What explains the differences between centres in the European screening trial? A simulation study Journal Article


Authors: Nevalainen, J.; Stenman, U. H.; Tammela, T. L.; Roobol, M.; Carlsson, S.; Talala, K.; Schröder, F. H.; Auvinen, A.
Article Title: What explains the differences between centres in the European screening trial? A simulation study
Abstract: Background The European Randomised study of Screening for Prostate Cancer (ERSPC) is a multicentre, randomised screening trial on men aged 55–69 years at baseline without known prostate cancer (PrCa) at randomisation to an intervention arm invited to screening or to a control arm. The ERSPC has shown a significant 21% reduction in PrCa mortality at 13 years of follow-up. The effect of screening appears to vary across centres, for which several explanations are possible. We set to assess if the apparent differences in PrCa mortality reduction between the centres can be explained by differences in screening protocols. Methods We examined the centre differences by developing a simulation model and estimated how alternative screening protocols would have affected PrCa mortality. Results Our results showed outcomes similar to those observed, when the results by centres were reproduced by simulating the screening regimens with PSA threshold of 3 versus 4 ng/ml, or screening interval of two versus four years. The findings suggest that the differences are only marginally attributable to the different screening protocols. Conclusion The small screening impact in Finland was not explained by the differences in the screening protocols. A possible reason for it was the contamination of and the unexpectedly low PrCa mortality in the Finnish control arm. © 2016 Elsevier Ltd
Keywords: prostate cancer; prostate-specific antigen; screening; longitudinal psa model; simulation model
Journal Title: Cancer Epidemiology
Volume: 46
ISSN: 1877-7821
Publisher: Elsevier Inc.  
Date Published: 2017-02-01
Start Page: 14
End Page: 19
Language: English
DOI: 10.1016/j.canep.2016.11.005
PROVIDER: scopus
PUBMED: 27889661
PMCID: PMC5415347
DOI/URL:
Notes: Article -- Export Date: 3 January 2017 -- Source: Scopus
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