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RESEARCH ARTICLE (Open Access)
Contents Vol 27(3)

Assessing the efficacy of cancer screening

Gemma Jacklyn A , Katy Bell A B and Andrew Hayen C *
+ Author Affiliations
- Author Affiliations

A Wiser Healthcare, Sydney School of Public Health, University of Sydney, NSW, Australia

B Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Qld, Australia

C Australian Centre for Public and Population Health Research, University of Technology Sydney, NSW, Australia

* Correspondence to: andrew.hayen@uts.edu.au

Public Health Research and Practice 27, e2731727 https://doi.org/10.17061/phrp2731727
Published: 26 July 2017

2017 © Jacklyn et al. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence, which allows others to redistribute, adapt and share this work non-commercially provided they attribute the work and any adapted version of it is distributed under the same Creative Commons licence terms.

Abstract

Background:Population-based cancer screening has been established for several types of cancer in Australia and internationally. Screening may perform differently in practice from randomised controlled trials, which makes evaluating programs complex. Materials and methods: We discuss how to assess the evidence of benefits and harms of cancer screening, including the main biases that can mislead clinicians and policy makers (such as volunteer, lead-time, length-time and overdiagnosis bias). We also discuss ways in which communication of risks can inform or mislead the community. Results: The evaluation of cancer screening programs should involve balancing the benefits and harms. When considering the overall worth of an intervention and allocation of scarce health resources, decisions should focus on the net benefits and be informed by systematic reviews. Communication of screening outcomes can be misleading. Many messages highlight the benefits while downplaying the harms, and often use relative risks and 5-year survival to persuade people to screen rather than support informed choice. Lessons learned: An evidence based approach is essential when evaluating and communicating the benefits and harms of cancer screening, to minimise misleading biases and the reliance on intuition.