Breast cancer screening policies

Breast cancer is currently the biggest single cause of mortality for women in developed countries. The incidence in NZ is pa
40% will die as a result of the disease. Breast cancer incidence and aggressiveness vary with the age of the patient. The di
early stages such a growth is usually benign. If left untreated, it will enlarge and often become malignant, invading adjacent
metastasis. The rate of progression varies from person to person and with age. The age-specific incidence of breast cance
menopause there is a temporary drop, after which the rate climbs again. About 95% of all potentially cancerous growths dis
detected as early as possible. In the 1970s screening trials were made in Sweden, England, and the USA in an effort to red
is the most effective method for detecting abnormal tissue growth. Research shows that for women of age 50 mammograph
into breast cancer within the next 12 months after screening. This is significantly higher than for other methods of screening
drops substantially as the time interval between screenings becomes longer. As the need for the introduction of an effective
governments, there was still some controversy as to the best screening policy to use. A screening policy is defined by the a
women between the ages of 48 and 70 at yearly intervals. In addition to the medical factors and partially avoidable loss of h
the cost of a screening was between $50 and $100, while the equipment cost was in the range of $200,000 to $300,000. Ea
and frequency of screening is increased, the number of machines and trained personnel needed also increases. Acquiring
enormous capital outlay and could not be done overnight. So, the problem faced by health providers in many countries wa
considerations and human suffering, and how the policy finally chosen should be implemented.

Age
No
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Lower
bound
-1
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75

Upper
bound
0
4
9
14
19
24
29
34
39
44
49
54
59
64
69
74
110

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28

Age
Lower Upper
bound bound
-1
0
0
4
5
9
10
14
15
19
20
24
25
29
30
34
35
39
40
44
45
49
50
54
55
59
60
64
65
69
70
74
75
110
-1
0
0
4
5
9
10
14
15
19
20
24
25
29
30
34
35
39
40
44
45
49

Women population
% of woman with breast cancer
By age
0
1,952,400
1,843,100
1,842,300
1,755,700
1,869,500
1,871,600
1,911,000
1,763,800
1,491,300
1,248,800
998,500
745,000
541,000
385,200
299,000
352,300

Cummulative
0
1,952,400
3,795,500
5,637,800
7,393,500
9,263,000
11,134,600
13,045,600
14,809,400
16,300,700
17,549,500
18,548,000
19,293,000
19,834,000
20,219,200
20,518,200
20,870,500

0
0
0
1%
3%
5%
11%
13%
17%
20%
10%
12%
14%
16%
16%
16%
16%

Women population
By age
0
1,952,400
1,843,100
1,842,300
1,755,700
1,869,500
1,871,600
1,911,000
1,763,800
1,491,300
1,248,800
998,500
745,000
541,000
385,200
299,000
352,300
0
1,952,400
1,843,100
1,842,300
1,755,700
1,869,500
1,871,600
1,911,000
1,763,800
1,491,300
1,248,800

Cummulative
0
1,952,400
3,795,500
5,637,800
7,393,500
9,263,000
11,134,600
13,045,600
14,809,400
16,300,700
17,549,500
18,548,000
19,293,000
19,834,000
20,219,200
20,518,200
20,870,500
0
1,952,400
3,795,500
5,637,800
7,393,500
9,263,000
11,134,600
13,045,600
14,809,400
16,300,700
17,549,500

% of woman with breast cancer

0
0
0
1%
3%
5%
11%
13%
17%
20%
10%
12%
14%
16%
16%
16%
16%
0
0
0
1%
3%
5%
11%
13%
17%
20%
10%

29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68

50
55
60
65
70
75
-1
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
-1
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75

54
59
64
69
74
110
0
4
9
14
19
24
29
34
39
44
49
54
59
64
69
74
110
0
4
9
14
19
24
29
34
39
44
49
54
59
64
69
74
110

998,500
745,000
541,000
385,200
299,000
352,300
0
1,952,400
1,843,100
1,842,300
1,755,700
1,869,500
1,871,600
1,911,000
1,763,800
1,491,300
1,248,800
998,500
745,000
541,000
385,200
299,000
352,300
0
1,952,400
1,843,100
1,842,300
1,755,700
1,869,500
1,871,600
1,911,000
1,763,800
1,491,300
1,248,800
998,500
745,000
541,000
385,200
299,000
352,300

