Population cancer screening: are we getting it right?

Programme stream(s): Early detection / diagnosis and prognosis , Prevention
Programme session type(s): Recent Advances session

Chair: Ian Tomlinson, University of Birmingham, UK
Speaker: Linda Sharp, Newcastle University, UK
Speaker: Mette Kalager, University of Oslo, Norway
Speaker: Richard Martin, University of Bristol, UK

11:00-12:30

Room: Carron

The session is based around the premise that whilst prevention is evidently better than cure (and early detection is better than late detection), population-based cancer prevention is wasteful, has patchy uptake and uses methods with sub-optimal performance. Nevertheless, truly precision screening will always be limited by the stochastic factors inherent in carcinogenesis. Where does the optimal balance lie between population participation, costs, and minimizing both unnecessary screening and the burden on screening services? How do we identify and reach that balance? Where can we substitute early detection for screening without major health impacts?

Effect of a low-intensity PSA-based screening intervention on prostate cancer mortality: the CAP randomized clinical trial
Speaker: Richard Martin
Affiliation: University of Bristol

Abstract:

: Prostate-cancer screening remains controversial because of concerns that potential mortality or quality of life benefits are outweighed by harms from over-detection and subsequent over-treatment. Aims: We investigated the effect of an invitation to a single PSA-screen for prostate cancer on prostate cancer detection and median 10-year prostate cancer mortality. Findings: In this UK-based cluster randomized clinical trial comparing 189,386 men aged 50-69 receiving a single PSA-screen and 219,439 controls undergoing standard (unscreened) practice, the proportion of men diagnosed with prostate cancer was higher in the intervention (4.3%) group than control (3.6%) group, but there was no significant difference in prostate cancer mortality (intervention, 0.29% vs. control, 0.29%) after a median follow-up of 10-years. Conclusion: The CAP single PSA-screen intervention detected more prostate cancer cases, but after a median of 10-years’ follow-up has, thus far, had no significant effect on prostate cancer mortality.