Unveiling Survival Insights: How Detection Methods and Screening Trial Biases Shape Surrogate and Mortality Outcomes

Music City Center 

Prognostic models in cancer use patient demographic and tumor characteristics to predict survival and dynamic disease prognosis. Past works in breast cancer and lung cancer have shown that cancer detection method, screen-detected or symptom-detected, has prognostic significance. We recently investigated this phenomenon in the lung component of the Prostate, Lung, Colorectal, and Ovarian (PLCO) screening trial. Patients were randomized to intervention, receiving four annual chest x-rays (CXRs), or to control, receiving usual care. In PLCO, lung cancer detection method has independent prognostic value exceeding that of variables commonly used in lung cancer prognostic models. Issues associated with lead-time bias and length-bias, and surrogate outcomes in cancer screening trials will be discussed in the context.

Screening Trial

lead-time bias

length-bias

surrogate outcomes