PhD defence Nadine Zielonke

Breast cancer is a major public health problem in Europe. It is the most frequently diagnosed neoplasm and leading cause of death in European women. But encouragingly, breast cancer mortality has been declining, essentially due to advancements in early diagnosis and improved treatment.
Breast cancer screening aims to reduce morbidity associated with advanced stages of the disease, as well as cancer-specific mortality. At present, breast cancer screening programs are well established in most European countries. But the burden of breast cancer as well as breast cancer screening programs vary considerably throughout Europe and the long-term effectiveness of screening has only been assessed in a few countries. These substantial differences may result in inappropriate interventions, excessive screening, and overtreatment on the one hand, or under-screening, delayed provision of appropriate treatment on the other.
In this thesis, the consequences of variations of breast cancer screening practices and potential ways to (further) optimize screening programs across Europe are investigated. Part 1 describes the effectiveness of breast cancer screening in Europe. In Part 2, an established microsimulation model (MISCAN-Breast) was used to estimate the impact of current screening policies and the potential harms and benefits of specific health policy changes. Furthermore, MISCAN-Breast was standardized into a user-friendly online application as part of the EU-TOPIA project (www.eu-topia.org).