Optimal breast cancer risk reduction policies tailored to personal risk level


Ergun M. A. , Hajjar A., Alagoz O., Rampurwala M.

HEALTH CARE MANAGEMENT SCIENCE, vol.25, no.3, pp.363-388, 2022 (SSCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 25 Issue: 3
  • Publication Date: 2022
  • Doi Number: 10.1007/s10729-022-09596-2
  • Journal Name: HEALTH CARE MANAGEMENT SCIENCE
  • Journal Indexes: Social Sciences Citation Index (SSCI), Scopus, ABI/INFORM, Business Source Elite, Business Source Premier, CINAHL, EconLit, EMBASE, MEDLINE, Public Affairs Index
  • Page Numbers: pp.363-388
  • Keywords: OR in medicine, Risk reduction, Markov decision process (MDP), Breast cancer, SURGICAL ADJUVANT BREAST, QUALITY-OF-LIFE, BOWEL PROJECT, FOLLOW-UP, DECISION-MAKING, FAMILY-HISTORY, PREVENTION, TAMOXIFEN, WOMEN, BRCA1
  • Istanbul Technical University Affiliated: No

Abstract

Depending on personal and hereditary factors, each woman has a different risk of developing breast cancer, one of the leading causes of death for women. For women with a high-risk of breast cancer, their risk can be reduced by two main therapeutic approaches: 1) preventive treatments such as hormonal therapies (i.e., tamoxifen, raloxifene, exemestane); or 2) a risk reduction surgery (i.e., mastectomy). Existing national clinical guidelines either fail to incorporate or have limited use of the personal risk of developing breast cancer in their proposed risk reduction strategies. As a result, they do not provide enough resolution on the benefit-risk trade-off of an intervention policy as personal risk changes. In addressing this problem, we develop a discrete-time, finite-horizon Markov decision process (MDP) model with the objective of maximizing the patient's total expected quality-adjusted life years. We find several useful insights some of which contradict the existing national breast cancer risk reduction recommendations. For example, we find that mastectomy is the optimal choice for the border-line high-risk women who are between ages 22 and 38. Additionally, in contrast to the National Comprehensive Cancer Network recommendations, we find that exemestane is a plausible, in fact, the best, option for high-risk postmenopausal women.