Screening for prostate cancer may have limited impact on decreasing prostate cancer-related mortality. A major disadvantage is overdiagnosis, whereby lesions are identified that would not have become evident during the man's lifetime if screening had not taken place. The present study aims to estimate the rate of overdiagnosis using Finnish data from the European randomized trial of prostate cancer screening.
We used data from 80,149 men randomized to a screening or a control group, distinguishing four birth cohorts. We used the "catch-up method" to identify when the difference in the cumulative incidence of prostate cancer between the screening and control groups had stabilized, implying that the screening has no further effect. We define the overdiagnosis rate to be the relative excess cumulative incidence in the screened group at that point. As an independent method, we also examined the diagnosis rates of T1c tumors as an indicator of early tumors detected by PSA.
The estimates of overdiagnosis rates from the catch-up method using the full period of available follow-up ranged between cohorts from 2.3% to 15.4%, and the T1c analysis gave very similar results.
Some overdiagnosis has occurred, but there is uncertainty about its extent. A long follow-up is required to demonstrate the full impact of screening. We evaluated the overdiagnosis rates at a population level, associated with being offered screening, taking account of contamination (screening among the controls). The overall evaluation of screening should incorporate mortality benefit, cost-effectiveness, and quality of life.
Cancer causes & control : CCC. 2021 Jul 27 [Epub ahead of print]
S D Walter, Jiarui Hu, Kirsi Talala, Teuvo Tammela, Kimmo Taari, Anssi Auvinen
Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. ., Department of Mathematics & Statistics, McMaster University, Hamilton, ON, Canada., Finnish Cancer Registry, Helsinki, Finland., Faculty of Medicine and Health Technology, and Tampere University Hospital, Tampere University, Tampere, Finland., Department of Urology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland., Faculty of Social Sciences, Tampere University, Tampere, Finland.