The theory of periodic screening I: Lead time and proportion detected

Abstract

A stochastic model for a periodic screening program is presented in which the natural history of a chronic disease is assumed to follow a progressive path from a preclinical state to a clinical state. The sampling of preclinical state sojourn times by screening examinations generates bounds on the preclinical state recurrence times. The distribution of the bounded forward recurrence time is derived and used to obtain the distribution and mean of the lead time, and relationships for calculating the proportion of preclinical cases detected. These expressions are derived in terms of the preclinical state sojourn-time distribution and adjustible parameters important in the design of a periodic screening program.