title: Limitations of basing screening policies on screening trials: The US Preventive Services Task Force and Prostate Cancer Screening.
abstract: BACKGROUND
  The US Preventive Services Task Force recently recommended against prostate-specific antigen screening for prostate cancer based primarily on evidence from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the US Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial.
  
  
  OBJECTIVE
  : To examine limitations of basing screening policy on evidence from screening trials.
  
  
  METHODS
  We reviewed published modeling studies that examined population and trial data. The studies (1) project the roles of screening and changes in primary treatment in the US mortality decline; (2) extrapolate the ERSPC mortality reduction to the long-term US setting; (3) estimate overdiagnosis based on US incidence trends; and (4) quantify the impact of control arm screening on PLCO mortality results.
  
  
  RESULTS
  Screening plausibly explains 45% and changes in primary treatment can explain 33% of the US prostate cancer mortality decline. Extrapolating the ERSPC results to the long-term US setting implies an absolute mortality reduction at least 5 times greater than that observed in the trial. Approximately 28% of screen-detected cases are overdiagnosed in the United States versus 58% of screen-detected cases suggested by the ERSPC results. Control arm screening can explain the null result in the PLCO trial.
  
  
  CONCLUSIONS
  Modeling studies indicate that population trends and trial results extended to the long-term population setting are consistent with greater benefit of prostate-specific antigen screening-and more favorable harm-benefit tradeoffs-than has been suggested by empirical trial evidence.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. retzioni@fhcrc.org
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.forename: Roman
authors.initials: R
authors.lastname: Gulati
authors.forename: Matt R
authors.initials: MR
authors.lastname: Cooperberg
authors.forename: David M
authors.initials: DM
authors.lastname: Penson
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.forename: Ian M
authors.initials: IM
authors.lastname: Thompson
mesh_terms: D003657:Decision Making; D055088:Early Detection of Cancer / Q000592:standards*; D019317:Evidence-Based Medicine / Q000379:methods*; D006291:Health Policy; D006801:Humans; D015994:Incidence; D008297:Male; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000592:standards; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology