Impact of disruptions in breast cancer control due to the COVID-19 pandemic on breast cancer mortality in the United States: Estimates from collaborative simulation modeling.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6562-6562
Author(s):  
Oguzhan Alagoz ◽  
Kathryn P. Lowry ◽  
Allison W. Kurian ◽  
Jeanne S. Mandelblatt ◽  
Mehmet Ali Ergun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
Cancer Control ◽  
The United States ◽  
Sensitivity Analyses ◽  
The Impact ◽  
Excess Deaths ◽  
Breast Cancer Control

6562 Background: The COVID-19 pandemic has disrupted breast cancer control through short-term declines in screening, delays in diagnosis and reduced/delayed treatments. We projected the impact of COVID-19 on future breast cancer mortality.Methods: Three established Cancer Intervention and Surveillance Modeling Network (CISNET) models projected the impact of pandemic-related care disruptions on breast cancer mortality between 2020 and 2030 vs. pre-pandemic care patterns. Based on Breast Cancer Surveillance Consortium data, we modeled reductions in mammography screening utilization, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first six months of the pandemic with return to pre-pandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. Results: By 2030, the models project 1,297 (model range: 1,054-1,900) cumulative excess deaths related to reduced screening; 1,325 (range: 266-2,628) deaths from delayed diagnosis of symptomatic women, and 207 (range: 146-301) deaths from reduced chemotherapy use for early-stage cancer. Overall, the models predict 2,487 (range 1,713-4,875) excess deaths, representing a 0.56% (range: 0.36%-0.99%) cumulative increase over deaths that would be expected by 2030 in the absence of the pandemic’s disruptions. Sensitivity analyses indicated that the impact on mortality would approximately double if the disruptions lasted for a 12-month period. Conclusions: The impact of the initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. The impact of the initial pandemic-related disruptions on breast cancer mortality will largely be mitigated by the rapid return to usual care. As the pandemic continues it will be important to monitor trends in care and reassess the mortality impact.[Table: see text]

scholarly journals Modeling the impact of population screening on breast cancer mortality in the United States

The Breast ◽  
2011 ◽  
Vol 20 ◽  
pp. S75-S81 ◽  
Author(s):  
Jeanne S. Mandelblatt ◽  
Kathleen A. Cronin ◽  
Donald A. Berry ◽  
Yaojen Chang ◽  
Harry J. de Koning ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Population Screening ◽  
The Impact

Using tumor genomic profile testing and comorbidity level to personalize chemotherapy decisions among older patients with early-stage breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12055-e12055
Author(s):  
Young Chandler ◽  
Claudine Isaacs ◽  
Jinani Jayasekera ◽  
Clyde B. Schechter ◽  
Christopher Cadham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
Older Women ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
Oncotype Dx ◽  
Sensitivity Analyses ◽  
Breast Cancers ◽  
Life Years ◽  
The Impact

e12055 Background: Under-representation of women ages 65+ (“older”) in the trials may limit clinical translation of results to this growing population. We used simulation modeling to estimate chemotherapy outcomes by age and comorbidity level among older women with early stage, estrogen-receptor+/HER2- breast cancers with an Oncotype DX score of 26+. Methods: A discrete-time stochastic state-transition model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups of women based on age (65-69, 70-74, 75-79, and 80-89) and comorbidity levels (no/low, moderate, and severe). Age-, comorbidity-specific non-cancer survival was derived from a random 5% sample of women enrolled in the Medicare Part A and B program from 1992 to 2005 and included in the SEER areas. Outcomes included life years (LYs), quality-adjusted life years (QALYs), and breast cancer and other-cause mortality with chemoendocrine therapy or endocrine therapy alone. Sensitivity analysis tested the impact on outcomes of varying values of uncertain parameters. Results: Women with life expectancies of ≥ 7 years had net gains of 0.17 to 0.45 LYs (2.0-5.4 months) with chemotherapy; this group was mainly women aged 65-69 and 70-74 with no/low or moderate comorbidity. Women destined to develop distant recurrence gained between 4.2-10.4 months. LYs were reduced by chemotherapy toxicity. The majority of women died of other causes, ranging from 59% to 98% across all age groups and comorbidity levels, but chemotherapy reduced breast cancer mortality by 14.5% and 25.7% among women ages 65-69 and 70-74 with no/low comorbidity, respectively. Results were robust in sensitivity analyses, and chemotherapy improved all outcomes as treatment efficacy increased, assuming no change in toxicity. Conclusions: Older women with early stage, estrogen-receptor+/HER2- breast cancers with Oncotype DX scores of 26+ may benefit from chemotherapy, when both conditions of age <75 and comorbidity at no/low or moderate level can be met. Personalized treatment decisions for older women will ultimately depend on comorbidity-specific lifespan and individual preferences for the balance of benefits and harms of chemotherapy.

