title: Quantification of harms in cancer screening trials: literature review.
abstract: OBJECTIVE
  To assess how often harm is quantified in randomised trials of cancer screening.
  
  
  METHODS
  Two authors independently extracted data on harms from randomised cancer screening trials. Binary outcomes were described as proportions and continuous outcomes with medians and interquartile ranges.
  
  
  METHODS
  For cancer screening previously assessed in a Cochrane review, we identified trials from their reference lists and updated the search in CENTRAL. For cancer screening not assessed in a Cochrane review, we searched CENTRAL, Medline, and Embase.
  
  
  METHODS
  Randomised trials that assessed the efficacy of cancer screening for reducing incidence of cancer, cancer specific mortality, and/or all cause mortality.
  
  
  METHODS
  Two reviewers independently assessed articles for eligibility. Two reviewers, who were blinded to the identity of the study's authors, assessed whether absolute numbers or incidence rates of outcomes related to harm were provided separately for the screening and control groups. The outcomes were false positive findings, overdiagnosis, negative psychosocial consequences, somatic complications, invasive follow-up procedures, all cause mortality, and withdrawals because of adverse events.
  
  
  RESULTS
  Out of 4590 articles assessed, 198 (57 trials, 10 screening technologies) matched the inclusion criteria. False positive findings were quantified in two of 57 trials (4%, 95% confidence interval 0% to 12%), overdiagnosis in four (7%, 2% to 18%), negative psychosocial consequences in five (9%, 3% to 20%), somatic complications in 11 (19%, 10% to 32%), use of invasive follow-up procedures in 27 (47%, 34% to 61%), all cause mortality in 34 (60%, 46% to 72%), and withdrawals because of adverse effects in one trial (2%, 0% to 11%). The median percentage of space in the results section that reported harms was 12% (interquartile range 2-19%).
  
  
  CONCLUSIONS
  Cancer screening trials seldom quantify the harms of screening. Of the 57 cancer screening trials examined, the most important harms of screening--overdiagnosis and false positive findings--were quantified in only 7% and 4%, respectively.
authors.affiliation: Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark.
authors.forename: Bruno
authors.initials: B
authors.lastname: Heleno
authors.forename: Maria F
authors.initials: MF
authors.lastname: Thomsen
authors.forename: David S
authors.initials: DS
authors.lastname: Rodrigues
authors.forename: Karsten J
authors.initials: KJ
authors.lastname: Jørgensen
authors.forename: John
authors.initials: J
authors.lastname: Brodersen
mesh_terms: D016001:Confidence Intervals; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000523:psychology; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D009369:Neoplasms / Q000145:classification / Q000175:diagnosis*; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic; D013315:Stress, Psychological / Q000209:etiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
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