Should we use total mortality rather than cancer specific mortality to judge cancer screening programmes? Yes
Ces deux articles s'opposent sur la question de savoir si, pour évaluer des programmes de dépistage du cancer, le critère de jugement doit être la mortalité totale ou la mortalité spécifique
Cancer screening is a source of much dispute—in the case of breast cancer, arguments have raged for more than a decade. One major concern is how the effects are to be measured. Disease specific mortality is used extensively in trials of cancer screening, and as the aim of screening is to reduce deaths from the target disease, this might seem to be a suitable end point. But the arguments against using disease specific mortality weigh heavily, and all cause mortality is a better measure.
Uncertainties relating to cause of death
Clearly, the accuracy of disease specific mortality depends on correctly identifying the cause of death. However, this is often unreliable, and it entails decisions that can introduce biases, either for or against screening. Claims that bias favouring screening predominates have been disputed. Nevertheless, one thing is sure: the accuracy of all cause mortality depends solely on the number of deaths identified and …
British Medical Journal , article en libre accès, 2011