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Estimating the frequency of indolent breast cancer in screening trials.

Publication ,  Journal Article
Shen, Y; Dong, W; Gulati, R; Ryser, MD; Etzioni, R
Published in: Stat Methods Med Res
April 2019

Cancer screening can detect cancer that would not have been detected in a patient's lifetime without screening. Standard methods for analyzing screening data do not explicitly account for the possibility that a fraction of tumors may remain latent indefinitely. We extend these methods by representing cancers as a mixture of those that progress to symptoms (progressive) and those that remain latent (indolent). Given sensitivity of the screening test, we derive likelihood expressions to simultaneously estimate (1) the rate of onset of preclinical cancer, (2) the average preclinical duration of progressive cancers, and (3) the fraction of preclinical cancers that are indolent. Simulations demonstrate satisfactory performance of the estimation approach to identify model parameters subject to precise specifications of input parameters and adequate numbers of interval cancers. In application to four breast cancer screening trials, the estimated indolent fraction among preclinical cancers varies between 2% and 35% when assuming 80% test sensitivity and varying specifications for the earliest time that participants could plausibly have developed cancer. We conclude that standard methods for analyzing screening data can be extended to allow some indolent cancers, but accurate estimation depends on correctly specifying key inputs that may be difficult to determine precisely in practice.

Duke Scholars

Published In

Stat Methods Med Res

DOI

EISSN

1477-0334

Publication Date

April 2019

Volume

28

Issue

4

Start / End Page

1261 / 1271

Location

England

Related Subject Headings

  • Statistics & Probability
  • Randomized Controlled Trials as Topic
  • Medical Overuse
  • Mammography
  • Humans
  • Female
  • Early Detection of Cancer
  • Breast Neoplasms
  • 4905 Statistics
  • 4202 Epidemiology
 

Citation

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Shen, Y., Dong, W., Gulati, R., Ryser, M. D., & Etzioni, R. (2019). Estimating the frequency of indolent breast cancer in screening trials. Stat Methods Med Res, 28(4), 1261–1271. https://doi.org/10.1177/0962280217754232
Shen, Yu, Wenli Dong, Roman Gulati, Marc D. Ryser, and Ruth Etzioni. “Estimating the frequency of indolent breast cancer in screening trials.Stat Methods Med Res 28, no. 4 (April 2019): 1261–71. https://doi.org/10.1177/0962280217754232.
Shen Y, Dong W, Gulati R, Ryser MD, Etzioni R. Estimating the frequency of indolent breast cancer in screening trials. Stat Methods Med Res. 2019 Apr;28(4):1261–71.
Shen, Yu, et al. “Estimating the frequency of indolent breast cancer in screening trials.Stat Methods Med Res, vol. 28, no. 4, Apr. 2019, pp. 1261–71. Pubmed, doi:10.1177/0962280217754232.
Shen Y, Dong W, Gulati R, Ryser MD, Etzioni R. Estimating the frequency of indolent breast cancer in screening trials. Stat Methods Med Res. 2019 Apr;28(4):1261–1271.
Journal cover image

Published In

Stat Methods Med Res

DOI

EISSN

1477-0334

Publication Date

April 2019

Volume

28

Issue

4

Start / End Page

1261 / 1271

Location

England

Related Subject Headings

  • Statistics & Probability
  • Randomized Controlled Trials as Topic
  • Medical Overuse
  • Mammography
  • Humans
  • Female
  • Early Detection of Cancer
  • Breast Neoplasms
  • 4905 Statistics
  • 4202 Epidemiology