Strategizing Screening for Melanoma in an Era of Novel Treatments: A Model-Based Approach
| Autor: | Alan C. Geller, Kemal Sonmez, Sancy A. Leachman, Ruth Etzioni, Kemal Caglar Gogebakan, Elizabeth G. Berry |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Epidemiology Population Early detection 03 medical and health sciences 0302 clinical medicine medicine Advanced disease Humans Mass Screening Stage (cooking) education Intensive care medicine Melanoma Aged education.field_of_study business.industry Incidence (epidemiology) Middle Aged medicine.disease Treatment efficacy Cancer registry 030104 developmental biology Oncology 030220 oncology & carcinogenesis Female business |
| Zdroj: | Cancer epidemiology, biomarkersprevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 29(12) |
| ISSN: | 1538-7755 |
| Popis: | Background: Benefit–harm tradeoffs of melanoma screening depend on disease risk and treatment efficacy. We developed a model to project outcomes of screening for melanoma in populations with different risks under historic and novel systemic treatments. Methods: Computer simulation model of a screening program with specified impact on overall and advanced-stage incidence. Inputs included meta-analyses of treatment trials, cancer registry data, and a melanoma risk prediction study Results: Assuming 50% reduction in advanced stage under screening, the model projected 59 and 38 lives saved per 100,000 men under historic and novel treatments, respectively. With 10% increase in stage I, the model projects 2.9 and 4.7 overdiagnosed cases per life saved and number needed to be screened (NNS) equal to 1695 and 2632 under historical and novel treatments. When screening was performed only for the 20% of individuals with highest predicted risk, 34 and 22 lives per 100,000 were saved under historic and novel treatments. Similar results were obtained for women, but lives saved were lower. Conclusions: Melanoma early detection programs must shift a substantial fraction of cases from advanced to localized stage to be sustainable. Advances in systemic therapies for melanoma might noticeably reduce benefits of screening, but restricting screening to individuals at highest risk will likely reduce intervention efforts and harms while preserving >50% of the benefit of nontargeted screening. Impact: Our accessible modeling framework will help to guide population melanoma screening programs in an era of novel treatments for advanced disease. |
| Databáze: | OpenAIRE |
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