The Cancer Intervention and Surveillance Modeling Network

The MISCAN-Fadia model was used to analyze the impact of screening and adjuvant treatment on U.S. breast cancer mortality between 1975 and 2000. MISCAN-Fadia uses the concept of “ fatal diameter ” to model survival and screening benefi t and is based on continuous tumor growth. It consists of four major components: population, natural history, screening, and treatment. Population parameters were quan-tifi ed using U.S. population data. Most natural history and screening parameters were fi tted to the Swedish Two County screening trial data; some were based on Surveillance, Epi-demiology, and End Results data. Adjuvant treatment param-eters were quantifi ed using data from the Early Breast Cancer Trialists ’ Collaborative Group’s meta-analysis. The simu-lated trend in incidence matches the observed trend reason-ably well; the simulated mortality is equal to the observed in 1975 but becomes increasingly too high in 2000. We estimate that screening leads to a 15 % and adjuvant treatment to a 21 % mortality reduction in the year 2000. [J Natl Cance