Getaneh Abraham M, Heijnsdijk Eveline Am, de Koning Harry J
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands,
Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
Public Health Res Pract. 2019 Jul 31;29(2):2921912. doi: 10.17061/phrp2921912.
Although randomised controlled trials are the preferred basis for policy decisions on cancer screening, it remains difficult to assess all downstream effects of screening, particularly when screening options other than those in the specific trial design are being considered. Simulation models of the natural history of disease can play a role in quantifying harms and benefits of cancer screening scenarios. Recently, the US Preventive Services Task Force issued a C-recommendation on screening for prostate cancer for men aged 55-69 years, implying at least moderate certainty that the benefit is small. However, modelling based on data from the European Randomized study of Screening for Prostate Cancer, which included quality-of-life estimates, showed that the ratio between benefits and harms is better, and likely to be reasonable, for men screened between the ages of 55 and 63 years (i.e. by using an earlier stopping age than applied in the trial setting). This commentary article considers the importance of simulation modelling in the decision-making process for (prostate) cancer screening. The paper also explores whether the recently published Cluster Randomized Trial of PSA Testing for Prostate Cancer, a trial of a single prostate specific antigen (PSA) testing intervention in the UK, changes the evidence for regular PSA testing for men aged 55-63 years by replicating the trial using a simulation model.
尽管随机对照试验是癌症筛查政策决策的首选依据，但评估筛查的所有下游影响仍然困难，尤其是在考虑特定试验设计之外的筛查选项时。疾病自然史的模拟模型可在量化癌症筛查方案的危害和益处方面发挥作用。最近，美国预防服务工作组对55至69岁男性的前列腺癌筛查发布了C级推荐，这意味着至少有中等程度的确定性认为益处很小。然而，基于前列腺癌筛查欧洲随机研究的数据进行的建模（其中包括生活质量评估）表明，对于55至63岁接受筛查的男性（即使用比试验设定更早的停止年龄），利弊比更好，且可能是合理的。这篇评论文章探讨了模拟建模在（前列腺）癌筛查决策过程中的重要性。本文还探讨了最近发表的英国一项针对前列腺癌的前列腺特异性抗原（PSA）检测整群随机试验，通过使用模拟模型复制该试验，是否改变了55至63岁男性定期进行PSA检测的证据。
