Evaluation of screening strategies for pre-malignant lesions using a biomathematical approach
by
Jihyoun Jeon
Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, USA
Coauthors: 1. Rafael Meza, Division of Mathematical Modeling, UBC Centre for Disease Control, Vancouver, Canada & Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, USA 2. Suresh H. Moolgavkar, Program in Biostatistics and Biomathematics, Fred Hutchinson Cancer Research Center, Seattle, USA 3. E. Georg Luebeck, Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, USA

We present mathematical expressions for the size distribution of screen-detectable pre-malignant lesions, conditional on no prior detection of cancer in the tissue of interest, based on a general multistage clonal expansion model of carcinogenesis. We apply these expressions to simulate the natural history of colorectal cancer and to evaluate the effect of a screen for adenomatous polyps and concomitant intervention on cancer risk. Our approach allows the efficient simulation of multiple screens and interventions and determination of the optimal timing of the screens. We further demonstrate the utility of our approach by computing the benefits of up to two colonoscopies on the lifetime risk of colorectal cancer. If time permits, I will present some preliminary results of the analysis of a screening trial using our methodology.

Date received: May 15, 2008