Increasing use of recommended screening strategies could reduce the U.S. cancer burden, according to research published November 22 in JAMA Network Open.
A team led by Amy Knudsen, PhD, from Massachusetts General Hospital in Boston found an increase of 10 percentage points in the uptake of lung, colorectal, breast, and cervical cancer screening at their respective starting ages as recommended by the U.S. Preventive Services Task Force (USPSTF) led to decreased cancer deaths. It highlighted that this could help the U.S. achieve the Cancer Moonshot initiative’s goals.
“Achieving these reductions is predicated on ensuring equitable access to screening,” Knudsen and co-authors wrote.
The Cancer Moonshot initiative is a White House effort to reduce cancer deaths. The Biden Administration’s renewed goal is to reduce cancer deaths by at least 50% over the next 25 years.
The researchers noted that despite USPSTF recommendations, the proportions of eligible U.S. adults who have been consistently screened are still below national targets. This spurred the initiative’s Blue Ribbon Panel to recommend expanded use of proven cancer prevention and early detection strategies.
The Knudsen team wanted to estimate the number of cancer deaths that could be prevented with a 10-percentage-point increase in the use of USPSTF-recommended screening. It reported that its decision analytical model study is an extension of previous studies conducted for the USPSTF from 2018 to 2023.
The team analyzed data for the following screening tests: annual low-dose CT for lung cancer among eligible adults ages 50 to 80; biennial mammography among women ages 40 to 74; colonoscopy every 10 years among adults ages 45 to 75; and triennial cervical cytology screening among female adults ages 21 to 29, followed by human papillomavirus testing every five years from ages 30 to 65 years.
The researchers found that with their 10-percentage-point increase setting, USPSTF recommendations could prevent 226 lung cancer deaths, 82 breast cancer deaths, 283 colorectal cancer deaths, and 81 cervical cancer deaths over the lifetimes of 100,000 persons eligible for screening.
They also found that these rates corresponded to an estimated 1,010 lung cancer deaths and 1,790 breast cancer deaths prevented over the lifetime of U.S. residents at the recommended age to begin screening in 2021.
Overall, the investigators estimated that each 10-percentage-point increase in uptake could result in a 1% reduction in lung cancer deaths, a 4% reduction in breast cancer deaths, a 21% reduction in colorectal cancer deaths, and a 40% reduction in cervical cancer deaths.
However, the team also reported that increased screening uptake led to generated harms, including an estimated 100,000 false-positive lung scans and 300,000 false-positive mammograms. The team additionally reported an estimated 6,000 colonoscopy complications and 348,000 colposcopies over the period of a lifetime.
The study authors noted that their research did not account for quality-of-life improvements from treatment of early-stage versus late-stage cancer or from preventing a person from ever having cancer through screening. They also wrote that the study did not account for the challenges or the cost of achieving a 10-percentage-point increase in screening uptake.
The study authors suggested that these results point to the success of increased screening uptake for the Cancer Moonshot initiative. However, they added that this alone will not achieve the initiative’s goals.
“Targeted efforts to increase uptake among groups with the highest mortality risk, combined with advances in prevention and treatment, will be needed,” they wrote.
The full study can be found here.
