Breast Cancer

 What is the best post-lumpectomy option for a 74yo with early stage breast cancer?

In 1999 Carter et al evaluated 5 post-lumpectomy treatment options for a 74yo women with early stage breast cancer, using 3 modelling methods: Markov Process, Analytic Hierarchy Process and Analytic Network Process. They returned the same 'best' option.
TipKJ Carter, NP Ritchey, F Castro, LP Caccamo, E Kessler, BA Erickson  Analysis of three decision making methods: a breast cancer patient as a model  Medical Decision Making 19: 49-57
 
The AHP results are represents in the Annalisa snapshot below.

 Options

  • Observe
  • Radiation
  • Tamoxifen
  • Radiation plus Tamoxifen
  • Mastectomy

 Attributes

  • Local recurrence
  • Metastasis
  • Pain
  • Disfigurement
  • Inconvenience
  • Death
  • Seroma
  • Thrombosis
  • Rib fracture (omitted in this Annalisa)
  • Secondary Cancer
  • Pulmonary thrombosis

 Ratings

From  Carter et al. They were produced by the 'strength of preference' approach adopted in the AHP methodology and may bear no necessary relationship to direct ratings from the evidence. In any case they may now be out of date, so as usual the example is illustrative of the way Annalisa may be used. Note: We assume the published rating for Radiation/Local recurrence of .029 should be .249

 Weightings

From Carter et al. using AHP 'strength of preference' method.

 Scores

From Carter et al.  Radiation plus Tamoxifen emerged as top-ranked in all three methods and Mastectomy ranked last in all three. The other rankings varied between the methods.

 Extras

Carter et al. concluded that "the choice of one approach over another depends upon the urgency of the decision and the detail desired from the analysis"
.  alt file here

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