Although randomised controlled trials are the preferred basis for policy decisions on cancer screening, it remains diffcult to assess all downstream effects of screening, particularly when screening options other than those in the specifc trial design are being considered. Simulation models of the natural history of disease can play a role in quantifying harms and benefts 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 beneft 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 benefts 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 specifc 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.,
Public Health Research & Practice
Department of Public Health

Getaneh, A.M., Heijnsdijk, E., & de Koning, H. (2019). The role of modelling in the policy decision making process for cancer screening: example of prostate specific antigen screening. Public Health Research & Practice, 29(2). doi:10.17061/phrp2921912