DocumentCode :
88782
Title :
A MDP Model for Breast and Ovarian Cancer Intervention Strategies for BRCA1/2 Mutation Carriers
Author :
Abdollahian, Mehrnaz ; Das, Tapas K.
Author_Institution :
Dept. of Ind. & Manage. Syst. Eng., Univ. of South Florida, Tampa, FL, USA
Volume :
19
Issue :
2
fYear :
2015
fDate :
Mar-15
Firstpage :
720
Lastpage :
727
Abstract :
Purpose: Women with BRCA1/2 mutations have higher risk for breast and ovarian cancers. Available intervention actions include prophylactic surgeries and breast screening, which vary significantly in cost, cancer prevention, and in resulting death from other causes. We present a model designed to yield optimal intervention strategies for mutation carriers between the ages of 30 and 65 and any prior intervention history. Methods: A Markov decision process (MDP) model is developed that considers yearly state transitions for the mutation carriers and state dependent intervention actions. State is defined as a vector comprising mutation type, health states, prior intervention actions, and age. A discounted value iteration algorithm is used to obtain optimal strategies from the MDP model using both cost and quality-adjusted life years (QALYs) as rewards. Results: The results from MDP model show that for 30-year-old women with BRCA1 mutation and no prior intervention history, the cost-optimal strategy is a combination of prophylactic mastectomy (PM) and prophylactic oophorectomy (PO) at age 30 with no screening afterwards. Whereas, the QALYs-optimal strategy suggests PO at age 30 and PM at age 50 with screening afterwards. For BRCA2 mutation carriers at age 30, the cost-optimal strategy is PO at age 30, PM at age 40, and yearly screening only after age 56. Corresponding QALYs-optimal strategy is PM at age 40 with screening. Strategies for all other ages (31 to 65) are obtained and presented. It is also demonstrated that the cost-optimal strategies offer near maximum survival rate and near minimum cancer incidence rates by age 70, when compared to other ad hoc strategies.
Keywords :
Markov processes; cancer; genetics; proteins; BRCA1 mutation carrier; BRCA2 mutation carrier; MDP Model; Markov decision process; PM-PO combination; QALYs-optimal strategy; breast cancer intervention strategies; breast screening; cancer prevention; discounted value iteration algorithm; ovarian cancer intervention strategies; prophylactic mastectomy; prophylactic oophorectomy; prophylactic surgeries; quality-adjusted life years; state dependent intervention actions; Breast cancer; History; Informatics; Markov processes; Surgery; BRCA1/2 mutations; Markov decision process (MDP); hereditary breast and ovarian cancer; intervention strategies;
fLanguage :
English
Journal_Title :
Biomedical and Health Informatics, IEEE Journal of
Publisher :
ieee
ISSN :
2168-2194
Type :
jour
DOI :
10.1109/JBHI.2014.2319246
Filename :
6803874
Link To Document :
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