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Purpose. Aggressive screening for asymptomatic disease is a bedrock of public health policy in the US. Cancer screening guidelines are generally of the form “screen starting at age x”. However, the benefits of early detection and treatment decline sharply with age because patients are more likely to die from comorbid conditions. The purpose of this study was to assess the relationship between age and the benefits of screening.
Methods. An analytical model expresses the net benefit from screening as a function of age. The benefit function has two components. The first is the survival advantage from early detection (valued in dollars). This component, which is declining in patient age, accounts for the risk of death from competing causes. The second component is the cost per detected case, which is a function of the incidence rate and is increasing in age. Parameters from the literature were used to compute the value function for the case of prostate cancer screening.
Results: The benefit from screening is not monotonically increasing in age, as implied by current screening policies. There will be cases when net benefits are positive in an interval (x,y) and negative otherwise. For annual prostate cancer screening, x=45 and y=68.
Conclusion: In some cases, it makes sense to stop screening after a certain age. Screening recommendations appear to be influenced more by the likelihood of detection than the benefit of treatment once detected.
See more of Poster Session - Public Health; Methodological Advances
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)