Estimating lead time and overdiagnosis in cancer screening programmes : the MOCCI method

Vratanar, Bor (avtor), Pohar Perme, Maja (avtor)

Background: Cancer screening enables earlier cancer diagnosis and treatment. The interval between cancer diagnosis by screening and the symptomatic detection in the absence of screening is termed lead time. If a patient's tumour, detected by screening, would never surface clinically, the patient is considered overdiagnosed. Estimating these quantities is crucial for evaluating cancer screening programmes. Development: We developed MOCCI (Minimizing Observed and Counterfactual Cancer Incidence), a novel parametric method for estimating the lead time distribution. MOCCI compares age- and calendar-stratified cancer incidence between individuals invited to screening and those not invited and estimates the lead time distribution that minimizes the incidence difference between the two groups. The probability of overdiagnosis is then estimated by comparing the model-predicted lead time with the time to death from other causes. Application: In an application to the Slovenian breast cancer screening programme, we estimated that 30% (95% confidence interval [CI], 20% to 39%) of screen-detected cases were non-progressive and 33% (95% CI, 25% to 43%) were overdiagnosed; assuming an exponential lead time distribution for progressive cancers, the mean lead time was 1.8 years (95% CI, 1.3 to 2.9). Conclusions: This study proposes a new method for estimating lead time and overdiagnosis. The proposed method (a) can accommodate various lead time distributions, (b) yields a lead time distribution that is aligned with the observed excess incidence arising from screening, and (c) enables the separation of different sources of overdiagnosis. The method provides stable estimates when sample sizes are large and the assumed lead time model is simple.

• Jezik: Angleški jezik
• Ključne besede: causal inference, counterfactual, deconvolution, incidence, lead time, overdiagnosis
• Tipologija: 1.01 - Izvirni znanstveni članek
• Organizacija: MF - Medicinska fakulteta
• Različica publikacije: Objavljena publikacija
• Datum objave: 01.01.2026
• Leto izida: 2026
• Št. strani: 8 str.
• Številčenje: Vol. 55, iss. 5, art. dyag167
• PID: 20.500.12556/RUL-186678
• UDK: 616-006:61:004:519.87
• ISSN pri članku: 1464-3685
• DOI: 10.1093/ije/dyag167
• COBISS.SI-ID: 288271107
• Datum objave v RUL: 04.09.2026

Gradivo je del revije

• Naslov: International journal of epidemiology
• Skrajšan naslov: Int J Epidemiol
• Založnik: Oxford
• ISSN: 1464-3685
• COBISS.SI-ID: 3204116

Licence

• Licenca: CC BY 4.0, Creative Commons Priznanje avtorstva 4.0 Mednarodna
• Povezava: http://creativecommons.org/licenses/by/4.0/deed.sl
• Opis: To je standardna licenca Creative Commons, ki daje uporabnikom največ možnosti za nadaljnjo uporabo dela, pri čemer morajo navesti avtorja.

Sekundarni jezik

• Jezik: Slovenski jezik
• Ključne besede: vzročno sklepanje, nasprotno dejstvo, dekonvolucija, incidenca, časovna prednost, prediagnosticiranje

Projekti

• Financer: ARIS - Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije
• Številka projekta: P3-0429
• Naslov: Slovenski raziskovalni program za celostno obravnavo raka SLORApro

• Financer: ARIS - Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije
• Številka projekta: P3-0154
• Naslov: Metodologija za analizo podatkov v medicini