We fully agree with the statement by Brenner and colleagues that more “substantiated extrapolations and simulation studies…for health policy decisions and prioritizations” are required in Germany to avoid “blind flying in cancer prevention”. The aim of our article was to draw attention to, with the help of such an extrapolation, the public debate on the benefit assessment of low-dose computed tomography screening in Germany and to the numerous relevant factors involved (including number needed to screen [NNS], number needed to harm [NNH], overdiagnosis, cost effectiveness, and quality of life).
It is extremely important to consider not only extrapolations and simulations prior to introducing a screening procedure but also a systematic and efficient evaluation after it has been introduced. For instance, screenings for breast cancer and skin cancer were introduced in Germany before conditions were in place to allow them to be evaluated in a timely, systematic, and efficient manner (1, 2).
A recently published, detailed analysis of cause-of-death statistics in the German federal state of Schleswig-Holstein revealed that the evidence for a decrease in melanoma mortality in Schleswig-Holstein is substantially weaker than previously assumed (3). The expected reduction in mortality from malignant melanoma of the skin has still not been shown (2, 3).
Evidence-based and cost-benefit assessments before and after the introduction of screening procedures must have a sustainable place not only in clinical, but also in preventive medicine.
Footnotes
Conflict of interest statement
Prof. Schuler has received consultant fees (advisory board) from AstraZeneca, Boehringer Ingelheim, Novartis, and Celgene, honoraria for expert opinion in legal proceedings, and conference fee reimbursement from Boehringer Ingelheim and Lilly. He has received financial support for research (third-party funds) from AstraZeneca, Boehringer Ingelheim, BMS, Lilly, and Novartis. He is a member of the scientific committee of the Institute for Quality and Efficiency in Health Care (IQWIG).
The remaining authors declare that no conflict of interests exists.
References
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