Risk-based screening programmes for cancer diagnosis: A systematic review with narrative synthesis

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Risk-based screening (RBS) is emerging as a novel strategy for cancer detection, potentially improving upon traditional age-based methods.
• Existing evidence on the real-world implementation and outcomes of RBS programs is fragmented across various cancer types.
• A systematic review is crucial to consolidate current knowledge on RBS methodologies and their effectiveness.

Purpose of the Study:

• To systematically review and synthesize the methodologies and outcomes of risk-based screening (RBS) programs for various cancer types.
• To evaluate the implementation strategies, diagnostic accuracy, and clinical outcomes associated with RBS.
• To identify gaps in the evidence base for scaling up RBS programs.

Main Methods:

• A comprehensive systematic search was conducted across multiple databases (MEDLINE, Embase, CINAHL, Web of Science, Cochrane, Scopus) up to July 2024.
• Included studies comprised prospective trials, randomized controlled trials (RCTs), and retrospective evaluations of RBS in asymptomatic populations.
• Data on geographic distribution, population characteristics, RBS methodology, diagnostic accuracy, and clinical outcomes were narratively synthesized.

Main Results:

• Thirty-three studies were included, predominantly focusing on colorectal, breast, and prostate cancers, with most trials originating from China, the Netherlands, and the US.
• Algorithmic approaches (48.5%) were the most common stratification method, followed by validated risk models (39.4%).
• RBS showed higher uptake in moderate-risk groups and demonstrated cost-effectiveness, improved quality-adjusted life years, and superior or non-inferior cancer detection rates compared to traditional screening.

Conclusions:

• Risk-based screening holds significant potential for optimizing healthcare resource allocation, minimizing patient harm, and enhancing screening receptiveness.
• Implementation outcomes suggest favorable uptake and detection rates, with evidence of cost-effectiveness.
• Further research is required to assess the long-term outcomes of RBS programs before they can be widely scaled.