scholarly journals Reflecting on 20 years of breast cancer modeling in CISNET: Recommendations for future cancer systems modeling efforts

2021 ◽  
Vol 17 (6) ◽  
pp. e1009020
Author(s):  
Amy Trentham-Dietz ◽  
Oguzhan Alagoz ◽  
Christina Chapman ◽  
Xuelin Huang ◽  
Jinani Jayasekera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resource Sharing ◽  
Early Stage ◽  
Cancer Control ◽  
The United States ◽  
Systems Modeling ◽  
Delivery Of Care ◽  
History Of ◽  
Structural Inequities ◽  
The Impact

Since 2000, the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET) modeling teams have developed and applied microsimulation and statistical models of breast cancer. Here, we illustrate the use of collaborative breast cancer multilevel systems modeling in CISNET to demonstrate the flexibility of systems modeling to address important clinical and policy-relevant questions. Challenges and opportunities of future systems modeling are also summarized. The 6 CISNET breast cancer models embody the key features of systems modeling by incorporating numerous data sources and reflecting tumor, person, and health system factors that change over time and interact to affect the burden of breast cancer. Multidisciplinary modeling teams have explored alternative representations of breast cancer to reveal insights into breast cancer natural history, including the role of overdiagnosis and race differences in tumor characteristics. The models have been used to compare strategies for improving the balance of benefits and harms of breast cancer screening based on personal risk factors, including age, breast density, polygenic risk, and history of Down syndrome or a history of childhood cancer. The models have also provided evidence to support the delivery of care by simulating outcomes following clinical decisions about breast cancer treatment and estimating the relative impact of screening and treatment on the United States population. The insights provided by the CISNET breast cancer multilevel modeling efforts have informed policy and clinical guidelines. The 20 years of CISNET modeling experience has highlighted opportunities and challenges to expanding the impact of systems modeling. Moving forward, CISNET research will continue to use systems modeling to address cancer control issues, including modeling structural inequities affecting racial disparities in the burden of breast cancer. Future work will also leverage the lessons from team science, expand resource sharing, and foster the careers of early stage modeling scientists to ensure the sustainability of these efforts.

Mammography Surveillance and Mortality in Older Breast Cancer Survivors

2007 ◽  
Vol 25 (21) ◽  
pp. 3001-3006 ◽  
Author(s):  
Timothy L. Lash ◽  
Matthew P. Fox ◽  
Diana S.M. Buist ◽  
Feifei Wei ◽  
Terry S. Field ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Cancer Mortality ◽  
Breast Cancer Survivors ◽  
Care Delivery ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Stage I ◽  
Early Stage Disease

