Juan

Thanks for highlighting this study and the media hype - have you any information on what the project cost?

I did some searching and found that one component study (on psychosocial effects) cost around £1.25m. However I could not find any info about the other costs.

If the cost information was available, how would the return on the investment in this project be assessed?

Michael

Sent from my iPad

On 29 Dec 2015, at 20:20, Juan Gérvas <[log in to unmask]> wrote:

-Nick, in fact i am preparing a graphic presentation to help readers, doctors and journalists

-i will comment about it in due time

-meantime, it can help two commentaries

http://www.healthnewsreview.org/2015/12/ovarian-cancer-screening-shop-for-the-story-emphasis-of-your-choice/

http://scienceblog.cancerresearchuk.org/2015/12/17/ovarian-cancer-screening-trial-a-tantalising-result/

-un saludo juan gérvas @JuanGrvas

2015-12-29 19:44 GMT+01:00 Myles, Nickolas [PH] <[log in to unmask]>:

Thank you Juan, for the clear evidence  summary. Will you write and publish a formal rebuttal, since the misleading information was broadly publicized and already reached our ears, the formal rebuttal should be made public ASAP ?

 

Nick Myles

Vancouver

 

 

From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Juan Gérvas
Sent: Monday, December 28, 2015 12:39 PM
To: [log in to unmask]
Subject: EBM and screening of ovarian cancer

 

-probably you can join me in reading the results of this RCT: the UKCTOCS

-first, please read the news: http://www.eurekalert.org/pub_releases/2015-12/tl-tll121515.php

Professor Jacobs says: "These results from UKCTOCS provide estimates of the mortality reduction attributable to ovarian cancer screening which range from 15% to 28%. Further follow up in UKCTOCS will provide greater confidence about the precise reduction in mortality which is achievable. It is possible that the mortality reduction after follow up for an additional 2-3 years will be greater or less than these initial estimates."

-then, go to the UKCTOCS page:
The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was designed to determine how many lives could be saved by screening for ovarian cancer. The trial coordinated from UCL, commenced in 2001 and has involved 13 centres across the UK.

-then, please go to the papers (two, including the supplement, both free and direct access)
Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901224-6/fulltext
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901224-6/supplemental

-the RCT ends with not significant impact in mortality, BUT a significant mortality benefit in a subgroup analysis (most of the mortality benefit occurred during the later years of follow-up: 8% during years 0 to 7 versus 23% during years 7 to 14 in the multimodality group and 2% versus 21% in the ultrasound group (what it was unexpected)
-the data showed that 338 (0.7%) women in the multimodality arm had ovarian cancer, 314(0.6%) in the ultrasound arm, and 630 (0.6%) of the women who were not screened;  148 (0.29%) women in the multimodality arm (MMS) died of ovarian cancer, 154 (0.30%) in the ultrasound arm (USS), and 347 (0.34%) of the women who were not screened.

-true positive were 199 (59%) in the multimodality arm and 161 (51%) in the ultrasound arm

-false negative were 79 (23%) in the multimodality arm (MMS) and 106 (34%) in the ultrasound arm (USS)
-screening-related complication rate of 8·6 per 100,000 in the MMS group and 18·6 per 100,000 in the USS group
-they noted no evidence of a difference in deaths because of other causes between the MMS, USS, and no screening groups; total deaths, 6.7 per 1,000 MMS, 6.4 USS and 6.6 in the women who were not screened; total cancer mortality: 3.4 per 1,000 MMS, 3.3 USS and 3.3 in the women who were not screened
-for each ovarian and peritoneal cancer detected by screening, an additional two women in the MMS group and ten women in the USS group had false-positive surgery
-women in the MMS group had a complication rate of 3·1%  and those in the USS group had a rate of 3·5%
-the ratio of women who had surgery for which ovaries had benign pathology or were normal to those diagnosed with ovarian and peritoneal cancer was 2·3-times higher in the MMS group and 5·3-times higher in the USS group than in the no screening group

-so, my question: could you recommend a screening test which has no impact on ovarian cancer mortality, no impact on cancer mortality, no impacto on total mortality, and has heavy harms)

-un saludo juan gérvas @JuanGrvas