1. COMPUTER MODELING APPLIED TO BREAST CANCER SCREENING TESTS IN RIO DE JANEIRO
Gerson 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
RESULTS
The 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

2. RESULTS CONTINUED
Another 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 JANEIRO
Gerson 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 CONTINUED
One 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.

3. 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 JANEIRO
Gerson 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.

4. CONCLUSIONS
COMPUTER MODELING APPLIED TO BREAST CANCER SCREENING TESTS IN RIO DE JANEIRO
Gerson 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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