Is mammography screening beneficial: An individual-based stochastic model for breast cancer incidence and mortality

The benefits of mammography screening have been controversial, with conflicting findings from various studies. We hypothesize that unmeasured heterogeneity in tumor aggressiveness underlies these conflicting results. Based on published data from the Canadian National Breast Screening Study (CNBSS),...

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Bibliographic Details
Published in:PLoS computational biology 2020-07, Vol.16 (7), p.e1008036-e1008036
Main Authors: Le, Thuy T. T, Adler, Frederick R
Format: Article
Language:English
Subjects:
Age factors
Biology and Life Sciences
Breast cancer
Care and treatment
Diagnosis
Evaluation
Health care
Health risks
Heterogeneity
Mammography
Medicine and Health Sciences
Mortality
Patients
People and places
Research and Analysis Methods
Software
Stochastic models
Stochasticity
Test reliability
Tumors
United States
Womens health
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Summary:The benefits of mammography screening have been controversial, with conflicting findings from various studies. We hypothesize that unmeasured heterogeneity in tumor aggressiveness underlies these conflicting results. Based on published data from the Canadian National Breast Screening Study (CNBSS), we develop and parameterize an individual-based mechanistic model for breast cancer incidence and mortality that tracks five stages of breast cancer progression and incorporates the effects of age on breast cancer incidence and all-cause mortality. The model accurately reproduces the reported outcomes of the CNBSS. By varying parameters, we predict that the benefits of mammography depend on the effectiveness of cancer treatment and tumor aggressiveness. In particular, patients with the most rapidly growing or potentially largest tumors have the highest benefit and least harm from the screening, with only a relatively small effect of age. However, the model predicts that confining mammography to populations with a high risk of acquiring breast cancer increases the screening benefit only slightly compared with the full population.
ISSN:1553-7358
1553-734X
1553-7358
DOI:10.1371/journal.pcbi.1008036