Quantification of harms in cancer screening trials: literature review

Bruno Heleno, Maria F Thomsen, David S Rodrigues, Karsten J Jorgensen, John Brodersen

Research output: Contribution to journalArticle

68 Citations (Scopus)
4 Downloads (Pure)

Abstract

Objectives To assess how often harm is quantified in randomised trials of cancer screening. Design Two authors independently extracted data on harms from randomised cancer screening trials. Binary outcomes were described as proportions and continuous outcomes with medians and interquartile ranges. Data sources For cancer screening previously assessed in a Cochrane review, we identified trials from their reference lists and updated the search in CENTRAL. For cancer screening not assessed in a Cochrane review, we searched CENTRAL, Medline, and Embase. Eligibility criteria for selecting studies Randomised trials that assessed the efficacy of cancer screening for reducing incidence of cancer, cancer specific mortality, and/or all cause mortality. Data extraction Two reviewers independently assessed articles for eligibility. Two reviewers, who were blinded to the identity of the study's authors, assessed whether absolute numbers or incidence rates of outcomes related to harm were provided separately for the screening and control groups. The outcomes were false positive findings, overdiagnosis, negative psychosocial consequences, somatic complications, invasive follow-up procedures, all cause mortality, and withdrawals because of adverse events. Results Out of 4590 articles assessed, 198 (57 trials, 10 screening technologies) matched the inclusion criteria. False positive findings were quantified in two of 57 trials (4\%, 95\% confidence interval 0\% to 12\%), overdiagnosis in four (7\%, 2\% to 18\%), negative psychosocial consequences in five (9\%, 3\% to 20\%), somatic complications in 11 (19\%, 10\% to 32\%), use of invasive follow-up procedures in 27 (47\%, 34\% to 61\%), all cause mortality in 34 (60\%, 46\% to 72\%), and withdrawals because of adverse effects in one trial (2\%, 0\% to 11\%). The median percentage of space in the results section that reported harms was 12\% (interquartile range 2-19\%). Conclusions Cancer screening trials seldom quantify the harms of screening. Of the 57 cancer screening trials examined, the most important harms of screening-overdiagnosis and false positive findings-were quantified in only 7\% and 4\%, respectively.
Original languageEnglish
Pages (from-to)5334-43
Number of pages9
JournalBMJ
Volume347
Issue numberNA
DOIs
Publication statusPublished - 16 Sep 2013

Keywords

  • RANDOMIZED CONTROLLED-TRIALS
  • SERVICES-TASK-FORCE
  • FOLLOW-UP
  • BREAST-CANCER
  • LUNG-CANCER
  • PROSTATE-CANCER
  • UPDATED GUIDELINES
  • COLORECTAL-CANCER
  • CLINICAL-TRIALS
  • AGE 40

Fingerprint Dive into the research topics of 'Quantification of harms in cancer screening trials: literature review'. Together they form a unique fingerprint.

Cite this