{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T20:46:06Z","timestamp":1785703566179,"version":"3.56.0"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Med Screen"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The standard metric to assess the benefit of cancer screening is reduction in cancer-specific mortality. However, patients may benefit from downstaging of disease due to screening, even among those who would have survived late-stage disease absent screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a model of stage and survival in the absence and presence of screening. Within each stage\/survival category without screening, there are transition probabilities to various stage\/survival and mode of detection (screen detected or not) categories under screening. The model includes rules for allowable transitions; for example, stage and survival are unchanged for non-screen detected cancers, and survival status changing from dying to surviving requires downstaging. A two-stage (early\/late) model was fit to National Lung Screening Trial (NLST) data. The low-dose computed tomography (LDCT) arm was considered the screening arm and the chest radiograph arm the control (non-screening) arm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 1032 and 993 lung cancer cases in the NLST LDCT and control arm, respectively. 15.2% of control arm cases were late-stage (III\/IV) survivors. Their rate of transitioning to early-stage (I\/II) survivors under screening was 18.4%, resulting in 2.8% (15.2% * 18.4%) of all cases transitioning from late-stage survivors under no screening to early-stage survivors with screening. 47.1% of late-stage control arm cases did not survive; their rate of transitioning to early-stage survivors under screening was 21.5%, resulting in 10.1% (47.1% * 21.5%) of all cases under no screening with that transition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Modeling the effects of screening on stage and survival can help elucidate a more holistic set of screening benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09691413261473145","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:15:24Z","timestamp":1785510924000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Downstaging as a direct patient benefit in cancer screening"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0350-3282","authenticated-orcid":false,"given":"Paul F","family":"Pinsky","sequence":"first","affiliation":[{"name":"Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elyse M","family":"LeeVan","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy S","family":"Rubinstein","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Patriotis","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori","family":"Minasian","sequence":"additional","affiliation":[{"name":"Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"e_1_3_2_2_2","volume-title":"Principles and practice of screening for disease","author":"Wilson JMG","year":"1968","unstructured":"Wilson JMG, Jungner G. Principles and practice of screening for disease. World Health Organization, 1968. Accessed online at whqlibdoc.who.int\/php\/WHO_PHP_34.pdf on Dec 12, 2025."},{"key":"e_1_3_2_3_2","first-page":"29","volume-title":"Cancer screening: theory and practice","author":"Prorok PC","year":"1999","unstructured":"Prorok PC, Kramer BS, Gohagan JK. Screening theory and study design: the basics. In: Kramer BS, Gohagan JK, Prorok PC (eds) Cancer screening: theory and practice. Marcel Dekker, 1999, pp.29\u201353."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-25-0201"},{"key":"e_1_3_2_5_2","unstructured":"National Cancer Institute. Surveillance Epidemiology and End Results (SEER) Program. http:\/\/seer.cancer.gov."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30641-0"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2024.114296"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2402141"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1102873"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.12738"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.7326\/M13-2316"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X17737507"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.24766"},{"key":"e_1_3_2_14_2","unstructured":"National Comprehensive Cancer Network 2026 Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer 3.3036"},{"key":"e_1_3_2_15_2","unstructured":"American Cancer Society. (2025 June 23). Non-small cell lung cancer treatment by stage. https:\/\/www.cancer.org\/cancer\/types\/lung-cancer\/treating-non-small-cell\/by-stage.html"},{"key":"e_1_3_2_16_2","unstructured":"American Cancer Society. (2024). Colon Cancer Treatment by Stage. https:\/\/www.cancer.org\/cancer\/types\/colon-rectal-cancer\/treating\/by-stage-colon.html"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12092679"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.01856"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.7305"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2010-0248"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.3712"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2025.10.001"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/09691413261440207"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.4011"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.2340\/1651-226X.2025.42825"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.20675"}],"container-title":["Journal of Medical Screening"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09691413261473145","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09691413261473145","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09691413261473145","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T19:47:58Z","timestamp":1785700078000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09691413261473145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":25,"alternative-id":["10.1177\/09691413261473145"],"URL":"https:\/\/doi.org\/10.1177\/09691413261473145","relation":{},"ISSN":["0969-1413","1475-5793"],"issn-type":[{"value":"0969-1413","type":"print"},{"value":"1475-5793","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]},"article-number":"09691413261473145"}}