion articles develop and exploit a simulation modeling framework to evaluate the effectiveness of breast cancer screening policies for U.S. women who are at least 65 years old. This first article examines the main components in the breast cancer screening-and-treatment process for older women; then it introduces a two-phase simulation approach to defining and modeling those components. Finally this article discusses the first-phase simulation, a natural-history model of the incidence and progression of untreated breast cancer for randomly sampled individuals from the designated population of older U.S. women. The companion article details the second-phase simulation, an integrated screening-and-treatment model that uses information about the genesis of breast cancer in the sampled individuals as generated by the natural-history model to estimate the benefits of different policies for screening the designated population and treating the women afflicted with the disease. Both simulation models are composed of interacting sub-models that represent key aspects of the incidence, progression, screening, treatment, survival, and cost of breast cancer in the population of older U.S. women as well as the overall structure of the system for detecting and treating the disease.

Keywords:

• Health care
• breast cancer
• screening older U.S. women
• medical decision making
• discrete-event simulation
• system dynamics
• combined discrete-continuous simulation
• chronic disease

Additional information

Notes on contributors

Jeremy J. Tejada

Jeremy J. Tejada is the founder and President of SIMCON Solutions, LLC. He is a member of Alpha Pi Mu, Tau Beta Pi, IIE, and the INFORMS Simulation Society. His personal web address is jjtejada.wordpress.com, and the company web address is simcon-solutions.com.

Julie S. Ivy

Julie S. Ivy is an Associate Professor and Fitts Faculty Fellow in the Edward P. Fitts Department of Industrial and Systems Engineering at North Carolina State University. She is a member of IIE and INFORMS.

James R. Wilson

James R. Wilson is a Professor in the Edward P. Fitts Department of Industrial and Systems Engineering at North Carolina State University. He is a member of ACM, ASA, and ASEE; and he is a Fellow of IIE and INFORMS. His web address is www.ise.ncsu.edu/jwilson.

Matthew J. Ballan

Matthew J. Ballan is a Ph.D. student in the Edward P. Fitts Department of Industrial and Systems Engineering at North Carolina State University. He is a member of Alpha Pi Mu, Tau Beta Pi, IIE, and the INFORMS Simulation Society.

Kathleen M. Diehl

Kathleen M. Diehl is an Associate Professor of Surgery at The University of Michigan. She is a member of the ACS, AMA, SSO, ASCO, ASBD, and ASBS. Her web address is http://www.uofmhealth.org/ profile/416/kathleen-mary-diehl-md.

Bonnie C. Yankaskas

Bonnie C. Yankaskas is Professor Emeritus, Department of Radiology and Adjunct Professor in the Department of Epidemiology, University of North Carolina.