COMPUTER MODELING APPLIED TO BREAST CANCER SCREENING TESTS IN RIO DE JANEIROGerson N da Cunha 1,3 Cid MM Vianna 1 Fabiano SG Oliveira 1 Gabriela BG Mosegui 2 Marcus PS Rodrigues 1 Fernando N Jardim 1 Antonio A F Peregrino 1

1. Social Medicine Institute - UERJ, Rio de Janeiro, Brazil; 2. Community Health Institute, Fluminense Federal University, Niteroi, Brazil; 3. Technological Faculty of the State of Rio de Janeiro – Petrópolis, Brazil.

ABSTRACT The Rio de Janeiro State has low indicators in screening exams of breast cancer. As an attempt to improve access to exams, particularly in regions with low population density, where the acquisition of mammography is not cost-effective, the use of mobile mammography is an alternative to increase screening tests for breast cancer. The objective of this research is to build a computer model to define the allocation of mobile mammography. The model considers the variables associated with the costs and deadlines, indicating when, where and how long, the mobile mammography units must remain in each city.

METHODS

The model was built in the modeling and simulation software AnyLogic, using Agent-Based modelling techniques. The main result is to determine the route of each vehicle available, to offer the desired coverage for each city. All inputs are parameterized, enabling simulate different scenarios and providing important information for decision-making. The time horizon, number of mammography devices (fixed and mobile) available, desired coverage of the population, production capacity of each device, adherence of urban and rural population, among others variables, were considered into the model.

User Agent modeling

RESULTSThe tests data came from Mountain Region of the Rio de Janeiro State, where less than half of cities has fixed mammography units. Women need to travel to other cities for the examination, which leads to decreased adherence to mammographic screening programs. With the proposed model was possible to determine the distribution of each physical device and the optimum number of mobile mammography units to cover to the entire population in a 2-year cycle. The number of mammography devices to provide coverage to the entire population of the region could be reduced by half with the routing proposed in the model.

Distribution devices in the Mountain Region

RESULTS CONTINUEDAnother available feature is the ability to vary the daily amount of available tests. The technical standard of the National Cancer Institute (INCA) defines 26 tests daily. In experiments were analyzed different values, such as half indicated by Brazilian Health System, besides the data found in 2013 for the region.

COMPUTER MODELING APPLIED TO BREAST CANCER SCREENING TESTS IN RIO DE JANEIROGerson N da Cunha 1,3 Cid MM Vianna 1 Fabiano SG Oliveira 1 Gabriela BG Mosegui 2 Marcus PS Rodrigues 1 Fernando N Jardim 1 Antonio A F Peregrino 1

1. Social Medicine Institute - UERJ, Rio de Janeiro, Brazil; 2. Community Health Institute, Fluminense Federal University, Niteroi, Brazil; 3. Technological Faculty of the State of Rio de Janeiro – Petrópolis, Brazil.

RESULTS CONTINUEDOne of the features of the proposed model is to analyze the coverage in the time frame defined in each simulation. The evolution of the coverage can be analyzed for the whole population and the urban and rural population separately.

RESULTS CONTINUED

Routing algorithms have several restrictions with respect to length of stay and return to the vertices already visited. The set time of stay in the city has a direct influence on the costs associated with the number of shifts performed. When considered small times, returns to the cities can be realized, which may increase adherence to screening. When considered higher times, decrease up shifts, but to stay in a city for a long time tends to reduce the adhesion of the population to the screening program. Simulations were performed considering 7, 14 and 30 days of stay.

COMPUTER MODELING APPLIED TO BREAST CANCER SCREENING TESTS IN RIO DE JANEIROGerson N da Cunha1,3 Cid MM Vianna1 Fabiano SG Oliveira1 Gabriela BG Mosegui2 Marcus PS Rodrigues1 Fernando N Jardim 1 Antonio A F Peregrino1

1. Social Medicine Institute - UERJ, Rio de Janeiro, Brazil; 2. Community Health Institute, Fluminense Federal University, Niteroi, Brazil; 3. Technological Faculty of the State of Rio de Janeiro – Petrópolis, Brazil.

RESULTS CONTINUED

Through the simulations, it was demonstrated that the amount of devices is higher than needed. Considering the offer coverage for 100% of the population, it would take only seven mammography: four fixed mammography installed in Nova Friburgo, Petrópolis (2) and Teresópolis and three mobile mammography. The number of devices could be half of the fourteen existing in the region.

CONCLUSIONS

COMPUTER MODELING APPLIED TO BREAST CANCER SCREENING TESTS IN RIO DE JANEIROGerson N da Cunha 1,3 Cid MM Vianna 1 Fabiano SG Oliveira 1 Gabriela BG Mosegui 2 Marcus PS Rodrigues 1 Fernando N Jardim 1 Antonio A F Peregrino 1

1. Social Medicine Institute - UERJ, Rio de Janeiro, Brazil; 2. Community Health Institute, Fluminense Federal University, Niteroi, Brazil; 3. Technological Faculty of the State of Rio de Janeiro – Petrópolis, Brazil.

In Brazil, the difficulty of access to mammography testing leads to women that are only diagnosed when the disease is already in an advanced state, punishing these women with more expensive, painful and most often less effective treatments. The need for women's travel to larger cities for the exam influence adherence to screening programs.

The aim of this study was to build a computational model that enables define logistics allocation of mobile mammography units, which defines when, where and for what period of time each mammography should stay in each city.

The model can be used as a tool in defining new equipment acquisition policies. To achieve 100% coverage of the population offer the Mountain Region of the Rio de Janeiro State, it would take seven mammography (4 fixed and 3 mobile equipment). Thus, the number required devices can be reduced by half. With these results it was possible to demonstrate the misconception in the acquisition and management of health policy throughout the mountainous region.

The model developed in this work is therefore an important decision support tool as it allows various scenarios to be simulated and analyzed. These scenarios enable health managers to make more efficient planning in relation to the acquisition and management of mammography. .

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