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Biases other than overdiagnosis can occur in screening programmes, namely lead time bias and length time bias.
Lead time and length time biases due to earlier detection account in part for this improved survival [ 4– 6].
23 24 25 Lead time and length time biases will spuriously modify survival even in the absence of a change in mortality.
However, these analyses are subject to confounding factors such as lead and length time bias, and it remains to be established conclusively if surveillance is beneficial.
22 Lead time and length time were to a large extent introduced by screening activities that led to increasing incidence of early stage breast cancers.
We hope that our results will prompt subsequent randomized controlled trials of MRI that are not affected by lead time and length time bias and overdiagnosis.
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23 It is therefore likely that our results are affected by lead- and length-time bias.
However, as was mentioned earlier, our study is inherently limited by lead- and length-time bias (as a result of widespread PSA testing and the natural history of PC), and the magnitude of such bias on our observed improvements in survival is unknown.
To address his comment that survival of screen-detected cases is known to be potentially affected by lead-time and length-time biases, we point out that published IELCAP data demonstrate a flat actuarial survival curve with no drop in survival consistent with delayed lead-time deaths out to 10 years (Henschke et al, 2006).
Previous studies are retrospective, leading to problems with lead-time (earlier detection results in a longer follow-up until event, even if the disease progression is the same) and length-time bias (slower growing tumours will be more easily detected, since they are detectable over a longer time period).
The spatiotemporal parameters computed were cadence, stride time and length, step time and length, and walking speed.
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