Breast cancer survival, competing risks and mixture cure model: a Bayesian analysis
AbstractCancer is a major public health burden and is the second leading cause of death in the USA. The US National Cancer Institute estimated overall costs of cancer in 2007 at $219.2 billion. Breast cancer has the highest cancer incidence rates among women and is the second leading cause of cancer death among women. The 'Surveillance, epidemiology, and end results' programme of the National Cancer Institute collects and publishes cancer survival data from 17 population-based cancer registries. The CANSURV software of the National Cancer Institute analyses cancer survival data from the programme by using parametric and semiparametric mixture cure models. Another popular approach in cancer survival is the competing risks approach which considers the simultaneous risks from cancer and various other causes. The paper develops a model that unifies the mixture cure and competing risks approaches and that can handle the masked causes of death in a natural way. Markov chain sampling is used for Bayesian analysis of this model, and modelling and computational issues of general and restricted structures are discussed. The various model structures are compared by using Bayes factors. This Bayesian model is used to analyse survival data for the approximately 620000 breast cancer cases from the programme. The estimated cumulative probabilities of death from breast cancer from the proposed mixture cure competing risks model is found to be lower than the estimates that are obtained from the CANSURV software. Whereas the estimate of the cure fraction is found to be dependent on the modelling assumptions, the survival and cumulative probability estimates are not sensitive to these assumptions. Breast cancer survival in different ethnic subgroups, in different age subgroups and in patients with localized, regional and distant stages of the disease are compared. The risk of mortality from breast cancer is found to be the dominant cause of death in the beginning part of the follow-up whereas the risk from other competing causes often became the dominant cause in the latter part. This interrelation between breast cancer and other competing risks varies among the different ethnic groups, the different stages and the different age groups. Copyright (c) 2009 Royal Statistical Society.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Bibliographic InfoArticle provided by Royal Statistical Society in its journal Journal of the Royal Statistical Society: Series A (Statistics in Society).
Volume (Year): 173 (2010)
Issue (Month): 2 ()
Contact details of provider:
Postal: 12 Errol Street, London EC1Y 8LX, United Kingdom
Web page: http://www.blackwellpublishing.com/journal.asp?ref=0964-1998
More information through EDIRC
You can help add them by filling out this form.
reading list or among the top items on IDEAS.Access and download statisticsgeneral information about how to correct material in RePEc.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wiley-Blackwell Digital Licensing) or (Christopher F. Baum).
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.