Depending on personal and hereditary factors, each woman has a different risk of developing
breast cancer, one of the leading causes of death for women. For women with a high-risk of
breast cancer, their risk can be reduced by two main therapeutic approaches: 1) preventive treatments such as hormonal
therapies (i.e.,
tamoxifen,
raloxifene,
exemestane); or 2) a risk reduction surgery (i.e.,
mastectomy). Existing national clinical guidelines either fail to incorporate or have limited use of the personal risk of developing
breast cancer in their proposed risk reduction strategies. As a result, they do not provide enough resolution on the benefit-risk trade-off of an intervention policy as personal risk changes. In addressing this problem, we develop a discrete-time, finite-horizon Markov decision process (MDP) model with the objective of maximizing the patient's total expected quality-adjusted life years. We find several useful insights some of which contradict the existing national
breast cancer risk reduction recommendations. For example, we find that
mastectomy is the optimal choice for the border-line high-risk women who are between ages 22 and 38. Additionally, in contrast to the National Comprehensive
Cancer Network recommendations, we find that
exemestane is a plausible, in fact, the best, option for high-risk postmenopausal women.