Evaluating the effectiveness of population-based breast cancer service screening: an analysis of parsimonious patient survival information with the time-varying Cox model

Rene Wei-Jung Chang, Grace Hsiao-Hsuan Jen, Kuan-Chia Lin, Tsung-Chi Cheng, Shao-Yuan Chuang, Shin-Liang Pan, Tony Hsiu-Hsi Chen, Amy Ming-Fang Yen

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: This study is aimed at estimating the unbiased effectiveness of population-based breast cancer service screening based on case survival information alone rather than large-scale individual screening data pursuant to the intention-to-treat principle of a randomized-controlled trial. METHODS: A novel time-dependent switched design with two modalities of cancer detection (screen-detected vs clinically detected) was proposed to evaluate the effectiveness of breast cancer screening. We used data on 767 patients from Kopparberg in the Swedish Two-County trial and on 78 587 patients in the Taiwan population-based service screening. We estimated the relative rate of the screen-detected vs the clinically detected with adjustment for both truncation and lead-time biases. The absolute effectiveness in terms of the number needed to screen (NNS) for averting one death from breast cancer was estimated. RESULTS: The relative rate of effectiveness was estimated as 33%, which was consistent with the 37% reported from the original Swedish randomized-controlled trial. The corresponding estimate for the Taiwan screening programme was 42%, which was also very close to that estimated using individual screening history data (41%). Both relative estimates were further applied to yield 446 and 806 of NNS for averting one death from breast cancer for the corresponding two data sets. CONCLUSION: The proposed time-dependent switched design and analysis with two modalities of case survival information provides a very efficient means for estimating the unbiased estimates of relative and absolute effectiveness of population-based breast cancer service screening dispensing with a large amount of individual screening history data.

Original languageEnglish
Pages (from-to)1910-1919
Number of pages10
JournalInternational Journal of Epidemiology
Volume51
Issue number6
Early online dateMay 13 2022
DOIs
Publication statusPublished - Dec 13 2022

Keywords

  • ITT effectiveness
  • mammography screening
  • survival analysis
  • time-dependent

ASJC Scopus subject areas

  • Epidemiology

Fingerprint

Dive into the research topics of 'Evaluating the effectiveness of population-based breast cancer service screening: an analysis of parsimonious patient survival information with the time-varying Cox model'. Together they form a unique fingerprint.

Cite this