Absolute effect of prostate cancer screening: balance of benefits and harms by center within the European randomized study of prostate cancer screening

PURPOSE The balance of benefits and harms in prostate cancer screening has not been sufficiently characterized. We related indicators of mortality reduction and overdetection by center within the European Randomized Study of Prostate Cancer Screening (ERSPC). EXPERIMENTAL DESIGN We analyzed the absolute mortality reduction expressed as number needed to invite (NNI = 1/absolute risk reduction; indicating how many men had to be randomized to screening arm to avert a prostate cancer death) for screening and the absolute excess of prostate cancer detection as number needed for overdetection (NNO = 1/absolute excess incidence; indicating the number of men invited per additional prostate cancer case), and compared their relationship across the seven ERSPC centers. RESULTS Both absolute mortality reduction (NNI) and absolute overdetection (NNO) varied widely between the centers: NNI, 200-7,000 and NNO, 16-69. Extent of overdiagnosis and mortality reduction was closely associated [correlation coefficient, r = 0.76; weighted linear regression coefficient, � = 33; 95% confidence interval (CI), 5-62; R (2) = 0.72]. For an averted prostate cancer death at 13 years of follow-up, 12 to 36 excess cases had to be detected in various centers. CONCLUSIONS The differences between the ERSPC centers likely reflect variations in prostate cancer incidence and mortality, as well as in screening protocol and performance. The strong interrelation between the benefits and harms suggests that efforts to maximize the mortality effect are bound to increase overdiagnosis and might be improved by focusing on high-risk populations. The optimal balance between screening intensity and risk of overdiagnosis remains unclear. Clin Cancer Res; 1-7. ©2015 AACR. DOI: https://doi.org/10.1158/1078-0432.CCR-15-0941 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-114924 Accepted Version Originally published at: Auvinen, Anssi; Moss, Sue M; Tammela, Teuvo L J; Taari, Kimmo; Roobol, Monique J; Schröder, Fritz H; Bangma, Chris H; Carlsson, Sigrid; Aus, Gunnar; Zappa, Marco; Puliti, Donella; Denis, Louis J; Nelen, Vera; Kwiatkowski, Maciej; Randazzo, Marco; Paez, Alvaro; Lujan, Marcos; Hugosson, Jonas (2016). Absolute effect of prostate cancer screening: balance of benefits and harms by center within the European randomized study of prostate cancer screening. Clinical Cancer Research, 22(1):243-249. DOI: https://doi.org/10.1158/1078-0432.CCR-15-0941 1 Absolute effect of prostate cancer screening: Balance of benefits and harms in ERSPC trial Anssi Auvinen, Sue M Moss, Teuvo L J Tammela, Kimmo Taari, Monique J Roobol, Fritz H Schröder, Chris H Bangma, Sigrid Carlsson, Gunnar Aus, Marco Zappa, Donella Puliti, Louis J Denis, Vera Nelen, Maciej Kwiatkowski, Marco Randazzo, Alvaro Paez, Marcos Lujan, Jonas Hugosson From University of Tampere, School of Health Sciences, Tampere, Finland; Centre for Cancer Prevention, Queen Mary University of London, London, UK; Department of Urology, Tampere University Hospital and Medical School, University of Tampere, Finland; Department of Urology, Helsinki University Central Hospital, Helsinki, Finland; Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Urology, Sahlgrenska Academy at University of Gothenburg, Sweden; Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, USA; Clinical and Descriptive Epidemiology and Registries Unit, ISPO – Cancer Research and Prevention Institute, Florence, Italy; Provinciaal Instituut voor Hygiene, Antwerp, Belgium; Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany; Department of Urology, University Hospital Zürich, Zürich, Switzerland; Department of Urology, Hospital Universitario de Fuenlabrada, Madrid, Spain; Urology Department, Hospital Infanta Cristina, Parla, Madrid, Spain Corresponding author: Prof. Anssi Auvinen, School of Health Sciences, FI-33014 University of Tampere, FINLAND. E-mail [email protected]