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American Journal of Epidemiology Vol. 148, No. 6: 609-619
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health

other

Estimating Sensitivity and Sojourn Time in Screening for Colorectal Cancer

A Comparison of Statistical Approaches

T. C. Prevost1, G. Launoy2, S. W. Duffy1 and H. H. Chen3

1Institute of Public Health, University Forvie Site Cambridge CB2 2SR, United Kingdom
2Registre des cancers digestifs du Calvados, INSERM Avenue Côte de Nacre, 14033 Caen cedex, France
3Graduate Institute of Epidemiology, College of Public Health, National Taiwan University Taipei, Taiwan

The effectiveness of cancer screening depends crucially on two elements: the sojourn time (that is, the duration of the preclinical screen-detectable period) and the sensitivity of the screening test. Previous literature on methods of estimating mean sojourn time and sensitivity has largely concentrated on breast cancer screening. Screening for colorectal cancer has been shown to be effective in randomized trials, but there is little literature on the estimation of sojourn time and sensitivity. It would be interesting to demonstrate whether methods commonly used in breast cancer screening could be used in colorectal cancer screening. In this paper, the authors consider various analytic strategies for fitting exponential models to data from a screening program for colorectal cancer conducted in Calvados, France, between 1991 and 1994. The models yielded estimates of mean sojourn time of approximately 2 years for 45- to 54-year-olds, 3 years for 55- to 64-year-olds, and 6 years for 65- to 74-year-olds. Estimates of sensitivity were approximately 75%, 50%, and 40% for persons aged 45–54, 55–64, and 65–74 years, respectively. There is room for improvement in all models in terms of goodness of fit, particularly for the first year after screening, but results from randomized trials indicate that the sensitivity estimates are roughly correct. Am J Epidemiol 1998;148:609-19.

colorectal neoplasms; mass screening; models; statistical; sensitivity; specificity


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