One question if I may
How can we have (in table 3 -primary analysis) a p value that is below 0.05 if the CI overlaps the 0%
Mortality 0-14 years
Roysran-Pamar model
p=0.021 but the CI ranges from -2% to 40%
I cannot figure it out
The CI makes should make it not statistically significant
It is the same thing in the secondary analysis
Is it linked to the Roysran-Parmar model? and if so can somebody explain it to me
Many thanks
De : Evidence based health (EBH) <[log in to unmask]> de la part de Juan Gérvas <[log in to unmask]>
Envoyé : 29 décembre 2015 05:40
À : [log in to unmask]
Objet : Re: EBM and screening of ovarian cancer-un saludo juan gérvas-for example, to know about compliance with annual screening: 1st year 98.4% MMS and 94.9% USS; last year (11st) 47.2% and 35.9% respectively-"normal" physicians and patients do not go to the paper, neither to it supplement document-in my own opinion, questions around this RCT are in some way about scientific honestity-in my own opinion, the press comments are an example of manipulation
2015-12-29 5:11 GMT+01:00 healingjia Price <[log in to unmask]>:
Thank you for bringing these studies up. I came across that press release and thought the mortality figures were about the same screened or unscreened and was just going to look more closely. The release is misleading especially given the information provided by you and this disconnect from numbers is what confuses the public too
Best-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