On Optimal Screening Ages

Abstract Several chronic diseases are characterized by an initial asymptomatic stage during which, if detected by screening, they can be cured in a more effective way. This article considers two statistical design problems in screening for chronic disease: the choice of examination ages and the choice of the part of the population to be screened. One main goal is capturing the trade-off between the costs of examination and the losses due to late detection, while accounting for the effects of age on the incidence of the disease, on mortality, and on the relative advantages of early detection. The problem is posed in a decision theoretic way. The model adopted considers a single individual, whose history relative to the disease is represented by a discrete-valued stochastic process. The transition structure is general, but known. The decision space includes all sequences of examination times, as well as no examination. The optimality criterion accounts for the cost of examinations and, in a general way, for...