Differentiating Between Lead-Time Bias and True Survival Benefits When Discussing Racial and Ethnic Disparities in Melanoma

To the Editor Marchetti et al¹ recently discussed racial and ethnic health disparities in melanoma and cautioned that “survival rates can be misleading when populations differ in the penetration and intensity of screening. Because of lead-time, length-time, and overdiagnosis biases, screening can increase survival rates without saving lives. This is because screening starts the clock earlier and preferentially detects more indolent cancers. This gives the appearance of a benefit through longer survival rates and earlier stages of diagnosis. As Black individuals are much less likely to be screened for melanoma, their survival rates may be spuriously lower compared with White individuals.”^1(p.1031)