RT Journal Article
SR Electronic
T1 Cumulative Incidence of False-Positive Results in Repeated, Multimodal Cancer Screening
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 212
OP 222
DO 10.1370/afm.942
VO 7
IS 3
A1 Jennifer Miller Croswell
A1 Barnett S. Kramer
A1 Aimee R. Kreimer
A1 Phil C. Prorok
A1 Jian-Lun Xu
A1 Stuart G. Baker
A1 Richard Fagerstrom
A1 Thomas L. Riley
A1 Jonathan D. Clapp
A1 Christine D. Berg
A1 John K. Gohagan
A1 Gerald L. Andriole
A1 David Chia
A1 Timothy R. Church
A1 E. David Crawford
A1 Mona N. Fouad
A1 Edward P. Gelmann
A1 Lois Lamerato
A1 Douglas J. Reding
A1 Robert E. Schoen
YR 2009
UL http://www.annfammed.org/content/7/3/212.abstract
AB PURPOSE Multiple cancer screening tests have been advocated for the general population; however, clinicians and patients are not always well-informed of screening burdens. We sought to determine the cumulative risk of a false-positive screening result and the resulting risk of a diagnostic procedure for an individual participating in a multimodal cancer screening program. METHODS Data were analyzed from the intervention arm of the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a randomized controlled trial to determine the effects of prostate, lung, colorectal, and ovarian cancer screening on disease-specific mortality. The 68,436 participants, aged 55 to 74 years, were randomized to screening or usual care. Women received serial serum tests to detect cancer antigen 125 (CA-125), transvaginal sonograms, posteroanterior-view chest radiographs, and flexible sigmoidoscopies. Men received serial chest radiographs, flexible sigmoidoscopies, digital rectal examinations, and serum prostate-specific antigen tests. Fourteen screening examinations for each sex were possible during the 3-year screening period. RESULTS After 14 tests, the cumulative risk of having at least 1 false-positive screening test is 60.4% (95% CI, 59.8%–61.0%) for men, and 48.8% (95% CI, 48.1%–49.4%) for women. The cumulative risk after 14 tests of undergoing an invasive diagnostic procedure prompted by a false-positive test is 28.5% (CI, 27.8%–29.3%) for men and 22.1% (95% CI, 21.4%–22.7%) for women. CONCLUSIONS For an individual in a multimodal cancer screening trial, the risk of a false-positive finding is about 50% or greater by the 14th test. Physicians should educate patients about the likelihood of false positives and resulting diagnostic interventions when counseling about cancer screening. Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.