The theory of case-control studies for early detection programs

Although case-control studies are widely used for evaluating the benefit of early detection programs, the theoretical basis underlying this application has not been well developed. In this paper the properties of chronic disease case-control studies for evaluating early detection programs are investigated. An idealized case-control study is analyzed and the theoretical expression for the odds ratio associated with the benefit of screening is derived. The odds ratio is related to the natural history of disease and the screening program. Our results indicate that case-control studies result in odds ratios that are surprisingly close to unity and consequently have low power.