18,548,000
19,293,000
19,834,000
20,219,200
20,518,200
20,870,500
0
1,952,400
3,795,500
5,637,800
7,393,500
9,263,000
11,134,600
13,045,600
14,809,400
16,300,700
17,549,500
18,548,000
19,293,000
19,834,000
20,219,200
20,518,200
20,870,500
0
1,952,400
3,795,500
5,637,800
7,393,500
9,263,000
11,134,600
13,045,600
14,809,400
16,300,700
17,549,500
18,548,000
19,293,000
19,834,000
20,219,200
20,518,200
20,870,500

12%
14%
16%
16%
16%
16%
0
0
0
1%
3%
5%
11%
13%
17%
20%
10%
12%
14%
16%
16%
16%
16%
0
0
0
1%
3%
5%
11%
13%
17%
20%
10%
12%
14%
16%
16%
16%
16%

error analysis for equipment unit cost

43488164400
suppose that the (incorrect) value p actually used is equal to k times the correct value p, or p = kp
k
0.2
incorrect value of equipment unit cost
50000
% error of parameter used from correct value
-80
perfomance measure im[plied by incorrect value
45393764400
optimal solution?
YES
%change in perfomance measure
4.3818818897

error analysis for training cost

43488164400
suppose that the (incorrect) value p actually used is equal to k times the correct value p, or p = kp
k
0.2
incorrect value of equipment unit cost
20
% error of parameter used from correct value
-80
perfomance measure im[plied by incorrect value
43489688880
optimal solution?
yes
%change in perfomance measure
0.0035055055

error analysis for value of one's life saved

43488164400
suppose that the (incorrect) value p actually used is equal to k times the correct value p, or p = kp
k
0.2
incorrect value of equipment unit cost
10000
% error of parameter used from correct value
-80
perfomance measure im[plied by incorrect value
4341033900
optimal solution?
no
%change in perfomance measure
-90.0178957657

error analysis for training cost

43488164400
suppose that the (incorrect) value p actually used is equal to k times the correct value p, or p = kp
k
0.2
incorrect value of equipment unit cost
% error of parameter used from correct value
perfomance measure im[plied by incorrect value
optimal solution?
%change in perfomance measure
-100

%change in perfomance measure

300
250
200
150
100

%change in perfomance

50
0
-100

-50

0
-50
-100
-150

50

100

150

200

250

Number of women with BC

Screening effectivity by age
By age
0
0
0
18,423
52,671
93,475
205,876
248,430
299,846
298,260
124,880
119,820
104,300
86,560
61,632
47,840
56,368

Cummulative
0
0
0
18,423
71,094
164,569
370,445
618,875
918,721
1,216,981
1,341,861
1,461,681
1,565,981
1,652,541
1,714,173
1,762,013
1,818,381

By age
0
0
50%
50%
50%
50%
50%
70%
70%
70%
70%
85%
85%
85%
85%
85%
85%

Number of women with BC

By age
0
0
0
18,423
52,671
93,475
205,876
248,430
299,846
298,260
124,880
119,820
104,300
86,560
61,632
47,840
56,368
0
0
0
18,423
52,671
93,475
205,876
248,430
299,846
298,260
124,880

Cummulative
0
0
0
18,423
71,094
164,569
370,445
618,875
918,721
1,216,981
1,341,861
1,461,681
1,565,981
1,652,541
1,714,173
1,762,013
1,818,381
0
0
0
18,423
71,094
164,569
370,445
618,875
918,721
1,216,981
1,341,861

Number of women with BC

detected

Screening effectivity by age

0
0
50%
50%
50%
50%
50%
70%
70%
70%
70%
85%
85%
85%
85%
85%
85%
0
0
50%
50%
50%
50%
50%
70%
70%
70%
70%

0
0
0
9,212
26,336
46,738
102,938
173,901
209,893
208,782
87,416
101,847
88,655
73,576
52,388
40,664
47,913

Cummulative
0
0
0
9,212
35,548
82,286
185,224
359,125
569,018
777,800
865,216
967,063
1,055,718
1,129,294
1,181,682
1,222,346
1,270,259

