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. 2018 Jul 23;115(29-30):481-486.
doi: 10.3238/arztebl.2018.0481.

The Impact of Cancer Screening on All-Cause Mortality

Andreas Stang  1 , Karl-Heinz Jöckel
Affiliations

The Impact of Cancer Screening on All-Cause Mortality

Andreas Stang et al. Dtsch Arztebl Int. .

Abstract

Background: It is a matter of debate whether, and if so, to what extent, cancer screening programs reduce all-cause mortality. Against this backdrop, we analyzed potential effects of several cancer screening approaches on all-cause mortality in two representative Western European populations.

Methods: We used mortality data from the UK (England &Wales) and Germany from 2015 and published figures from screening studies on relative reduction in mortality for screened cancers to calculate the expected decline in all-cause mortality in these countries. We determined the required sample size for demonstrating a 3% reduction in all-cause mortality with a narrow (95%) confidence interval in a hypothetical screening trial.

Results: A relative 20% reduction in breast cancer mortality can be accompanied by a maximum 1.7-1.8% reduction in all-cause mortality in England & Wales and Germany, respectively. Expected declines are smaller for sigmoidoscopy screening (1.0-1.2%), prostate-specific antigen (PSA) screening (0.4-0.6%), and skin cancer screening (0.2%). To obtain a 95% confidence interval of +/-1% for demonstrating a 3% decline in all-cause mortality, a study size of 596 200 persons is required.

Conclusion: Because the proportion of cancer deaths in all deaths in Western Europe is relatively low, cancer screening procedures can reduce all-cause mortality by only 1-3%. However, this reduction is relevant to public health.

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Figures

Figure
Figure
Relation between the relative rate reduction of a screening program for a cancer and the mortality rate of a cancer without screening to reach a relative 1%, 2%, or 3% reduction in all-cause mortality among people aged 50–74 years in the UK (England & Wales) and Germany. The all-cause mortality rate among men aged 50–74 years in the UK (England & Wales) and Germany is approximately 1100 per 100 000 person-years; all-cause mortality among women aged 50–74 years in the UK (England & Wales) and Germany is about 690 per 100 000 person-years; RRR: relative rate reduction in cancer-specific mortality due to screening; reduction in the all-cause mortality rate of 1% (▲), 2% (■), and 3% ()
eFigure
eFigure
Age-specific mortality rates of screening-detectable cancers in Germany and the UK (England & Wales), 2015
See this image and copyright information in PMC

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