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Headshot of Stephanie Wheeler.
UNC Lineberger’s Stephanie Wheeler, PhD, MPH.

In an editorial published Jan. 16 in JAMA, UNC Lineberger’s Stephanie Wheeler, PhD, MPH, and colleagues endorsed the use of simulation models to assess the impact of cancer control initiatives, including screening and treatment, calling the model-generated insights critical to making informed public health policy and establishing cancer research priorities in the future.

Wheeler, Ethan Basch, MD, MSc, FASCO, of UNC Lineberger and the UNC School of Medicine, and Gabrielle Rocque, MD, of the University of Alabama at Birmingham, provided commentary on a study by Jennifer L. Caswell-Jin, MD, and colleagues who used four simulation models developed within the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network to determine that breast cancer screening and the treatment of breast cancers (ranging from early stage to metastatic disease) were each associated with the reduction of breast cancer mortality between 1975 and 2019 in the United States.

“Systems science approaches like the simulation modeling used in this study can help researchers, policy makers, healthcare providers and the public better understand to what extent, and in which circumstances, scientific advancements in cancer care delivery have translated to better public health outcomes,” said Wheeler, the Michael S. O’Malley Distinguished Professor in the Department of Health Policy and Management at the UNC Gillings School of Global Public Health and associate director of Community Outreach and Engagement at UNC Lineberger. “These methods also can help point to opportunities for future research prioritization and investments — insights that are beneficial for funders and researchers interested in supporting the most impactful science possible.”

Headshot of Ethan Basch.
UNC Lineberger’s Ethan Basch, MD, MSc.

Basch, the chief of oncology and the Richard M. Goldberg Distinguished Professor in Medical Oncology at the UNC School of Medicine and director of UNC Lineberger’s Cancer Outcomes Research Program, said the study is important for several reasons. “First, it demonstrates the true value of investments in clinical research in breast cancer in terms of survival gains. Second, it elucidates where more investments are needed. And third, it highlights why public funding of modeling and other outcomes research is vital to progress in cancer care.”

While the simulation models have been effective in assessing the association between screening, treatment and lower cancer mortalities, Wheeler and her colleagues note there is still a significant need to better understand why rural, Black and uninsured patient populations remain at greatest risk of dying from breast cancer, compared with urban, white and insured patients.

“Understanding and quantifying how, and to what extent, improvements in screening and treatment have influenced subpopulation-level outcomes remains a critical need to inform public health programming, optimize clinical care delivery, and enhance intervention efforts tailored to marginalized populations to address disparities in outcomes,” the authors wrote.