Abstract
<jats:p><div>Abstract Background:<p>Earlier cancer detection through advancements in screening technologies and increased screening access and adherence may improve cancer survival. We developed a quantitative approach using a matrix equation to characterize cancer stage shift resulting from cancer screening interventions and estimated resulting survival improvements.</p> Methods:<p>The expected percent survival improvement was defined <i>a priori</i> as 20%, and the analysis sought to characterize the stage shift required to achieve this goal. The matrix equation was populated with incidence and cause-specific survival for 16 cancers by stage at diagnosis using the National Cancer Institute Surveillance, Epidemiology, and End Results database. Linear programming was used to solve for the matrix given a set of constraints formulated to steer the solution toward the least amount of downstaging required to achieve the objective and to partially compensate for length-time bias.</p> Results:<p>Three common trends emerged across almost all cancer types: (i) Most of the survival improvement can be achieved by detecting disease prior to stage IV; (ii) remaining survival improvements can be achieved by detecting just one stage earlier; and (iii) stage I diagnosis is not necessary to achieve measurable survival improvement goals. Lung cancer required more aggressive earlier detection than others, an expected result as lung cancer has a very high incidence and very poor survival.</p> Conclusions:<p>This flexible mathematical framework may be helpful for public health officials to characterize how earlier cancer detection can affect cancer survival.</p> Impact:<p>Our results suggest that detecting cancer prior to distant metastases may significantly improve survival.</p></div></jats:p>