Separate Estimation of Primary and Secondary Cancer Preventive Impact: Analysis of a Case-Control Study of Skin Self-Examination and Melanoma
作者:
ColinB. Begg,
Ying Huang,
Marianne Berwick,
期刊:
Journal of the American Statistical Association
(Taylor Available online 1996)
卷期:
Volume 91,
issue 436
页码: 1381-1387
ISSN:0162-1459
年代: 1996
DOI:10.1080/01621459.1996.10476706
出版商: Taylor & Francis Group
关键词: Cancer prevention;Confounding;Lead-time bias;Screening test;Survival analysis
数据来源: Taylor
摘要:
Case-control studies increasingly have been used to evaluate the impact of cancer screening strategies. In this context the intent of the screening test has been to reduce cancer mortality by early detection of cancers, permitting curative therapy in some patients who would die of the disease if diagnosis were delayed until the disease was detected clinically. This phenomenon is known as secondary prevention. In an analysis of a case-control study of skin self-examination (SSE) in reducing mortality from melanoma, it was recognized that the exposure (SSE) may encourage the removal of precancerous nevi (moles), thereby reducing cancer incidence (primary prevention). This article describes an analytic strategy for obtaining separate estimates of the primary and secondary preventive impact of the screening practice. The method is focused primarily on resolving the problem of lead-time bias, caused by the artifactual advancement of the time of diagnosis in cases detected by screening.
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