Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Med Decis Making. 2018 Apr;38(1_suppl):54S-65S. doi: 10.1177/0272989X17711928.
The MISCAN-Fadia microsimulation model uses continuous tumor growth to simulate the natural history of breast cancer and has been used extensively to estimate the impact of screening and adjuvant treatment on breast cancer incidence and mortality trends. The model simulates individual life histories from birth to death, with and without breast cancer, in the presence and in the absence of screening and treatment. Life histories are simulated according to discrete events such as birth, tumor inception, the tumor's clinical diagnosis diameter in the absence of screening, and death from breast cancer or death from other causes. MISCAN-Fadia consists of 4 main components: demography, natural history of breast cancer, screening, and treatment. Screening impact on the natural history of breast cancer is assessed by simulating continuous tumor growth and the "fatal diameter" concept. This concept implies that tumors diagnosed at a size that is between the screen detection threshold and the fatal diameter are cured, while tumors diagnosed at a diameter larger than the fatal tumor diameter metastasize and lead to breast cancer death. MISCAN-Fadia has been extended by including a different natural history for molecular subtypes based on a tumor's estrogen receptor (ER) status and human epidermal growth factor receptor 2 (HER2) status. In addition, personalized screening strategies that target women based on their risk such as breast density have been incorporated into the model. This personalized approach to screening will continue to develop in light of potential polygenic risk stratification possibilities and new screening modalities.
MISCAN-Fadia 微观模拟模型利用肿瘤的连续生长来模拟乳腺癌的自然史，并被广泛用于估计筛查和辅助治疗对乳腺癌发病率和死亡率趋势的影响。该模型模拟了个体从出生到死亡的生命史，包括有无乳腺癌、有无筛查和治疗。生命史是根据离散事件模拟的，如出生、肿瘤起始、无筛查时肿瘤的临床诊断直径以及死于乳腺癌或其他原因。MISCAN-Fadia 由 4 个主要部分组成：人口统计学、乳腺癌自然史、筛查和治疗。通过模拟肿瘤的连续生长和“致命直径”概念来评估筛查对乳腺癌自然史的影响。该概念意味着在筛检检测阈值和致命直径之间的大小诊断的肿瘤被治愈，而直径大于致命肿瘤直径的肿瘤转移并导致乳腺癌死亡。MISCAN-Fadia 已经扩展到包括基于肿瘤雌激素受体 (ER) 状态和人表皮生长因子受体 2 (HER2) 状态的不同分子亚型的自然史。此外，该模型还纳入了基于女性乳房密度等风险的个性化筛查策略。这种针对筛查的个性化方法将根据潜在的多基因风险分层可能性和新的筛查方式不断发展。
