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Do national cancer screening guidelines reduce mortality?

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Abstract

The effectiveness of cancer screening is a salient health policy issue that remains unresolved. This article sheds new light on the benefits of population-wide cancer screening. We investigate changes in mortality after the introduction of screening guidelines for breast and prostate cancers in the USA and UK. We use differences in the timing of guideline adoption, differences in ages recommended for screening, and differences in which cancers are detectable by screening to identify the effect of cancer screening guidelines. Our quadruple-differencing strategy finds a moderately sized mortality benefit from mammography and prostate-specific antigen (PSA) screening guidelines among recommended age groups and little change in mortality rates among age groups not recommended to receive screening. As a falsification test, we verify that prostate cancer rates among men did not fall after the introduction of mammography screening and breast cancer rates among women did not fall after the introduction of the PSA test.

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Notes

  1. A number of studies have examined cancer survival, including Lakdawalla et al. (2010) and Sun et al. (2010) in the USA and Berrino et al. (2007), Karim-Kos et al. (2008), Sant et al. (2009), and Coleman et al. (2011) in Europe.

  2. There may be good reasons why the coefficient estimate for ages not recommended for screening should not be zero, however. On the one hand, if there are spillovers across age groups so that some people who are not recommended for screening get screened, the estimate should be the same sign as the estimate for ages recommended for screening. This will lead to a downward bias in our DDDD estimates. On the other hand, if the introduction of the guideline leads fewer resources to be delivered to ages not recommended for screening, our DDDD estimates are biased upward. The former effect seems more plausible, but both are possibilities.

  3. Both countries used ICD version 7 prior to 1968 and version 8 between 1968 and 1978 before switching to version 9 in 1979. The US switched to version 10 in 1999 while the UK switched in 2001.

References

  • Aaron H, Schwartz W, Cox M (2005) Can we say no? The challenge of rationing health care. Brookings Institution Press, Washington, DC

    Google Scholar 

  • Andriole G, Crawford E, Grubb R, Buys S, Chia D, Church T et al (2009) Mortality results from a randomized prostate-cancer screening trial. N Engl J Med 360:1310–1319

    Article  Google Scholar 

  • Autier P, Boniol M, La Vecchia C et al (2010) Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ 341:c3620

    Article  Google Scholar 

  • Autier P, Boniol M, Gavin A, Vatten L (2011) Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ 343

  • Barry M (2009) Screening for prostate cancer—the controversy that refuses to die. N Engl J Med 360:1351–1354

    Article  Google Scholar 

  • Bechis S, Carroll P, Cooperberg M (2011) Impact of age at diagnosis on prostate cancer treatment and survival. J Clin Oncol 29(2):235–241

    Article  Google Scholar 

  • Berrino F, De Angelis R, Sant M et al (2007) Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study. Lancet Oncol 8(9):773–783

    Article  Google Scholar 

  • Bleyer A, Welch G (2012) Effect of three decades of screening mammography on breast cancer incidence. N Engl J Med 367:1998–2005

    Article  Google Scholar 

  • Cameron C, Gelbach J, Miller D (2011) Robust inference with multi-way clustering. J Bus Econ Stat 29(2):238–249

    Article  Google Scholar 

  • Chou R, Croswell J, Dana T, Bougatsos C, Blazina I, Fu R et al (2011) Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 155(11):762–771

    Article  Google Scholar 

  • Coleman MP, Forman D, Bryant H et al (2011) Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet 377(9760):127–138

    Article  Google Scholar 

  • Djulbegovic M, Beyth R, Neuberger M, Stoffs T, Vieweg J (2010) Screening for prostate cancer: systematic review and meta-analysis of randomized controlled trials. BMJ 341:c4543

    Article  Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472):1687–1717

    Article  Google Scholar 

  • Faden R, Chalkidou K, Appleby J, Waters H, Leider J (2009) Expensive cancer drugs: a comparison between the United States and the United Kingdom. Milbank Q 87(4):789–819

    Article  Google Scholar 

  • Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS One 4(11):e7695

    Article  Google Scholar 

  • Gøtzsche PC, Nielsen M (2011) Screening for breast cancer with mammography. Cochrane Database Syst Rev (1):CD001877. doi: 10.1002/14651858.CD001877.pub4

  • Hankley B, Feuer E, Clegg L, Hayes R, Legler J, Prorok P, Ries L, Merrill R, Kaplan R (1999) Cancer surveillance series: interpreting trends in prostate cancer—part 1: evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Nat Cancer Inst 91(12):1017–1024

    Article  Google Scholar 

  • Jaslow, Ryan (2013) Urologists no longer recommend routine PSA testing for prostate cancer. May 3, 2013. CBS News. www.cbsnews.com/news/urologists-no-longer-recommend-routine-psa-testing-for-prostate-cancer. Accessed 28 Oct 2014

  • Karim-Kos H, de Vries E, Soerjomataram I et al (2008) Recent trends of cancer in Europe: a combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 44(10):1345–1389

    Article  Google Scholar 

  • Lakdawalla D, Sun E, Jena A, Reyes C, Philipson T, Goldman D (2010) An economic evaluation of the war on cancer. J Health Econ 29(3):333–346

    Article  Google Scholar 

  • Malani A (2006) Identifying placebo effects with data from clinical trials. J Pol Econ 114(2):236–256

    Article  Google Scholar 

  • Malani A, Philipson, T (2011) Can medical progress be sustained? Implications of the link between development and output markets. NBER Working Paper No. 17011. National Bureau of Economic Research, Inc., Cambridge, MA

  • Mandelblatt J, Cronin K, Bailey S, Berry D, de Koning H, Draisma G et al (2009) Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 151:738–747

    Article  Google Scholar 

  • Mason A, Drummond M (2009) Public funding of new cancer drugs: is NICE getting nastier? Eur J Cancer 45(7):1188–1192

    Article  Google Scholar 

  • National Cancer Institute (1991) Smoking and tobacco control monograph 1: strategies to control tobacco use in the Unites States: a blueprint for public health action in the 1990s. U.S. Department of Health and Human Services, Washington, DC, NIH Publication No. 92–3316

    Google Scholar 

  • Oliver S, Gunnell D, Donovan J (2000) Comparison of trends in prostate cancer mortality in England and Wales and the USA. Lancet 355(9217):1788–1789

    Article  Google Scholar 

  • Rothwell P (2005) External validity of randomised controlled trials: “To whom do the results of this trial apply?”. Lancet 365:82–93

    Article  Google Scholar 

  • Ruhm C (2000) Are recessions good for your health? Q J Econ 115(2):617–650

    Article  Google Scholar 

  • Sant M, Allemani C, Santaquilani M et al (2009) EUROCARE-4. Survival of cancer patients diagnosed in 1995–1999. Results and commentary. Eur J Cancer 45(6):931–991

    Article  Google Scholar 

  • Schopper D, de Wolf C (2009) How effective are breast cancer screening programmes by mammography? Review of the current evidence. Eur J Cancer 45(11):1916–1923

    Article  Google Scholar 

  • Schroder F, Hugosson J, Roobol M, Tammela T, Ciatto S, Nelen V et al (2009) Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 360:1320–1328

    Article  Google Scholar 

  • Sickles E (2000) Breast imaging: from 1965 to present. Radiology 215:1–16

    Article  Google Scholar 

  • Sun E, Jena, A, Lakdawalla D, Reyes C, Philipson T, Goldman D (2010) The contributions of improved therapy and earlier detection to cancer survival gains, 1988–2000. Forum Health Econ Pol 13(2), Article 1

  • Vargo-Gogola T, Rosen J (2007) Modeling breast cancer: one size does not fit all. Nat Rev Cancer 7:659–672

    Article  Google Scholar 

  • Wilcken N, Horbuckle J, Ghersi D (2003) Chemotherapy alone versus endocrine therapy alone for metastatic breast cancer. Cochrane Database Syst Rev (2):CD002747

  • Woolf S (2010) The 2009 breast cancer screening recommendations of the U.S. Preventive Services Task Force. J Am Med Assoc 303(2):162–163

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Health Care Management, Colonial Penn Center, The Wharton School, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, USA

    Adam Leive

  2. Department of Economics, George Mason University, MSN 1D3, Fairfax, VA, 22030, USA

    Thomas Stratmann

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  1. Adam Leive
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  2. Thomas Stratmann
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Correspondence to Adam Leive.

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Responsible editor: Erdal Tekin

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Leive, A., Stratmann, T. Do national cancer screening guidelines reduce mortality?. J Popul Econ 28, 1075–1095 (2015). https://doi.org/10.1007/s00148-014-0536-6

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  • DOI: https://doi.org/10.1007/s00148-014-0536-6

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