Evaluating cancer screening programs using survival analysis

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

The main purpose of cancer screening programs is to provide early treatment to patients that are diagnosed with cancer on a screening test, thus increasing their chances of survival. To test this hypothesis directly, one should compare the survival of screen-detected cases to the survival of their counterparts not included to the program. In this study, we develop a general notation and use it to formally define the comparison of interest. We explain why the naive comparison between screen-detected and interval cases is biased and show that the total bias that arises in this case can be decomposed as a sum of lead time bias, length time bias, and bias due to overdetection. With respect to the estimation, we show what can be estimated using existing methods. To fill in the missing gap, we develop a new nonparametric estimator that allows us to estimate the survival of the control group, that is, the survival of cancer cases that would be screen-detected among those not included to the program. By joining the proposed estimator with existing methods, we show that the contrast of interest can be estimated without neglecting any of the biases. Our approach is illustrated using simulations and empirical data.

• Language: English
• Keywords: bias, breast cancer, survival analysis, cancer screening, counterfacts
• Work type: Article
• Typology: 1.01 - Original Scientific Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2023
• Number of pages: 24 str.
• Numbering: Vol. 65, iss. 7, art. 2200344
• PID: 20.500.12556/RUL-152331
• UDC: 616-006
• ISSN on article: 0323-3847
• DOI: 10.1002/bimj.202200344
• COBISS.SI-ID: 154649603
• Publication date in RUL: 20.11.2023

Record is a part of a journal

• Title: Biometrical journal
• Shortened title: Biom. j.
• Publisher: Wiley
• ISSN: 0323-3847
• COBISS.SI-ID: 25098752

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: rak na dojki, statistika, analiza preživetja