Assessing lead time bias due to mammography screening on estimates of loss in life expectancy.
Assessing lead time bias due to mammography screening on estimates of loss in life expectancy.
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DOI：
10.1186/s13058-022-01505-3
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发表时间：
2022-02-23
期刊：
影响因子：
--
通讯作者：
Andersson TM
中科院分区：
文献类型：
--
作者：
Syriopoulou E;Gasparini A;Humphreys K;Andersson TM
用于总结癌症预后的一个越来越流行的测量是预期寿命损失（LLE），即癌症诊断后预期寿命的减少。还可以得出生命损失的比例，提高各年龄组的可比性，因为LLE高度依赖于年龄。LLE和PLL通常用于评估癌症对剩余寿命和跨群体（例如社会经济群体）的影响。然而，在存在筛查的情况下，尚不清楚人群组间的部分差异是否可归因于前置时间偏倚。提前时间是由于早期诊断而增加的额外时间，即从肿瘤检测到筛查到癌症被诊断出来的时间。它导致人为夸大的生存估计，即使没有真实的生存改善。在本文中，我们使用了一种基于模拟的方法，以评估由于乳腺X线摄影筛查的提前时间对乳腺癌患者的LLE和PLL估计的影响。在瑞典环境中开发的自然史模型用于模拟乳腺癌肿瘤的生长和症状检测时的年龄。然后，实施了一项类似于瑞典现行指南的筛查计划，邀请40-74岁的个人每两年参加一次;考虑了筛查敏感性和出勤率的不同情况。为了隔离筛选的前置时间偏倚，我们假设筛选不影响实际死亡时间。最后，估计的LLE和PLL获得的存在和不存在的筛选，他们的差异被用来推导出的前置时间偏差。在高筛查敏感性情况下，假设完美的筛查出席率，LLE的最大绝对偏倚为0.61年。当完全出勤假设被放宽以允许在筛选访视期间不完全出勤时，绝对偏倚降低至0.46年。PLL估计值也存在偏倚。分析结果表明，前置时间偏差影响LLE和PLL指标，因此在解释跨日历时间或人群的比较时需要特别考虑。在线版本包含补充材料，可通过10.1186/s13058-022-01505-3获得。
An increasingly popular measure for summarising cancer prognosis is the loss in life expectancy (LLE), i.e. the reduction in life expectancy following a cancer diagnosis. The proportion of life lost (PLL) can also be derived, improving comparability across age groups as LLE is highly age-dependent. LLE and PLL are often used to assess the impact of cancer over the remaining lifespan and across groups (e.g. socioeconomic groups). However, in the presence of screening, it is unclear whether part of the differences across population groups could be attributed to lead time bias. Lead time is the extra time added due to early diagnosis, that is, the time from tumour detection through screening to the time that cancer would have been diagnosed symptomatically. It leads to artificially inflated survival estimates even when there are no real survival improvements. In this paper, we used a simulation-based approach to assess the impact of lead time due to mammography screening on the estimation of LLE and PLL in breast cancer patients. A natural history model developed in a Swedish setting was used to simulate the growth of breast cancer tumours and age at symptomatic detection. Then, a screening programme similar to current guidelines in Sweden was imposed, with individuals aged 40–74 invited to participate every second year; different scenarios were considered for screening sensitivity and attendance. To isolate the lead time bias of screening, we assumed that screening does not affect the actual time of death. Finally, estimates of LLE and PLL were obtained in the absence and presence of screening, and their difference was used to derive the lead time bias. The largest absolute bias for LLE was 0.61 years for a high screening sensitivity scenario and assuming perfect screening attendance. The absolute bias was reduced to 0.46 years when the perfect attendance assumption was relaxed to allow for imperfect attendance across screening visits. Bias was also present for the PLL estimates. The results of the analysis suggested that lead time bias influences LLE and PLL metrics, thus requiring special consideration when interpreting comparisons across calendar time or population groups. The online version contains supplementary material available at 10.1186/s13058-022-01505-3.
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DOI：
10.1186/1472-6874-14-33
发表时间：
2014-02-24
期刊：
BMC women's health
影响因子：
--
作者：
Lagerlund M;Sontrop JM;Zackrisson S
通讯作者：
Zackrisson S
影响因子：
2.3
作者：
Abrahamsson, Linda;Humphreys, Keith
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影响因子：
3.8
作者：
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影响因子：
4.4
作者：
Lundqvist A;Andersson E;Ahlberg I;Nilbert M;Gerdtham U
通讯作者：
Gerdtham U
影响因子：
2
作者：
Nelson, Christopher P.;Lambert, Paul C.;Jones, David R.
通讯作者：
Jones, David R.