A projection of benefits due to fecal occult blood test for colorectal cancer

Abstract 

Objectives: A prospective study to estimate benefits due to fecal occult blood tests for colorectal cancer are carried out for both males and females, under different screening frequencies. Methods: We apply the statistical method developed by Wu et al. (2007) [1] using the Minnesota colorectal cancer study group data, to make Bayesian inference for the lead time, the time of diagnosis advanced by screening for both male and female participants in a periodic screening program. The lead time is distributed as a mixture of a point mass at zero and a piecewise continuous distribution. The two parts of the mixture correspond to two aspects of the screening: the probability of no benefit, or the percentage of interval cases; and the probability distribution of the early diagnosis time. We present estimates of these two measures for males and females by simulation studies using the Minnesota study group data. We also provide the mean, mode, variance, and density curve of the program's lead time by gender. This may provide policy makers important information on the effectiveness of the FOBT screening in colorectal cancer early detection. Results: The mean lead time increases as the screening time interval decreases for both males and females. The standard error of the lead time also increases as the screening time interval decreases for both genders. Females seem get more benefit than males, in that females usually have a longer lead time than males if both take the test at the same time interval and the lead time mode for females is greater than that of males in the same screening time interval. Conclusion: According to the predictive estimation of the lead time distribution, to guarantee a 90% chance of early detection, it seems necessary for the males to take the fecal occult blood test every 9 months, while the females can take it annually.

Keywords: Lead time, Colorectal cancer screening, Fecal occult blood test (FOBT), Sensitivity, Sojourn time, Transition probability