The lead time distribution when lifetime is subject to competing risks in cancer screening

Dongfeng Wu, Karen Kafadar, Gary L. Rosner, Lyle D. Broemeling

Research output: Contribution to journalArticlepeer-review


This paper extends the previous probability model for the distribution of lead time in periodic cancer screening exams, namely, in that the lifetime T is treated as a random variable, instead of a fixed value. Hence the number of screens for a given individual is a random variable as well. We use the actuarial life table from the Social Security Administration to obtain the lifetime distribution, and then use this information to project the lead time distribution for someone with a future screening schedule. Simulation studies using the HIP study group data provide estimates of the lead time under different screening frequencies. The projected lead time has two components: a point mass at zero (corresponding to interval cases detected between screening exams) and a continuous probability density. We present estimates of the projected lead time for participants in a breast cancer screening program. The model is more realistic and can inform optimal screening frequency. This study focuses on breast cancer screening, but is applicable to other kinds of cancer screening also.

Original languageEnglish (US)
Article number1363
JournalInternational Journal of Biostatistics
Issue number1
StatePublished - 2014


  • cancer screening
  • lead time
  • lifetime
  • sensitivity
  • sojourn time
  • transition probability density

ASJC Scopus subject areas

  • Statistics and Probability
  • Statistics, Probability and Uncertainty


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