Number of women with BC

detected
By age
Cummulative
0
0
0
9,212
26,336
46,738
102,938
173,901
209,893
208,782
87,416
101,847
88,655
73,576
52,388
40,664
47,913
0
0
0
9,212
26,336
46,738
102,938
173,901
209,893
208,782
87,416

0
0
0
9,212
35,548
82,286
185,224
359,125
569,018
777,800
865,216
967,063
1,055,718
1,129,294
1,181,682
1,222,346
1,270,259
0
0
0
9,212
35,548
82,286
185,224
359,125
569,018
777,800
865,216

119,820
104,300
86,560
61,632
47,840
56,368
0
0
0
18,423
52,671
93,475
205,876
248,430
299,846
298,260
124,880
119,820
104,300
86,560
61,632
47,840
56,368
0
0
0
18,423
52,671
93,475
205,876
248,430
299,846
298,260
124,880
119,820
104,300
86,560
61,632
47,840
56,368

1,461,681
1,565,981
1,652,541
1,714,173
1,762,013
1,818,381
0
0
0
18,423
71,094
164,569
370,445
618,875
918,721
1,216,981
1,341,861
1,461,681
1,565,981
1,652,541
1,714,173
1,762,013
1,818,381
0
0
0
18,423
71,094
164,569
370,445
618,875
918,721
1,216,981
1,341,861
1,461,681
1,565,981
1,652,541
1,714,173
1,762,013
1,818,381

s the correct value p, or p = kp

0.4
0.6
100000
150000
-60
-40
44917364400
44440964400
YES
YES
YES
3.2864114173
2.1909409448

85%
85%
85%
85%
85%
85%
0
0
50%
50%
50%
50%
50%
70%
70%
70%
70%
85%
85%
85%
85%
85%
85%
0
0
50%
50%
50%
50%
50%
70%
70%
70%
70%
85%
85%
85%
85%
85%
85%

0.8
200000
-20
43964564400

101,847
88,655
73,576
52,388
40,664
47,913
0
0
0
9,212
26,336
46,738
102,938
173,901
209,893
208,782
87,416
101,847
88,655
73,576
52,388
40,664
47,913
0
0
0
9,212
26,336
46,738
102,938
173,901
209,893
208,782
87,416
101,847
88,655
73,576
52,388
40,664
47,913

967,063
1,055,718
1,129,294
1,181,682
1,222,346
1,270,259
0
0
0
9,212
35,548
82,286
185,224
359,125
569,018
777,800
865,216
967,063
1,055,718
1,129,294
1,181,682
1,222,346
1,270,259
0
0
0
9,212
35,548
82,286
185,224
359,125
569,018
777,800
865,216
967,063
1,055,718
1,129,294
1,181,682
1,222,346
1,270,259

1
1.2
250000
300000
0
20
43488164400
43011764400
YES
YES
1.0954704724
0 -1.0954704724

s the correct value p, or p = kp

0.4
0.6
40
60
-60
-40
43489307760
43488926640
yes
yes
yes
0.0026291291
0.0017527528

s the correct value p, or p = kp

0.4
0.6
20000
30000
-60
-40
13708615800
23480778000
no
no
yes
-68.477363924 -46.0065093021

s the correct value p, or p = kp

0.4

-100

%change in perfomance measure

0.8
80
-20
43488545520

1
1.2
100
120
0
20
43488164400
43487783280
yes
yes
0.0008763764
0 -0.0008763764

0.8
40000
-20
33399788400

1
1.2
50000
60000
0
20
43488164400
53576540400
yes
yes
-23.1979807361
0 23.1979807361

0.6

0.8

1.2

-100

-100

-100

-100

Screening
frequency

Remarks
1
2
3
4

Detected at stadium 4
Detected at stadium 3
Detected at stadium 2
Detected at stadium 1

Cure rate
30%
50%
70%
80%

Screening equipment capacity per year

Value of one's life saved
Number of personnel per equipment
Screening cost
Equipment unit cost
Training cost

Screening frequency

Cure rate
CURE
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2

0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.3
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5

