American Journal of Epidemiology Advance Access originally published online on January 22, 2007
American Journal of Epidemiology 2007 165(8):874-881; doi:10.1093/aje/kwk075
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PRACTICE OF EPIDEMIOLOGY |
Evidence of a Healthy Volunteer Effect in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial
1 Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD
2 Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
3 Office of Disease Prevention, National Institutes of Health, Bethesda, MD
4 School of Public Health, University of Minnesota, Minneapolis, MN
5 Department of Hematology/Oncology, Marshfield Clinic, Marshfield, WI
6 Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
7 Department of Medicine, University of Pittsburgh, Pittsburgh, PA
8 Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
9 Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
Correspondence to Dr. Paul Pinsky, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, 6130 Executive Boulevard, EPN 3064, Bethesda, MD 20892 (e-mail: pinskyp{at}mail.nih.gov).
Received for publication May 17, 2006. Accepted for publication September 25, 2006.
Volunteers for prevention or screening trials are generally healthier and have lower mortality than the general population. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) is an ongoing, multicenter, randomized trial that randomized 155,000 men and women aged 55–74 years to a screening or control arm between 1993 and 2001. The authors compared demographics, mortality rates, and cancer incidence and survival rates of PLCO subjects during the early phase of the trial with those of the US population. Incidence and mortality from PLCO cancers (prostate, lung, colorectal, and ovarian) were excluded because they are the subject of the ongoing trial. Standardized mortality ratios for all-cause mortality were 46 for men, 38 for women, and 43 overall (100 = standard). Cause-specific standardized mortality ratios were 56 for cancer, 37 for cardiovascular disease, and 34 for both respiratory and digestive diseases. Standardized mortality ratios for all-cause mortality increased with time on study from 31 at year 1 to 48 at year 7. Adjusting the PLCO population to a standardized demographic distribution would increase the standardized mortality ratio only modestly to 54 for women and 55 for men. Standardized incidence ratios for all cancer were 84 in women and 73 in men, with a large range of standardized incidence ratios observed for specific cancers.
demography; mass screening; mortality; neoplasms; randomized controlled trials; standardized mortality ratio; survival rate
Abbreviations: PLCO, Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SEER, Surveillance, Epidemiology, and End Results
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