Effects of lead time, length bias, and false-negative assurance on screening for breast cancer

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Abstract
This article presents a model of breast cancer screening programs. The model shows the effects of the screening threshold, screen sensitivity, and false-negative assurance on the cumulative mortality rate in the screened population. It shows that factors of screen design and a penalty associated with false-negative assurance can result in excess mortality rates in screened populations-especially in those age classes in which the incidence of rapidly growing tumors is high. Factors related to the magnitude of this effect are described.