title: Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark.
abstract: OBJECTIVE
  To determine a pooled, quantitative estimate of the length of time needed after breast or colorectal cancer screening before a survival benefit is observed.
  
  
  METHODS
  Meta-analysis of survival data from population based, randomized controlled trials comparing populations screened and not screened for breast or colorectal cancer. Trials were identified as high quality by reviews from the Cochrane Collaboration and United States Preventive Services Task Force.
  
  
  METHODS
  Trials undertaken in the United States, Denmark, United Kingdom, and Sweden.
  
  
  METHODS
  Screened patients older than 40 years.
  
  
  METHODS
  Time to death from breast or colorectal cancer in screened and control populations.
  
  
  METHODS
  Fecal occult blood testing for colorectal cancer screening, mammography for breast cancer screening.
  
  
  RESULTS
  Our study included five and four eligible trials of breast and colorectal cancer screening, respectively. For breast cancer screening, 3.0 years (95% confidence interval 1.1 to 6.3) passed before one death from breast cancer was prevented for every 5000 women screened. On average across included studies, it took 10.7 years (4.4 to 21.6) before one death from breast cancer was prevented for 1000 women screened. For colorectal cancer screening, 4.8 years (2.0 to 9.7) passed before one death from colorectal cancer was prevented for 5000 patients screened. On average across included studies, it took 10.3 years (6.0 to 16.4) before one death from colorectal cancer was prevented for 1000 patients screened.
  
  
  CONCLUSIONS
  Our results suggest that screening for breast and colorectal cancer is most appropriate for patients with a life expectancy greater than 10 years. Incorporating time lag estimates into screening guidelines would encourage a more explicit consideration of the risks and benefits of screening for breast and colorectal cancer.
authors.affiliation: Division of Geriatrics, University of California San Francisco, San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
authors.forename: Sei J
authors.initials: SJ
authors.lastname: Lee
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: Irena
authors.initials: I
authors.lastname: Stijacic-Cenzer
authors.forename: Jessamyn
authors.initials: J
authors.lastname: Conell-Price
authors.forename: Sarah
authors.initials: S
authors.lastname: O'Brien
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008327:Mammography; D008403:Mass Screening / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009780:Occult Blood; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology