IDEAS home Printed from
   My bibliography  Save this article

A Stochastic Model for Calibrating the Survival Benefit of Screen-Detected Cancers


  • Hsiu-Hsi Chen
  • Amy Ming-Fang Yen
  • Laszlo Tabár


Comparison of the survival of clinically detected and screen-detected cancer cases from either population-based service screening programs or opportunistic screening is often distorted by both lead-time and length biases. Both are correlated with each other and are also affected by measurement errors and tumor attributes such as regional lymph node spread. We propose a general stochastic approach to calibrate the survival benefit of screen-detected cancers related to both biases, measurement errors, and tumor attributes. We apply our proposed method to breast cancer screening data from one arm of the Swedish Two-County trial in the trial period together with the subsequent service screening for the same cohort. When there is no calibration, the results—assuming a constant (exponentially distributed) post-lead-time hazard rate (i.e., a homogeneous stochastic process)—show a 57% reduction in breast cancer death over 25 years. After correction, the reduction was 30%, with approximately 12% of the overestimation being due to lead-time bias and 15% due to length bias. The additional impacts of measurement errors (sensitivity and specificity) depend on the type of the proposed model and follow-up time. The corresponding analysis when the Weibull distribution was applied—relaxing the assumption of a constant hazard rate—yielded similar findings and lacked statistical significance compared with the exponential model. The proposed calibration approach allows the benefit of a service cancer screening program to be fairly evaluated. This article has supplementary materials online.

Suggested Citation

  • Hsiu-Hsi Chen & Amy Ming-Fang Yen & Laszlo Tabár, 2012. "A Stochastic Model for Calibrating the Survival Benefit of Screen-Detected Cancers," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 107(500), pages 1339-1359, December.
  • Handle: RePEc:taf:jnlasa:v:107:y:2012:i:500:p:1339-1359
    DOI: 10.1080/01621459.2012.716335

    Download full text from publisher

    File URL:
    Download Restriction: Access to full text is restricted to subscribers.

    As the access to this document is restricted, you may want to search for a different version of it.

    More about this item


    Access and download statistics


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:taf:jnlasa:v:107:y:2012:i:500:p:1339-1359. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Chris Longhurst). General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.