A Systematic Review Analysis of Randomized Clinical Trials to Estimate the Lifetime Gained with Cancer Screening Tests
DOI:
https://doi.org/10.63278/10.63278/mme.v31.1Keywords:
Cancer Screening, Life Expectancy, Randomized Controlled Trials (RCTs).Abstract
Background: Cancer screening has been a pivotal component of global cancer control strategies since the introduction of the National Cancer Act in 1971. Screening tests such as mammography, fecal occult blood testing (FOBT), prostate-specific antigen (PSA) testing, and computed tomography (CT) for lung cancer are widely utilized to detect cancers early or prevent them through the identification and removal of precursors. While the benefits of screening in terms of reduced cancer-specific mortality are well-established, the impact on life expectancy remains less clear, particularly when accounting for potential harms from screening and subsequent treatments.
Methods: This study conducted a systematic review of randomized controlled trials (RCTs) assessing cancer screening’s impact on all-cause mortality and life expectancy. We included trials with follow-up periods of 10 to 15 years, focusing on six common screening methods: mammography for breast cancer, PSA testing for prostate cancer, FOBT, sigmoidoscopy, and colonoscopy for colorectal cancer, and CT for lung cancer in current and former smokers. Trials were identified through comprehensive searches in MEDLINE and the Cochrane Library, with a primary focus on studies comparing screening versus no screening. Lifetime gains were calculated using relative risks for all-cause mortality reported in the trials.
Results: Our analysis included 18 RCTs, encompassing over 2 million participants. Sigmoidoscopy was the only screening test to show a statistically significant increase in life expectancy, with a gain of 110 days (95% CI, 0-274 days). Mammography, FOBT (annual and biennial), and PSA testing did not show significant life expectancy benefits. Colonoscopy and lung cancer screening each showed potential increases of 37 days and 107 days, respectively, though with wide confidence intervals indicating uncertainty. A combined cancer screening study suggested a mean gain of 123 days (95% CI, 6-227 days).
Conclusion: This study suggests that while some cancer screenings, such as sigmoidoscopy, may provide modest increases in life expectancy, many commonly used tests do not show significant improvements in overall longevity. the impact on life expectancy can vary depending on the screening method. Future research with longer follow-up periods and more robust trial designs is needed to better understand the long-term effects of cancer screening on longevity.
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Copyright (c) 2024 Moamen Abdelfadil Ismail, Amani Khalid Alrefaei, Salma Mohammad Alyaqoub, Hassan Ali H Alalawi, Aladham Ahmed K Raeedi, Meshari Hassan A. Asiri, Huda Mohammed Allam, Faisal Fahad Alhejaili, Rajaeei Albazroon, Reem Abdulhakim Alkhayal, Laila Hussain Faqihi, Abdulmohsen Jaser Almutairi, Abdulhadi Hashim Halawani, Meshail Mansour Alsaud, Areej Youseef Saleh Alyanboawi
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