Purpose There are more than 2,000,000 breast cancer survivors in the United States today. While surveillance for asymptomatic recurrence and second primary is included in consensus recommendations, the effectiveness of this surveillance has not been well characterized. Our purpose is to estimate the effectiveness of surveillance mammography in a cohort of breast cancer survivors with complete ascertainment of surveillance mammograms and negligible losses to follow-up. Patients and Methods We enrolled 1,846 stage I and II breast cancer patients who were at least 65 years old at six integrated health care delivery systems. We used medical record review and existing databases to ascertain patient, tumor, and therapy characteristics, as well as receipt of surveillance mammograms. We linked personal identifiers to the National Death Index to ascertain date and cause of death. We matched four controls to each breast cancer decedent to estimate the association between receipt of surveillance mammogram and breast cancer mortality. Results One hundred seventy-eight women died of breast cancer during 5 years of follow-up. Each additional surveillance mammogram was associated with a 0.69-fold decrease in the odds of breast cancer mortality (95% CI, 0.52 to 0.92). The protective association was strongest among women with stage I disease, those who received mastectomy, and those in the oldest age group. Conclusion Given existing recommendations for post-therapy surveillance, trials to compare surveillance with no surveillance are unlikely. This large observational study provides support for the recommendations, suggesting that receipt of surveillance mammograms reduces the rate of breast cancer mortality in older patients diagnosed with early-stage disease.

scholarly journals Breast Cancer Prevalence and Mortality among Hispanic Subgroups in the United States, 2009–2013

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Bijou R. Hunt
Keyword(s):  
Breast Cancer ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Female Breast Cancer ◽  
South American ◽  
Cancer Prevalence ◽  
Targeted Interventions ◽  
Hispanic Subgroup

Background. This paper presents data on breast cancer prevalence and mortality among US Hispanics and Hispanic subgroups, including Cuban, Mexican, Puerto Rican, Central American, and South American.Methods. Five-year average annual female breast cancer prevalence and mortality rates for 2009–2013 were examined using data from the National Health Interview Survey (prevalence) and the National Center for Health Statistics and the American Community Survey (mortality rates).Results. Overall breast cancer prevalence among US Hispanic women was 1.03%. Although the estimates varied slightly by Hispanic subgroup, these differences were not statistically significant. The breast cancer mortality rate for Hispanics overall was 17.71 per 100,000 women. Higher rates were observed among Cubans (17.89), Mexicans (18.78), and Puerto Ricans (19.04), and a lower rate was observed among Central and South Americans (10.15). With the exception of the rate for Cubans, all Hispanic subgroup rates were statistically significantly different from the overall Hispanic rate. Additionally, all Hispanic subgroups rates were statistically significantly higher than the Central and South American rate.Conclusion. The data reveal significant differences in mortality across Hispanic subgroups. These data enable public health officials to develop targeted interventions to help lower breast cancer mortality among the highest risk populations.

scholarly journals Simulation of Chemotherapy Effects in Older Breast Cancer Patients With High Recurrence Scores

2019 ◽  
Vol 112 (6) ◽  
pp. 574-581 ◽  
Author(s):  
Young Chandler ◽  
Jinani C Jayasekera ◽  
Clyde B Schechter ◽  
Claudine Isaacs ◽  
Christopher J Cadham ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Expression Profile ◽  
Early Stage ◽  
Breast Cancer Mortality ◽  
Sensitivity Analyses ◽  
Absolute Difference ◽  
Breast Cancer Patients ◽  
Genomic Expression ◽  
Life Years

Abstract Background Tumor genomic expression profile data are used to guide chemotherapy choice, but there are gaps in evidence for women aged 65 years and older. We estimate chemotherapy effects by age and comorbidity level among women with early-stage, hormone receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancers and Oncotype DX scores of 26 or higher. Methods A discrete-time stochastic state transition simulation model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups based on age (65–69, 70–74, 75–79, and 80–89 years) and comorbidity levels (no or low, moderate, severe). Outcomes were discounted at 3%, and included quality-adjusted life-years (QALYs), life-years, and breast cancer and other-cause mortality with chemoendocrine vs endocrine therapy. Sensitivity analysis tested the effect of varying uncertain parameters. Results Women aged 65–69 years with no or low comorbidity gained 0.16 QALYs with chemo-endocrine and reduced breast cancer mortality from 34.8% to 29.7%, for an absolute difference of 5.1%; this benefit was associated with a 12.8% rate of grade 3–4 toxicity. Women aged 65–69 years with no or low or moderate comorbidity levels, and women aged 70–74 years with no or low comorbidity had small chemotherapy benefits. All women aged 75 years and older experienced net losses in QALYs with chemo-endocrine therapy. The results were robust in sensitivity analyses. Chemotherapy had greater benefits as treatment effectiveness increased, but toxicity reduced the QALYs gained. Conclusion Among women aged 65–89 years whose tumors indicate a high recurrence risk, only those aged 65–74 years with no or low or moderate comorbidity have small benefits from adding chemotherapy to endocrine therapy. Genomic expression profile testing (and chemotherapy use) should be reserved for women aged younger than 75 years without severe comorbidity.

