Lead Time Bias - Relationship Between Screening and Survival

Relationship Between Screening and Survival

By screening, the intention is to diagnose a disease earlier than it would be without screening. Without screening, the disease may be discovered later once symptoms appear.

Even if in both cases a person will die at the same time, because the disease was diagnosed early with screening, the survival time since diagnosis is longer with screening. No additional life has been gained (and indeed, there may be added anxiety as the patient must live with knowledge of the disease for longer). For example, most people with the genetic disorder Huntington's disease are diagnosed when symptoms appear around age 50, and they die around age 65. The typical patient therefore lives about 15 years after diagnosis. With a genetic test, it is possible to diagnose this disorder at birth. If this newborn baby dies around age 65, he or she will have "survived" 65 years after diagnosis, without having actually lived any longer than the people who were diagnosed late in life.

Looking at raw statistics, screening will appear to increase survival time (this gain is called lead time). If we do not think about what survival time actually means in this context, we might attribute success to a screening test that does nothing but advance diagnosis.

Lead time bias is also an important determinant for the 5 (and 10-) Year survival.

Lead time bias can affect interpretation of the five-year survival rate.