Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms

Abstract

This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.

Random effects models of tumour growth for investigating interval breast cancer

“…1 Among radiologists, the proportion of interval cancers (of the sum of screen detected and interval cancers) is used as a proxy of the false negative rate and a performance measure of screening. 2,3 For a critique of this proxy and a description of its relationship with "true" test sensitivity, on the basis of multi-state models see Lange et al 4 The interval cancer proportion is also used to compare different screening modalities or supplemental screening, [5][6][7][8] to compare different screening intervals, 9 to study the incidence of cases in the interval time between consecutive screens, 6,10,11 and to study the importance of mammographic (breast) density [12][13][14] and image settings for screening performance. 15,16 In this paper, we propose an approach for deriving an analytical expression for the proportion of interval breast cancer cases among regular attenders of screening using a natural history model of breast cancer.…”

Mammography in Breast Disease Screening and Diagnosis

“…Digital mammography (DM) represents the gold standard for breast cancer screening in women aged 40 and over (especially 50–69 years old), with different guidelines proposed around the world [ 6 ]. Nevertheless, although screening is considered the main instrument to achieve early diagnosis, the effectiveness of its current modalities is highly debated due to the presence of false-positive and false-negative cases, interval cancers, and overdiagnosis, which are associated with discomfort and/or potential psychological harm to the patients [ 7 ].…”