Stratified breast cancer follow-up using a partially observable MDP

J. W.M. Otten, A. Witteveen, I. M.H. Vliegen, S. Siesling, J. B. Timmer, Maarten IJzerman

Research output: Chapter in Book/Report/Conference proceedingChapterAcademicpeer-review

6 Citations (Scopus)
28 Downloads (Pure)


Frequency and duration of follow-up for patients with breast cancer is still under discussion. Current follow-up consists of annual mammography for the first five years after treatment and does not depend on the personal risk of developing a locoregional recurrence (LRR) or second primary tumor. Aim of this study is to gain insight in how to allocate resources for optimal and personal follow-up. We formulate a discrete-time Partially Observable Markov Decision Process (POMDP) with a finite horzion in which we aim to maximize the total expected number of quality-adjusted life years (QALYs). Transition probabilities were obtained from data from the Netherlands Cancer Registry (NCR). Twice a year the decision is made whether or not a mammography will be performed. Recurrent disease can be detected by both mammography or women themselves (self-detection). The optimal policies were determined for three risk categories based on differentiation of the primary tumor. Our results suggest a slightly more intensive follow-up for patients with a high risk and poorly differentiated tumor, and a less intensive schedule for the other risk groups.
Original languageEnglish
Title of host publicationMarkov Decision Processes in Practice
EditorsRichard J. Boucherie, Nico M. van Dijk
Place of PublicationCham
Number of pages22
ISBN (Electronic)978-3-319-47766-4
ISBN (Print)978-3-319-47764-0
Publication statusPublished - Mar 2017

Publication series

NameInternational Series in Operations Research & Management Science
PublisherSpringer International Publishing
ISSN (Print)0884-8289


  • Partially observable Markov decision process (POMDP)
  • Breast cancer
  • Optimal policies
  • Stratified follow-up
  • Markov decision process (MDP)
  • 2023 OA procedure


Dive into the research topics of 'Stratified breast cancer follow-up using a partially observable MDP'. Together they form a unique fingerprint.

Cite this