textBACKGROUND: Screening for prostate cancer advances the time of diagnosis
 (lead time) and detects cancers that would not have been diagnosed in the
 absence of screening (overdetection). Both consequences have considerable
 impact on the net benefits of screening. METHODS: We developed simulation
 models based on results of the Rotterdam section of the European
 Randomized Study of Screening for Prostate Cancer (ERSPC), which enrolled
 42,376 men and in which 1498 cases of prostate cancer were identified, and
 on baseline prostate cancer incidence and stage distribution data. The
 models were used to predict mean lead times, overdetection rates, and
 ranges (corresponding to approximate 95% confidence intervals) associated
 with different screening programs. RESULTS: Mean lead times and rates of
 overdetection depended on a man's age at screening. For a single screening
 test at age 55, the estimated mean lead time was 12.3 years (range =
 11.6-14.1 years) and the overdetection rate was 27% (range = 24%-37%); at
 age 75, the estimates were 6.0 years (range = 5.8-6.3 years) and 56%
 (range = 53%-61%), respectively. For a screening program with a 4-year
 screening interval from age 55 to 67, the estimated mean lead time was
 11.2 years (range = 10.8-12.1 years), and the overdetection rate was 48%
 (range = 44%-55%). This screening program raised the lifetime risk of a
 prostate cancer diagnosis from 6.4% to 10.6%, a relative increase of 65%
 (range = 56%-87%). In annual screening from age 55 to 67, the estimated
 overdetection rate was 50% (range = 46%-57%) and the lifetime prostate
 cancer risk was increased by 80% (range = 69%-116%). Extending annual or
 quadrennial screening to the age of 75 would result in at least two cases
 of overdetection for every clinically relevant cancer detected.
 CONCLUSIONS: These model-based lead-time estimates support a prostate
 cancer screening interval of more than 1 year.

/pdf/lead-times-and-overdetection-due-to-prostate-specific-m0qok7a4pu.pdf

Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer.

European experts consensus statement on cystic tumours of the pancreas.

Background: Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients. Methods: In this multicenter, randomized, controlled trial in the Netherlands, we assigned 40,373 women between the ages of 50 and 75 years with extremely dense breast tissue and normal results on screening mammography to a group that was invited to undergo supplemental MRI or to a group that received mammography screening only. The groups were assigned in a 1:4 ratio, with 8061 in the MRI-invitation group and 32,312 in the mammography-only group. The primary outcome was the between-group difference in the incidence of interval cancers during a 2-year screening period. Results: The interval-cancer rate was 2.5 per 1000 screenings in the MRI-invitation group and 5.0 per 1000 screenings in the mammography-only group, for a difference of 2.5 per 1000 screenings (95% confidence interval [CI], 1.0 to 3.7; P<0.001). Of the women who were invited to undergo MRI, 59% accepted the invitation. Of the 20 interval cancers that were diagnosed in the MRI-invitation group, 4 were diagnosed in the women who actually underwent MRI (0.8 per 1000 screenings) and 16 in those who did not accept the invitation (4.9 per 1000 screenings). The MRI cancer-detection rate among the women who actually underwent MRI screening was 16.5 per 1000 screenings (95% CI, 13.3 to 20.5). The positive predictive value was 17.4% (95% CI, 14.2 to 21.2) for recall for additional testing and 26.3% (95% CI, 21.7 to 31.6) for biopsy. The false positive rate was 79.8 per 1000 screenings. Among the women who underwent MRI, 0.1% had either an adverse event or a serious adverse event during or immediately after the screening. Conclusions: The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period. (Funded by the University Medical Center Utrecht and others.

https://www.nejm.org/doi/suppl/10.1056/NEJMoa1903986/suppl_file/nejmoa1903986_appendix.pdf

Supplemental MRI Screening for Women with Extremely Dense Breast Tissue

textBACKGROUND: Comprehensive analyses have shown that screening for cancer
 usually induces net costs. In this study, the possible costs and savings
 of endoscopic colorectal cancer screening are explored to investigate
 whether the induced savings may compensate for the costs of screening.
 METHODS: A simulation model for evaluation of colorectal cancer screening,
 MISCAN-COLON, is used to predict costs and savings for the U.S.
 population, assuming that screening is performed during a period of 30
 years. Plausible baseline parameter values of epidemiology, natural
 history, screening test characteristics, and unit costs are based on
 available data and expert opinion. Important parameters are varied to
 extreme but plausible values. RESULTS: Given the expert opinion-based
 assumptions, a program based on every 5-year sigmoidoscopy screenings
 could result in a net savings of direct health care costs due to
 prevention of cancer treatment costs that compensate for the costs of
 screening, diagnostic follow-up, and surveillance. This result persists
 when costs and health effects are discounted at 3%. The "break-even"
 point, the time required before savings exceed costs, is 35 years for a
 screening program that terminates after 30 years and 44 years for a
 screening program that continues on indefinitely. However, net savings
 increase or turn into net costs when alternative assumptions about natural
 history of colorectal cancer, costs of screening, surveillance, and
 diagnostics are considered. CONCLUSIONS: Given the present, limited
 knowledge of the disease process of colorectal cancer, test
 characteristics, and costs, it may well be that the induced savings by
 endoscopic colorectal cancer screening completely compensate for the
 costs.

/pdf/endoscopic-colorectal-cancer-screening-a-cost-saving-hob18r6583.pdf

J.Th.N. Lubbe

Papers

The MISCAN simulation program for the evaluation of screening for disease

A simulation approach to cost-effectiveness and cost-benefit calculations of screening for the early detection of disease

Predicting the effects of mass-screening for disease — a simulation approach