Screening and the number needed to treat

Richardson, Ann

doi:10.1136/jms.8.3.125

Cited by 41 publications

(29 citation statements)

References 14 publications

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“…The number needed to be screened to save one breast cancer death was calculated according to the method of Richardson, (2001) (Supplementary Material 13). …”

Section: Methodsmentioning

confidence: 99%

Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study

et al. 2016

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Background:Population breast screening has been implemented in the UK for over 25 years, but the size of benefit attributable to such programmes remains controversial. We have conducted the first individual-based cohort evaluation of population breast screening in the UK, to estimate the impact of the NHS breast screening programme (NHSBSP) on breast cancer mortality.Methods:We followed 988 090 women aged 49–64 years in 1991 resident in England and Wales, who because of the staggered implementation of the NHSBSP, included both invited subjects and an uninvited control group. Individual-level breast screening histories were linked to individual-level mortality and breast cancer incidence data from national registers. Risk of death from breast cancer was investigated by incidence-based mortality analyses in relation to intention to screen and first round attendance. Overdiagnosis of breast cancer following a single screening round was also investigated.Results:Invitation to NHSBSP screening was associated with a reduction in breast cancer mortality in 1991–2005 of 21% (RR=0.79, 95% CI: 0.73–0.84, P<0·001) after adjustment for age, socioeconomic status and lead-time. Breast cancer deaths among first invitation attenders were 46% lower than among non-attenders (RR=0.54, 95% CI: 0.51–0·57, P<0.001) and 32% lower following adjustment for age, socioeconomic status and self-selection bias (RR=0.68, 95% CI: 0.63–0·73, P<0.001). There was little evidence of overdiagnosis associated with invitation to first screen.Conclusions:The results indicate a substantial, statistically significant reduction in breast cancer mortality between 1991 and 2005 associated with NHSBSP activity. This is important in public health terms.

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“…The number needed to be screened to save one breast cancer death was calculated according to the method of Richardson, (2001) (Supplementary Material 13). …”

Section: Methodsmentioning

confidence: 99%

Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study

et al. 2016

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“…Recently it has been suggested the term NNS should be adjusted for participation rate and that this be known as the NNBS-number needed to be screened. 25 The number of people who actually need to participate in screening to prevent one death is lower than the number of people who need to be invited to screen to prevent one death; therefore, NNBS figures are usually lower than the *The number of cancers detected by a screening programme or the prevalence of detected cancers at a screening round is also sometimes referred to as the detection rate. 1 NNS.…”

Section: Number Needed To Screen (Nns)mentioning

confidence: 99%

Cancer screening

Barratt

2002

Journal of Epidemiology &Amp; Community Health

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“…Due to the more tangible information provided by absolute effect measures, reporting guidelines for randomized trials recommend showing both types of results (5,6). Number needed to treat is the absolute measure used for treatment trials, and number needed to screen the equivalent metric for screening trials (7,8). To factor in incomplete compliance in screening trials (particularly population-based effectiveness trials), number needed to invite has been developed as a further indicator of absolute screening effect (9).…”

Section: Introductionmentioning

confidence: 99%

Absolute Effect of Prostate Cancer Screening: Balance of Benefits and Harms by Center within the European Randomized Study of Prostate Cancer Screening

Auvinen

Moss

Tammela

et al. 2016

Clinical Cancer Research

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Purpose The balance of benefits and harms in prostate cancer screening has not been sufficiently characterized. We related indicators of mortality reduction and overdetection by center within the European Randomized Study of Prostate Cancer Screening. Experimental Design We analyzed the absolute mortality reduction expressed as number needed to invite (NNI=1/absolute risk reduction; indicating how many men had to be randomized to screening arm to avert a prostate cancer death) for screening and the absolute excess of prostate cancer detection as number needed for overdetection (NNO=1/absolute excess incidence; indicating the number of men invited per additional prostate cancer case), and compared their relationship across the seven ERSPC centers. Results Both absolute mortality reduction (NNI) and absolute overdetection (NNO) varied widely between the centers: NNI 200-7000 and NNO 16-69. Extent of overdiagnosis and mortality reduction were closely associated (correlation coefficient r=0.76, weighted linear regression coefficient β=33, 95% 5-62, R2=0.72). For an averted prostate cancer death at 13 years of follow-up, 12-36 excess cases had to be detected in various centers. Conclusions The differences between the ERSPC centers likely reflect variations in prostate cancer incidence and mortality, as well as in screening protocol and performance. The strong interrelation between the benefits and harms suggests that efforts to maximize the mortality effect are bound to increase overdiagnosis, and might be improved by focusing on high-risk populations. The optimal balance between screening intensity and risk of overdiagnosis remains unclear.

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Screening and the number needed to treat

Cited by 41 publications

References 14 publications

Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study

Effect of population breast screening on breast cancer mortality up to 2005 in England and Wales: an individual-level cohort study

Cancer screening

Absolute Effect of Prostate Cancer Screening: Balance of Benefits and Harms by Center within the European Randomized Study of Prostate Cancer Screening

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