What explains the differences between centres in the European screening trial? A simulation study

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http://hdl.handle.net/10138/236601

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Nevalainen , J , Stenman , U-H , Tammela , T L , Roobol , M , Carlssone , S , Talalag , K , Schroder , F H & Auvinen , A 2017 , ' What explains the differences between centres in the European screening trial? A simulation study ' , Cancer Epidemiology , vol. 46 , pp. 14-19 . https://doi.org/10.1016/j.canep.2016.11.005

Title: What explains the differences between centres in the European screening trial? A simulation study
Author: Nevalainen, Jaakko; Stenman, Ulf-Hakan; Tammela, Teuvo L.; Roobol, Monique; Carlssone, Sigrid; Talalag, Kirsi; Schroder, Fritz H.; Auvinen, Anssi
Contributor: University of Helsinki, Clinicum
Date: 2017-02
Language: eng
Number of pages: 6
Belongs to series: Cancer Epidemiology
ISSN: 1877-7821
URI: http://hdl.handle.net/10138/236601
Abstract: Background: The European Randomised study of Screening for Prostate Cancer (ERSPC) is a multicentre, randomised screening trial on men aged 55-69 years at baseline without known prostate cancer (PrCa) at randomisation to an intervention arm invited to screening or to a control arm. The ERSPC has shown a significant 21% reduction in PrCa mortality at 13 years of follow-up. The effect of screening appears to vary across centres, for which several explanations are possible. We set to assess if the apparent differences in PrCa mortality reduction between the centres can be explained by differences in screening protocols. Methods: We examined the centre differences by developing a simulation model and estimated how alternative screening protocols would have affected PrCa mortality. Results: Our results showed outcomes similar to those observed, when the results by centres were reproduced by simulating the screening regimens with PSA threshold of 3 versus 4 ng/ml, or screening interval of two versus four years. The findings suggest that the differences are only marginally attributable to the different screening protocols. Conclusion: The small screening impact in Finland was not explained by the differences in the screening protocols. A possible reason for it was the contamination of and the unexpectedly low PrCa mortality in the Finnish control arm. (C) 2016 Elsevier Ltd. All rights reserved.
Subject: Longitudinal PSA model
Prostate cancer
Prostate-specific antigen
Screening
Simulation model
PROSTATE-CANCER MORTALITY
DIGITAL RECTAL EXAMINATION
ROTTERDAM SECTION
FOLLOW-UP
ANTIGEN
CONTAMINATION
PSA
1182 Biochemistry, cell and molecular biology
3122 Cancers
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