Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark

Abstract

Objectives: To determine a pooled, quantitative estimate of the length of time needed after breast or colorectal cancer screening before a survival benefit is observed.

Design: Meta-analysis of survival data from population based, randomized controlled trials comparing populations screened and not screened for breast or colorectal cancer. Trials were identified as high quality by reviews from the Cochrane Collaboration and United States Preventive Services Task Force.

Setting: Trials undertaken in the United States, Denmark, United Kingdom, and Sweden.

Population: Screened patients older than 40 years.

Primary outcome measures: Time to death from breast or colorectal cancer in screened and control populations.

Interventions: Fecal occult blood testing for colorectal cancer screening, mammography for breast cancer screening.

Results: Our study included five and four eligible trials of breast and colorectal cancer screening, respectively. For breast cancer screening, 3.0 years (95% confidence interval 1.1 to 6.3) passed before one death from breast cancer was prevented for every 5000 women screened. On average across included studies, it took 10.7 years (4.4 to 21.6) before one death from breast cancer was prevented for 1000 women screened. For colorectal cancer screening, 4.8 years (2.0 to 9.7) passed before one death from colorectal cancer was prevented for 5000 patients screened. On average across included studies, it took 10.3 years (6.0 to 16.4) before one death from colorectal cancer was prevented for 1000 patients screened.

Conclusions: Our results suggest that screening for breast and colorectal cancer is most appropriate for patients with a life expectancy greater than 10 years. Incorporating time lag estimates into screening guidelines would encourage a more explicit consideration of the risks and benefits of screening for breast and colorectal cancer.

Fig 1 Trial selection criteria. FOBT=fecal occult blood test; HIP=Health Insurance Plan; CNBSS=Canadian National Breast Screening Study. Kopparberg and Ostergotland studies make up the Two-County Study. We used the synthesized data from the Combined Swedish Trials for our analysis

Fig 2 Pooled mortality curves for colorectal cancer. Values are the number of deaths from colorectal cancer prevented per 1000 people screened (that is, the absolute risk reduction). *P<0.05

Fig 3 Pooled mortality curves for breast cancer. Values are the number of deaths from breast cancer prevented per 1000 people screened (that is, the absolute risk reduction). *P<0.05