Long-term projections of the harm-benefit trade-off in prostate cancer screening are more favorable than previous short-term estimates

Roman Gulati, Angela B. Mariotto, Shu Chen, John L. Gore, Ruth Etzioni

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Objective: To project long-term estimates of the number needed to screen (NNS) and the additional number needed to treat (NNT) to prevent one prostate cancer death with prostate-specific antigen (PSA) screening in Europe and in the United States. Study Design and Setting: A mathematical model of disease-specific deaths in screened and unscreened men given information on overdiagnosis, disease-specific survival in the absence of screening, screening efficacy, and other-cause mortality is presented. A simulation framework is used to incorporate competing causes of death. Results: Assuming overdiagnosis and screening efficacy consistent with European Randomized study of Screening for Prostate Cancer (ERSPC) results, we project that, after 25 years, 262 men need to be screened and nine additional men need to be screen detected to prevent one prostate cancer death. Corresponding estimates of the NNS and the additional NNT under a range of overdiagnosis rates that are consistent with U.S. incidence are 186-220 and 2-5. Conclusions: Long-term estimates of the NNS and the additional NNT are an order of magnitude lower than the short-term estimates published with the results of the ERSPC trial and may be consistent with cost-effective PSA screening in the general U.S. population.

Original languageEnglish (US)
Pages (from-to)1412-1417
Number of pages6
JournalJournal of Clinical Epidemiology
Volume64
Issue number12
DOIs
StatePublished - Dec 1 2011

Keywords

  • Cost-benefit analysis
  • Mass screening
  • Prostate-specific antigen
  • Prostatic neoplasms
  • Simulation modeling
  • Treatment efficacy

ASJC Scopus subject areas

  • Epidemiology

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