0
0
0
2763.6
7900.8
14021.4
30881.4
52170.3
62967.9
62634.6
26224.8
30554.1
26596.5
22072.8
15716.4
12199.2
14373.9
0
0
0
4606
13168
23369
51469
86950.5
104946.5
104391
43708

VALUE WOMEN SAFE

$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000

2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4

1.4
350000
40
42535364400

YES

0.5
0.5
0.5
0.5
0.5
0.5
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.7
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8
0.8

1.6
400000
60
42058964400
YES
YES
-2.1909409448 -3.2864114173

50923.5
44327.5
36788
26194
20332
23956.5
0
0
0
6448.4
18435.2
32716.6
72056.6
121730.7
146925.1
146147.4
61191.2
71292.9
62058.5
51503.2
36671.6
28464.8
33539.1
0
0
0
7369.6
21068.8
37390.4
82350.4
139120.8
167914.4
167025.6
69932.8
81477.6
70924
58860.8
41910.4
32531.2
38330.4

$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000
$50,000

1.8
450000
80
41582564400

2
500000
100
41128654000
NO

-4.3818818897

-5.4256380617

1.4
140
40
43487402160

yes

1.6
160
60
43487021040
yes
yes
-0.0017527528 -0.0026291291

1.4
70000
40
63664916400

yes

1.6
80000
60
73753292400
yes
yes
46.3959614722 69.5939422083

1.8
180
80
43486639920

2
200
100
43486258800
yes

-0.0035055055

-0.0043818819

1.8
90000
80
83841668400

2
100000
100
93930044400
yes

92.7919229444

115.9899036806

1.4

1.6

1.8

-100

-100

-100

-100

6,400

$50,000
2

$75
$250,000
$100

BENEFIT
0
0
0
138180000
395040000
701070000
1544070000
2608515000
3148395000
3131730000
1311240000
1527705000
1329825000
1103640000
785820000
609960000
718695000
0
0
0
230300000
658400000
1168450000
2573450000
4347525000
5247325000
5219550000
2185400000

NUMBER OF SCREENG
0
1952400
1843100
1842300
1755700
1869500
1871600
1911000
1763800
1491300
1248800
998500
745000
541000
385200
299000
352300
0
3904800
3686200
3684600
3511400
3739000
3743200
3822000
3527600
2982600
2497600

SCREENING EQ CAPACITY /YEAR

0
306
288
288
275
293
293
299
276
234
196
157
117
85
61
47
56
0
611
576
576
549
585
585
598
552
467
391

2546175000
2216375000
1839400000
1309700000
1016600000
1197825000
0
0
0
322420000
921760000
1635830000
3602830000
6086535000
7346255000
7307370000
3059560000
3564645000
3102925000
2575160000
1833580000
1423240000
1676955000
0
0
0
368480000
1053440000
1869520000
4117520000
6956040000
8395720000
8351280000
3496640000
4073880000
3546200000
2943040000
2095520000
1626560000
1916520000

2.2
550000
120
40707154000
NO
NO
-6.3948672895

1997000
1490000
1082000
770400
598000
704600
0
5857200
5529300
5526900
5267100
5608500
5614800
5733000
5291400
4473900
3746400
2995500
2235000
1623000
1155600
897000
1056900
0
7809600
7372400
7369200
7022800
7478000
7486400
7644000
7055200
5965200
4995200
3994000
2980000
2164000
1540800
1196000
1409200

313
233
170
121
94
111
0
916
864
864
823
877
878
896
827
700
586
469
350
254
181
141
166
0
1221
1152
1152
1098
1169
1170
1195
1103
933
781
625
466
339
241
187
221

2.4
600000
140
40285654000

2.6
650000
160
39864154000
NO

-7.3640965173

-8.3333257451

2.2
220
120
43485877680
yes
yes
-0.0052582583

2.2
110000
120
104018420400
yes
no
139.187884417

2.4
240
140
43485496560

2.6
260
160
43485115440
yes

-0.0061346346

-0.007011011

2.4
120000
140
114150228000

2.6
130000
160
124312300000
no

162.4857350843

185.8531780201

2.2

2.4

2.6

-100

-100

-100

NUMBER OF PERSONEL NEEDED

0
612
576
576
550
586
586
598
552
468
392
314
234
170
122
94
112
0
1222
1152
1152
1098
1170
1170
1196
1104
934
782

