Methods and Applications of Statistics in Clinical Trials, Volume 2: Planning, Analysis, and Inferential Methods

Chapter 43

Screening, Models of

Chris Stevenson

43.1 Introduction

Screening asymptomatic people to allow the early detection and treatment of chronic diseases is an important part of modern medicine and public health. For screening to be both an efficient and cost-effective medical intervention, it must be carefully targeted and evaluated. Mathematical models of disease screening constitute one of the major tools in the design and evaluation of screening programs.

The purpose of this article is to describe models for disease screening and how they have developed in recent years. The discussion focuses on screening for cancer, because most of the methodological advances in screening design and evaluation have concerned cancer screening. In the first part of the article we describe the characteristics of these models and illustrate them with a discussion of a simple screening model. In the second part we describe the development of the two main types of model. In the third part we discuss model fitting and validation, and in the final part we briefly describe models for diseases other than cancer and discuss the current state and possible future directions for models of disease screening.

This is not intended to be an exhaustive study of all modeling of disease screening. Rather, it is intended to be a description of the main approaches used and their strengths and weaknesses. For more detailed reviews of modeling disease screening, see Eddy and Shwartz [30]), Shwartz and Plough ...