
316 Discrete Event Simulation for Health Technology Assessment
is not able to detect cancer that has spread beyond the breast, and so the
impact of surveillance mammography is via the early detection and treat-
ment of local recurrence. These lesions can be treated, which may reduce the
progression of local recurrence to distant metastases.
Three health events related to localized recurrence were dened. One was
impalpable local recurrence. This is a recurrence within the treated, or the oppo-
site, breast that is only detectable by follow-up mammography because it
cannot be felt during manual breast examination. A second event was removed
impal ...