EQ COST
0
76500000
72000000
72000000
68750000
73250000
73250000
74750000
69000000
58500000
49000000
39250000
29250000
21250000
15250000
11750000
14000000
0
152750000
144000000
144000000
137250000
146250000
146250000
149500000
138000000
116750000
97750000

SCREENING COST
0
146430000
138232500
138172500
131677500
140212500
140370000
143325000
132285000
111847500
93660000
74887500
55875000
40575000
28890000
22425000
26422500
0
292860000
276465000
276345000
263355000
280425000
280740000
286650000
264570000
223695000
187320000

TRANING COST
0
61200
57600
57600
55000
58600
58600
59800
55200
46800
39200
31400
23400
17000
12200
9400
11200
0
122200
115200
115200
109800
117000
117000
119600
110400
93400
78200

626
466
340
242
188
222
0
1832
1728
1728
1646
1754
1756
1792
1654
1400
1172
938
700
508
362
282
332
0
2442
2304
2304
2196
2338
2340
2390
2206
1866
1562
1250
932
678
482
374
442

2.8
700000
180
39442654000

NO

78250000
58250000
42500000
30250000
23500000
27750000
0
229000000
216000000
216000000
205750000
219250000
219500000
224000000
206750000
175000000
146500000
117250000
87500000
63500000
45250000
35250000
41500000
0
305250000
288000000
288000000
274500000
292250000
292500000
298750000
275750000
233250000
195250000
156250000
116500000
84750000
60250000
46750000
55250000

3
750000
200
39021154000
NO
-9.3025549729 -10.2717842007

149775000
111750000
81150000
57780000
44850000
52845000
0
439290000
414697500
414517500
395032500
420637500
421110000
429975000
396855000
335542500
280980000
224662500
167625000
121725000
86670000
67275000
79267500
0
585720000
552930000
552690000
526710000
560850000
561480000
573300000
529140000
447390000
374640000
299550000
223500000
162300000
115560000
89700000
105690000

62600
46600
34000
24200
18800
22200
0
183200
172800
172800
164600
175400
175600
179200
165400
140000
117200
93800
70000
50800
36200
28200
33200
0
244200
230400
230400
219600
233800
234000
239000
220600
186600
156200
125000
93200
67800
48200
37400
44200

2.8
280
180
43484734320

yes

3
300
200
43484353200
yes
-0.0078873874 -0.0087637638

2.8
140000
180
134474372000

no

3
150000
200
144636444000
no
209.2206209559 232.588063892

2.8

-100

-100

TOTAL COST
0
222991200
210290100
210230100
200482500
213521100
213678600
218134800
201340200
170394300
142699200
114168900
85148400
61842000
44152200
34184400
40433700
0
445732200
420580200
420460200
400714800
426792000
427107000
436269600
402680400
340538400
285148200

BENEFIT
0
-222991200
-210290100
-72050100
194557500
487548900
1330391400
2390380200
2947054800
2961335700
1168540800
1413536100
1244676600
1041798000
741667800
575775600
678261300
0
-445732200
-420580200
-190160200
257685200
741658000
2146343000
3911255400
4844644600
4879011600
1900251800

17175524700

228087600
170046600
123684000
88054200
68368800
80617200
0
668473200
630870300
630690300
600947100
640062900
640785600
654154200
603770400
510682500
427597200
342006300
255195000
185275800
131956200
102553200
120800700
0
891214200
841160400
840920400
801429600
853333800
854214000
872289000
805110600
680826600
570046200
455925000
340093200
247117800
175858200
136487400
160984200

SCREENING YANG EFEKTIF

2318087400
2046328400
1715716000
1221645800
948231200
1117207800
0
-668473200
-630870300
-308270300
320812900
995767100
2962044400
5432380800
6742484600
6796687500
2631962800
3222638700
2847730000
2389884200
1701623800
1320686800
1556154300
0
-891214200
-841160400
-472440400
252010400
1016186200
3263306000
6083751000
7590609400
7670453400
2926593800
3617955000
3206106800
2695922200
1919661800
1490072600
1755535800

28048066200

38920857900

43488164400
43488164400

4X SETAHUN
UMUR 15-110