Economics of cancer screening programs

Whynes, David K.

doi:10.1586/14737167.4.1.61

Cited by 2 publications

(2 citation statements)

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“…The economic rationale for such a comparison is as follows. 103 Cancer is a progressive disease, evolving through a sequence of stages. Treatment is initiated once the disease is detected and, for any particular treatment, patient prognosis is a negative function of the stage of progression at detection.…”

Section: Introductionmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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Section: Introductionmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

Self Cite

236

231

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“…For the moment it is important to avoid the so-called 'implement now and trust' approach (Whynes, 2004). Apparent coincidence of interests between manufacturers, who see an enormous market for HPV tests, and women and physicians, who would favour any extra test for added reassurance, should not distract from the evaluation of the real benefit of using HPV testing in cervical cancer screening and its associated financial and emotional cost.…”

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confidence: 99%

Human papillomavirus testing in cervical cancer screening

Franceschi

Mahé

2005

Br J Cancer

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Research on the use of human papillomavirus (HPV) DNA testing in the screening and management (triage) of cervical lesions began in the late 1980s with the growing evidence that certain (high-risk (HR)) HPV types were the cause of cervical cancer IARC, 2005). Since women not infected with HR HPV types, even with abnormal cytology, are at negligible risk for cervical cancer, HPV testing could be superior to cytology in cervical cancer screening (Cuzick et al, 1999;Nobbenhuis et al, 1999). Human papillomavirus testing may also be cost-effective if it allows for a longer screening interval, or for screening to be discontinued at an earlier age than currently recommended (i.e., 65 years). Follow-up studies of women with negative cytology, according to HPV status, are therefore important. In this issue, Bulkmans et al (2005) and Grainge et al (2005), using two different study designs, provide further evidence of the value of adding HPV testing to cervical cytology in screening programmes.In their 5-year cohort study in The Netherlands of 2810 women aged 30 -60 years with normal cytology, Bulkmans et al (2005) show that, in agreement with previous findings from the US (Sherman et al, 2003), France (Clavel et al, 2004) and the UK (Cuzick et al, 2003;Peto et al, 2004), HR HPV testing combined with cytology has higher sensitivity and higher negative predictive value for cervical intraepithelial neoplasia (CIN) 3 and cancer than cytology alone. Specificity was, however, slightly lower for HPV testing and cytology (93%) than cytology alone (95%).The improvement in sensitivity and negative predictive value made possible by the addition of HR HPV testing to cytology supports the use of viral testing in order to increase the screening interval, although the findings of Bulkmans et al (2005) should be interpreted with some caution as their study was relatively small, and, as the authors emphasise, an increased sensitivity is implicit in performing any additional test (Franco and Ferenczy, 1999).Also in this issue, Grainge et al (2005) report the findings of a nested case -control study based on women with a normal cytological smear between 1988 and 1992 (termed the baseline smear) who later, after an average of 6.8 years, received a histologically confirmed diagnosis of CIN 2 or worse. Excluding CIN2, which is biologically and clinically difficult to distinguish from CIN1, there were 346 CIN3 cases and 51 cervical cancer cases together with 591 control women who never had cytological abnormalities. Although Grainge et al (2005) found a significantly higher HPV positivity among cases compared to controls, a substantial proportion of women tested negative for HPVs in baseline smears less than 4 years (67%), and 4 -13 years (74%), before the diagnosis of CIN3/cervical cancer. Unfortunately, such use of long-stored archived cervical smears is prone to the danger of false-negative HPV findings (De Roda, 1995) and crosscontamination (Chua and Hjerpe, 1995).It is important to bear in mind, however, that the detection of HPV at a sin...

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Economics of cancer screening programs

Cited by 2 publications

References 38 publications

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Human papillomavirus testing in cervical cancer screening

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