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Dr Zahl's main point is that what he calls 'statistical' estimates of lead time are exaggerated, leading to underestimation of overdiagnosis, due to inclusion of overdiagnosed cancers in the estimation.
Assessments also included estimates of lead intakes and blood lead levels.
Thus, we chose to present the more refined job/industry-specific estimates of lead exposure (Koh et al. 2014).
31 Estimates of lead time varied between 1.6 and 4 years and even differed in articles by the same authors.
Also, most estimates of lead time are derived from models which include overdiagnosed cancers in their calculation of lead time, leading to underestimates of true overdiagnosis.
Using expected remaining lifetimes for the UK male population in 2001 2003, and estimates of lead time from the literature, age-specific probabilities of overdiagnosis were calculated.
Similar(38)
This is an unreliable approach because current estimates of lead-time disregard overdiagnosis and its substantial influence on such calculations.
Similar to models that require an estimate of lead time, some ecological and cohort studies have performed a statistical adjustment for lead time in their analyses, which introduces uncertainty.
Both may result in the analysis of a sample that is less likely to be susceptible to the adverse health effects of lead exposure than the general population, which would lead to an underestimate of the observed effect estimate of lead exposure on mortality.
Sir, Your correspondents' main assertion is that our estimate of lead time in breast screening is too large due to the inclusion of all breast cancer cases in its estimation and that as a consequence our estimate of overdiagnosis is too small.
Because of the small numbers, the cumulative estimates of occupational lead fume and lead dust exposure were also combined into an overall lead exposure variable.
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