Sandra Lee

Principal Research Scientist
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There is a growing interest in public health programs targeted at diagnosing chronic diseases earlier-especially breast, cervical, colorectal, ovarian, and prostate cancers. The goal is to diagnose these diseases earlier relative to the stage at diagnosis under usual care with the expectation that mortality will be reduced.


In collaboration with Dr. Marvin Zelen, we have developed stochastic models using the natural history of disease to address issues that arise in screening programs. These models have helped to guide public health programs in the choice of examination schedules. The main features of such schedules are the initial age to begin examinations, the number of examinations, and the intervals between them. We have introduced two new ideas, threshold method and schedule sensitivity, that have been used to generate and compare screening examination schedules.


We have further expanded the stochastic models by developing a series of probability equations to predict the mortality reduction associated with screening programs. Predicting mortality is a function of the characteristics of the case-finding process and the detection modality. The model makes two basic assumptions: first, that the disease is described by a progressive disease model and second, that potential benefit of early detection arises from a stage shift.


The model can be used to predict the mortality benefit of early detection programs. More importantly, however, it can be used to assess proposed schedules for early detection programs which will enable policy makers to compare costs and mortality benefits. We have applied theoretical results mainly to the area of breast cancer screening, but will also apply results to other disease sites such as colon, lung, and prostate cancers.



Dr. Lee received her ScD from Harvard School of Public Health in 1994 and then completed a postdoctoral fellowship at DFCI. In 1996, she joined the faculty of DFCI. Currently she is a senior research scientist involved in methodological research in biostatistical science and collaborative research in cancer clinical trials. Her statistical research focuses on screening methods for early detection of cancer. She also participates in the Eastern Cooperative Oncology Group and in DFCI statistical consulting.


Recent Publications

Butterfield LH, Zhao F, Lee S, Tarhini AA, Margolin KA, White RL, Atkins M,
Cohen GI, Whiteside TL, Kirkwood JM, Lawson DH. Immune correlates of GM-CSF and melanoma peptide vaccination in a randomized trial for the adjuvant therapy of resected high-risk melanoma (E4697). Clin Cancer Res. 2017 May 23. pii: clincanres.3016.2016. doi: 10.1158/1078-0432.CCR-16-3016. [Epub ahead of print]


Zhou J, Mahoney KM, Giobbie-Hurder A, Zhao F, Lee S, Liao X, Rodig S, Li J, Wu
X, Butterfield LH, Piesche M, Manos MP, Eastman LM, Dranoff G, Freeman GJ, Hodi FS. Soluble PD-L1 as a Biomarker in Malignant Melanoma Treated with Checkpoint Blockade. Cancer Immunol Res. 2017 Jun;5(6):480-492.


Kalinsky K, Lee S, Rubin KM, Lawrence DP, Iafrarte AJ, Borger DR, Margolin KA,
Leitao MM Jr, Tarhini AA, Koon HB, Pecora AL, Jaslowski AJ, Cohen GI, Kuzel TM,
Lao CD, Kirkwood JM. A phase 2 trial of dasatinib in patients with locally
advanced or stage IV mucosal, acral, or vulvovaginal melanoma: A trial of the
ECOG-ACRIN Cancer Research Group (E2607). Cancer. 2017 Mar 23.


Agarwala SS, Lee SJ, Yip W, Rao UN, Tarhini AA, Cohen GI, Reintgen DS, Evans
TL, Brell JM, Albertini MR, Atkins MB, Dakhil SR, Conry RM, Sosman JA, Flaherty
LE, Sondak VK, Carson WE, Smylie MG, Pappo AS, Kefford RF, Kirkwood JM. Phase III Randomized Study of 4 Weeks of High-Dose Interferon-α-2b in Stage T2bNO, T3a-bNO, T4a-bNO, and T1-4N1a-2a (microscopic) Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E1697). J Clin Oncol. 2017 Mar 10;35(8):885-892.


Najita JS, Swetter SM, Geller AC, Gershenwald JE, Zelen M, Lee SJ. Sex
Differences in Age at Primary Melanoma Diagnosis in a Population-Based Analysis (US Surveillance, Epidemiology, and End Results, 2005-2011). J Invest Dermatol. 2016 Sep;136(9):1894-7.


Mandelblatt JS, Stout NK, Schechter CB, van den Broek JJ, Miglioretti DL,
Krapcho M, Trentham-Dietz A, Munoz D, Lee SJ, Berry DA, van Ravesteyn NT, Alagoz O, Kerlikowske K, Tosteson AN, Near AM, Hoeffken A, Chang Y, Heijnsdijk EA, Chisholm G, Huang X, Huang H, Ergun MA, Gangnon R, Sprague BL, Plevritis S, Feuer E, de Koning HJ, Cronin KA. Collaborative Modeling of the Benefits and Harms Associated With Different U.S. Breast Cancer Screening Strategies. Ann Intern Med. 2016 Feb 16;164(4):215-25.


Lawson DH, Lee S, Zhao F, Tarhini AA, Margolin KA, Ernstoff MS, Atkins MB,
Cohen GI, Whiteside TL, Butterfield LH, Kirkwood JM. Randomized,
Placebo-Controlled, Phase III Trial of Yeast-Derived Granulocyte-Macrophage
Colony-Stimulating Factor (GM-CSF) Versus Peptide Vaccination Versus GM-CSF Plus Peptide Vaccination Versus Placebo in Patients With No Evidence of Disease After Complete Surgical Resection of Locally Advanced and/or Stage IV Melanoma: A Trial of the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group (E4697). J Clin Oncol. 2015 Dec 1;33(34):4066-76.


Wilson MA, Zhao F, Khare S, Roszik J, Woodman SE, D'Andrea K, Wubbenhorst B,
Rimm DL, Kirkwood JM, Kluger HM, Schuchter LM, Lee SJ, Flaherty KT, Nathanson KL. Copy Number Changes Are Associated with Response to Treatment with Carboplatin, Paclitaxel, and Sorafenib in Melanoma. Clin Cancer Res. 2016 Jan 15;22(2):374-82.


Tarhini AA, Lin Y, Zahoor H, Shuai Y, Butterfield LH, Ringquist S, Gogas H,
Sander C, Lee S, Agarwala SS, Kirwood JM. Pro-Inflammatory Cytokines Predict
Relapse-Free Survival after One Month of Interferon-α but Not Observation in
Intermediate Risk Melanoma Patients. PLoS One. 2015 Jul 20;10(7):e0132745.


Villaruz LC, Huang G, Romkes M, Kirkwood JM, Buch SC, Nukui T, Flaherty KT,
Lee SJ, Wilson MA, Nathanson KL, Benos PV, Tawbi HA. MicroRNA expression
profiling predicts clinical outcome of carboplatin/paclitaxel-based therapy in
metastatic melanoma treated on the ECOG-ACRIN trial E2603. Clin Epigenetics. 2015 Jun 4;7:58.


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