Journal of the National Cancer Institute Advance Access published online on August 28, 2007
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djm101
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© The Author 2007. Published by Oxford University Press.
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Interval Cancers in Prostate Cancer Screening: Comparing 2- and 4-Year Screening Intervals in the European Randomized Study of Screening for Prostate Cancer, Gothenburg and Rotterdam
Affiliations of authors: Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands (MJR, FHS); Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden (AG, JH)
Correspondence to: Monique J. Roobol, PhD, Department of Urology, Erasmus Medical Centre, Rm NH 224, PO Box 2040, 3000 CA Rotterdam, The Netherlands (e-mail: m.roobol{at}erasmusmc.nl).
Background: The incidence of prostate cancer has increased substantially since it became common practice to screen asymptomatic men for the disease. The European Randomized Study of Screening for Prostate Cancer (ERSPC) was initiated in 1993 to determine how prostate-specific antigen (PSA) screening affects prostate cancer mortality. Variations in the screening algorithm, such as the interval between screening rounds, likely influence the morbidity, mortality, and quality of life of the screened population.
Methods: We compared the number and characteristics of interval cancers, defined as those diagnosed during the screening interval but not detected by screening, in men in the screening arm of the ERSPC who were aged 55–65 years at the time of the first screening and were participating through two centers of the ERSPC: Gothenburg (2-year screening interval, n = 4202) and Rotterdam (4-year screening interval, n = 13301). All participants who were diagnosed with prostate cancer through December 31, 2005, but at most 10 years after the initial screening were ascertained by linkage with the national cancer registries. A potentially life-threatening (aggressive) interval cancer was defined as one with at least one of the following characteristics at diagnosis: stage M1 or N1, plasma PSA concentration greater than 20.0 ng/mL, or Gleason score greater than 7. We used Mantel Cox regression to assess differences between rates of interval cancers and aggressive interval cancers at the two centers. All statistical tests were two-sided.
Results: The 10-year cumulative incidence of all prostate cancers in Rotterdam versus Gothenburg was 1118 (8.41%) versus 552 (13.14%) (P<.001), the cumulative incidence of interval cancer was 57 (0.43%) versus 31 (0.74%) (P = .51), and the cumulative incidence of aggressive interval cancer was 15 (0.11%) versus 5 (0.12%) (P = .72).
Conclusion: The rate of interval cancer, especially aggressive interval cancer, was low in this study. The 2-year screening interval had higher detection rates than the 4-year interval but did not lead to lower rates of interval and aggressive interval prostate cancers.
| CONTEXT AND CAVEATS Prior knowledge Prostate cancer incidence has risen substantially since screening men without symptoms of the disease has become common practice. Study design Prostate screening trial of men in Sweden (Gothenburg, 2-year interval) and in The Netherlands (Rotterdam, 4-year interval). Numbers of prostate cancers that were clinically diagnosed within the screening interval (interval cancers) in the two centers were compared. Contributions The cumulative incidence of prostate cancer for a period of 10 years was higher in Gothenburg than in Rotterdam, but the numbers of interval prostate cancers, including those that were potentially life threatening, were similar in the two centers. Implications Although more prostate cancers were detected overall in the center using the 2-year than the 4-year screening interval, the 2-year interval did not decrease the detection of interval prostate cancers. Limitations In Rotterdam, men were randomly assigned to the screening arm after consent, whereas in Gothenburg, men were assigned before consent. This difference in the randomization procedure may have led to selection bias in the Gothenburg center of the study and to a healthy screenee bias in the Rotterdam center of the study. In addition, response rate was slightly higher in Gothenburg than in Rotterdam. It is unknown whether these results can be generalized to other populations.
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Manuscript received March 20, 2007; revised June 21, 2007; accepted July 6, 2007.
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J Natl Cancer Inst 2007 99: 1279-1280.
J Natl Cancer Inst 2007 99: 1277.
J Natl Cancer Inst 2007 99: 1277.
J Natl Cancer Inst 2007 99: 1277.
J Natl Cancer Inst 2007 99: 1277.
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