Recommendations for cancer screening would be different if we measured endpoints that are valid, reliable, specific, and important to patients

Recommendations for cancer screening would be different if we measured endpoints that are valid, reliable, specific, and important to patients

Background Despite enthusiasm for cancer screening, systematic reviews consistently fail to show that screening reduces all-cause mortality. This narrative review explores conceptual issues, and inconsistencies between evidence and opinion about screening. Review We examined the interpretation of sc...

Full description

Saved in:
Bibliographic Details
Published in:Cancer causes & control Vol. 31; no. 8; pp. 705 - 711
Main Authors: Porzsolt, Franz, Matosevic, Rafael, Kaplan, Robert M.
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01-08-2020
Springer Nature B.V
Subjects:
Biomedical and Life Sciences
Biomedicine
Cancer
Cancer Research
Cancer screening
Commentary
Epidemiology
Hematology
Life expectancy
Life span
Medical screening
Mortality
Oncology
Public Health
Traditions
Prevention
Cancer screening
Health services research
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Despite enthusiasm for cancer screening, systematic reviews consistently fail to show that screening reduces all-cause mortality. This narrative review explores conceptual issues, and inconsistencies between evidence and opinion about screening. Review We examined the interpretation of screening studies in relation to three intellectual traditions: (1) The relationship between prevention and cure; (2) Confirmation bias and the challenge of incorporating new data: less care may produce better outcomes than more care; (3) The answers to three structured questions about efficacy, effectiveness, and value of treatments proposed by Sir Archie Cochrane and Sir Austin Bradford Hill. Synthesis When considering extensions of life expectancy or all-cause mortality, systematic reviews typically show cancer screening to have only small effects and often non-significant effects on all-cause mortality. Early diagnosis does not assure application of an intervention that alters the pathway toward demise. The interpretation of screening results is also affected by several known biases. Investigators and advocates are encumbered by an over focus on studies designed to determine if a treatment can work under ideal circumstances. To advance the field, we need a greater emphasis on evaluations that ask ‘Does the treatment work under real-world conditions?’, and ‘Is the treatment worth it?’ in terms of outcomes that are meaningful to patients.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
ISSN:0957-5243
1573-7225
DOI:10.1007/s10552-020-01309-w