A Conditional Approach to Measure Mortality Reductions Due to Cancer Screening

The prevailing lack of consensus about the comparative harms and benefits of cancer screening stems, in part, from the inappropriate calculations of the expected mortality impact of a sustained screening programme. There is an inherent, and often substantial, time lag from the time of screening until the resulting mortality reductions begin, reach their maximum and ultimately end. However, the cumulative mortality reduction reported in a randomised screening trial is typically calculated over an arbitrarily defined follow-up period, including follow-up time where the mortality impact is yet to realise or where it has already been exhausted. Because of this, the cumulative reduction cannot be used for projecting the mortality impact expected from a sustained screening programme. For this purpose, we propose a new measure, the time-specific probability of being helped by screening, given that the cancer would have proven fatal otherwise. This can be decomposed into round-specific impacts, which in turn can be parametrised and estimated from the trial data. This represents a major shift in quantifying the benefits due to a sustained screening programme, based on statistical evidence extracted from existing trial data. We illustrate our approach using data from screening trials in lung and colorectal cancers.