Simulation Modeling of Oral Cancer Development with Risk Stratification: How Potential Screening Programs Can Be...

Area of Science:

• Oncology
• Public Health
• Health Informatics

Background:

• Early detection of oral cavity cancer is hindered by the absence of defined populations and screening regimens balancing risk and benefit.
• Existing screening methods lack precision in identifying individuals most likely to benefit from early intervention.

Purpose of the Study:

• To develop and validate a microsimulation model (SCORE) for evaluating oral cancer screening strategies.
• To assess the impact of risk-stratified biopsy referral on screening efficiency and patient outcomes.

Main Methods:

• Constructed the Simulation of Cancers of the Oral cavity and Risk Exposures (SCORE) microsimulation model incorporating smoking, alcohol exposure, and lesion characteristics.
• Simulated oral potentially malignant disorders (OPMD) progression and evaluated screening strategies with and without a risk-based biopsy decision rule.
• Calibrated the model to national cancer registry data and compared outcomes like life expectancy, cancer incidence, and mortality.

Main Results:

• All evaluated screening strategies reduced oral cancer incidence and mortality by at least 20-26% compared to no screening.
• Risk-stratified biopsy referral improved diagnostic efficiency, requiring 8 biopsies per treatable diagnosis.
• In high-risk men, screening with or without the biopsy rule showed comparable benefits in reducing cancer deaths and incidence.
• Applying the biopsy rule in non-high-risk groups reduced biopsies by 38% while maintaining cancer burden reductions.

Conclusions:

• The SCORE model facilitates virtual trials for optimizing oral cancer screening regimens and identifying target populations.
• Risk-stratified screening strategies, particularly with the biopsy decision rule, enhance diagnostic efficiency and minimize unnecessary procedures.
• SCORE can accelerate the evaluation of new screening technologies and clinical recommendations for oral cancer prevention.