DESCRIPTION (Adapted from the applicant's abstract): The case-control
method has been used frequently to evaluate the impact of screening behavior
on cancer mortality, most prominently with regard to the PAP test for cervix
cancer and mammography for breast cancer. Although such observational
studies are unlikely to be definitive they can provide useful exploratory
evidence for the preventive impact of the intervention under study.
Motivated by our recent experience in analyzing a study of skin
self-examination and its role in preventing mortality from melanoma, we have
developed a methodology for separately estimating the impact of the
intervention on primary and secondary prevention, and we believe that the
method adds both insight and validity to the existing methods for analyzing
case-control studies. The general goal of this proposal is to further
develop this new methodology and to examine its statistical properties, with
a view to developing general guidelines for the design, conduct and analysis
of studies examining the joint effects of primary and secondary prevention.
Specifically, we will examine the impact of violations of key assumptions of
the new method, namely stationarity of incidence rates and screening
behavior. We will develop methods for determining how much follow-up time
is required for a valid analysis. Finally, we will develop guidelines for
study design, including sample size calculations.
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