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[Evidence for cancer screening programs; what is a fitting metric?]
1Amsterdam UMC, afd. Epidemiology & Data Science, Amsterdam.
Cancer screening trials need reliable outcome measures. While cancer-related mortality is standard, alternative measures like stage shift are debated for their limitations in evaluating screening effectiveness.
Area of Science:
- Oncology
- Clinical Trials
- Public Health
Context:
- Cancer screening programs require robust evidence on benefits, harms, and resource allocation.
- Traditional randomized cancer screening trials rely on cancer-related mortality as the primary outcome.
- This necessitates large cohorts and extensive follow-up periods.
Purpose:
- To evaluate the suitability of primary outcome measures in cancer screening trials.
- To discuss the limitations of alternative outcome measures, such as stage shift.
- To inform the design and interpretation of evidence for cancer screening interventions.
Summary:
- Cancer screening program implementation demands a thorough assessment of health benefits, harms, and resource utilization.
- Cancer-related mortality has been the primary endpoint in most randomized cancer screening trials.
- Alternative measures, like stage shift used in the UK NHS-Galleri trial, are being considered but face scrutiny regarding their limitations.
Impact:
- Highlights the critical need for appropriate outcome measures in cancer screening research.
- Informs ongoing discussions about the validity and limitations of surrogate endpoints in cancer screening.
- Aids in the design of future cancer screening trials to ensure reliable evidence generation.
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