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

Jilaveanu LB, Zhao F, Zito CR, Kirkwood JM, Nathanson KL, D'Andrea K, Wilson M, Rimm DL, Flaherty KT, Lee SJ, Kluger HM. Expression of drug targets in patients treated with sorafenib, Carboplatin and Paclitaxel. PLoS One. 2013 Aug 6;8(8):e69748.


Slingluff CL Jr, Lee S, Zhao F, Chianese-Bullock KA, Olson WC, Butterfield LH, Whiteside TL, Leming PD, Kirkwood JM. A Randomized Phase II Trial of
Multi-epitope Vaccination withMelanoma Peptides for Cytotoxic T-Cells and Helper T-Cells forPatients with Metastatic Melanoma (E1602). Clin Cancer Res. 2013 May 7. [Epub ahead of print]

Flaherty KT, Lee SJ, Zhao F, Schuchter LM, Flaherty L, Kefford R, Atkins MB, Leming P, Kirkwood JM. Phase III trial of carboplatin and paclitaxel with or without sorafenib in metastatic melanoma. J Clin Oncol. 2013 Jan 20;31(3):373-9.

Siddappa NB, Hemashettar G, Shanmuganathan V, Semenya AA, Sweeney ED, Paul KS, Lee SJ, Secor WE, Ruprecht RM. Schistosoma mansoni enhances host susceptibility to mucosal but not intravenous challenge by R5 Clade C SHIV. PLoS Negl Trop Dis. 2011 Aug;5(8):e1270.

Lakhashe SK, Wang W, Siddappa NB, Hemashettar G, Polacino P, Hu SL, Villinger F, Else JG, Novembre FJ, Yoon JK, Lee SJ, Montefiori DC, Ruprecht RM, Rasmussen RA. Vaccination against heterologous R5 clade C SHIV: prevention of infection and correlates of protection. PLoS One. 2011;6(7):e22010.

Lakhashe SK, Velu V, Sciaranghella G, Siddappa NB, Dipasquale JM, Hemashettar G, Yoon JK, Rasmussen RA, Yang F, Lee SJ, Montefiori DC, Novembre FJ, Villinger F, Amara RR, Kahn M, Hu SL, Li S, Li Z, Frankel FR, Robert-Guroff M, Johnson WE, Lieberman J, Ruprecht RM. Prime-boost vaccination with heterologous live vectors encoding SIV gag and multimeric HIV-1 gp160 protein: efficacy against repeated mucosal R5 clade C SHIV challenges. Vaccine. 2011 Aug 5;29(34):5611-22.

Rao UN, Lee SJ, Luo W, Mihm MC Jr, Kirkwood JM. Presence of tumor-infiltrating lymphocytes and a dominant nodule within primary melanoma are prognostic factors for relapse-free survival of patients with thick (t4) primary melanoma: pathologic analysis of the e1690 and e1694 intergroup trials. Am J Clin Pathol. 2010 Apr;133(4):646-53.

Chenine AL, Siddappa NB, Kramer VG, Sciaranghella G, Rasmussen RA, Lee SJ, Santosuosso M, Poznansky MC, Velu V, Amara RR, Souder C, Anderson DC, Villinger F, Else JG, Novembre FJ, Strobert E, O'Neil SP, Secor WE, Ruprecht RM. Relative transmissibility of an R5 clade C simian-human immunodeficiency virus across different mucosae in macaques parallels the relative risks of sexual HIV-1 transmission in humans via different routes. J Infect Dis. 2010 Apr 15;201(8):1155-63.

Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, Huang H, Lee SJ, Munsell M, Plevritis SK, Ravdin P, Schechter CB, Sigal B, Stoto MA, Stout NK, van Ravesteyn NT, Venier J, Zelen M, Feuer EJ; Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med. 2009 Nov 17;151(10):738-47.

Litzow MR, Othus M, Cripe LD, Gore SD, Lazarus HM, Lee SJ, Bennett JM, Paietta EM, Dewald GW, Rowe JM, Tallman MS; Eastern Cooperative Oncology Group Leukemia Committee. Failure of three novel regimens to improve outcome for patients with relapsed or refractory acute myeloid leukaemia: a report from the Eastern Cooperative Oncology Group. Br J Haematol. 2010 Jan;148(2):217-25.


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