scholarly journals Challenges, Opportunities, and Priorities for Advancing Breast Cancer Control in Zambia: A Consultative Meeting on Breast Cancer Control

2019 ◽  
pp. 1-7 ◽  
Author(s):  
Anna Cabanes ◽  
Sharon Kapambwe ◽  
Susan Citonje-Msadabwe ◽  
Groesbeck P. Parham ◽  
Kennedy Lishimpi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Detection ◽  
Breast Cancer Mortality ◽  
Cancer Control ◽  
Control Program ◽  
Cervical Cancer Prevention ◽  
National Guidelines ◽  
National Breast ◽  
National Priority ◽  
Breast Cancer Control

In 2016, the Zambian government made cancer control a national priority and released a National Cancer Control Strategic Plan for 2016 to 2021, which focuses on malignancies of the breast, cervix, and prostate, and retinoblastoma. The plan calls for a collective reduction in the cancer burden by 50%. In support of this vision, Susan G. Komen sponsored a consultative meeting in Lusaka, Zambia, in September 2017 to bring together the country’s main breast cancer stakeholders and identify opportunities to improve breast cancer control. The recommendations generated during the discussions are presented. There was general agreement that the first step toward breast cancer mortality reduction should consist of implementation of early detection service platforms focused on women who are symptomatic. Participants also agreed that the management of all components of the national breast cancer control program should be integrated and led by the Ministry of Health. As much as possible, early detection and treatment services presently offered by the Cervical Cancer Prevention Program of Zambia and Cancer Diseases Hospital should be leveraged. Efforts are under way through multiple stakeholders to implement the following recommendations: development of national guidelines for the early diagnosis of breast cancer, training of breast surgeons, implementation of early detection and surgical treatment service platforms at the district-hospital level, and epidemiologic research, including the improvement of electronic recording mechanisms.

scholarly journals Using Simulation Modeling to Inform Strategies to Reduce Breast Cancer Mortality in Black Women in the District of Columbia

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Aimee M. Near ◽  
Jeanne S. Mandelblatt ◽  
Clyde B. Schechter ◽  
Michael A. Stoto
Keyword(s):  
Breast Cancer ◽  
Black Women ◽  
Adjuvant Treatment ◽  
Cancer Mortality ◽  
Simulation Modeling ◽  
Breast Cancer Mortality ◽  
District Of Columbia ◽  
Cancer Control ◽  
The Past ◽  
The Us

Background. Black women in the District of Columbia (DC) have the highest breast cancer mortality in the US. Local cancer control planners are interested in how to most efficiently reduce this mortality. Methods. An established simulation model was adapted to reflect the experiences of Black women in DC and estimate the past and future impact of changes in use of screening and adjuvant treatment. Results. The model estimates that the observed reduction in mortality that occurred from 1975 to 2007 attributable to screening, treatment, and both was 20.2%, 25.7%, and 41.0% respectively. The results suggest that, by 2020, breast cancer mortality among Black women in DC could be reduced by 6% more by initiating screening at age 40 versus age 50. Screening annually may also reduce mortality to a greater extent than biennially, albeit with a marked increase in false positive screening rates. Conclusion. This study demonstrates how modeling can provide data to assist local planners as they consider different cancer control policies based on their individual populations.

Sign in / Sign up

Export Citation Format

Share Document