Incorporating human behaviour in simulation models of screening for breast cancer

Simulation modelling is widely used in many industries in order to assess and evaluate alternative options and to test strategies or operating rules which are too complex to be modelled analytically. Simulation software has developed its capability in parallel with the growth in computing power since the 1980s. However in practice, the results from the most sophisticated and complex simulation model may not truly reflect what happens in the real world, because such models do not account for human behaviour. For example, in the domain of healthcare simulation is often used to evaluate the outcomes from medical interventions such as new drug treatments. However in reality patients may not complete the course of a prescribed medication, perhaps because they find the side-effects unpleasant. A simulation study designed to evaluate this medication which ignores such behavioural factors may give unreliable results. In this paper we describe a model for screening for breast cancer which includes behavioural factors to model women’s decisions to attend for mammography. The model results indicate that increasing attendance through education or publicity campaigns can be equally as effective as decreasing the intervals between screens. This would have considerable cost implications for healthcare providers.