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How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages

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Listed:
  • Kadiyala Srikanth

    (RAND Corporation, Santa Monica, CA, USA)

  • Strumpf Erin

    (McGill University, Department of Economics and Department of Epidemiology, Biostatistics and Occupational Health, 855 Sherbrooke St. West, Montreal, Quebec H3A 2T7, Canada)

Abstract

We estimate the marginal benefits of population-based cancer screening by comparing cancer test and detection rates on either side of US guideline-recommended initiation ages (age 40 for breast cancer and age 50 for colorectal cancer during the study period). Using a regression discontinuity design and self-reported test data from national health surveys, we find test rates for breast and colorectal cancer increase at the guideline age thresholds by 109% and 78%, respectively. Data from cancer registries in twelve US states indicate that cancer detection rates increase at the same thresholds by 50% and 49%, respectively. We estimate significant effects of screening on earlier breast cancer detection (1.2 cases/1000 screened) at age 40 and colorectal cancer detection (1.1 cases/1000 individuals screened) at age 50. Forty-eight and 73% of the increases in breast and colorectal case detection occur among middle-stage cancers (localized and regional) with most of the remainder among early-stage (in-situ). Our analysis suggests that the cost of detecting an asymptomatic case of breast cancer at age 40 via population-based screening is $107,000–134,000 and that the cost of detecting an asymptomatic case of colorectal cancer at age 50 is $473,000–485,000.

Suggested Citation

  • Kadiyala Srikanth & Strumpf Erin, 2016. "How Effective is Population-Based Cancer Screening? Regression Discontinuity Estimates from the US Guideline Screening Initiation Ages," Forum for Health Economics & Policy, De Gruyter, vol. 19(1), pages 87-139, June.
    • Handle: RePEc:bpj:fhecpo:v:19:y:2016:i:1:p:87-139:n:2
    DOI: 10.1515/fhep-2014-0014
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    References listed on IDEAS

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    1. David M. Cutler, 2008. "Are We Finally Winning the War on Cancer?," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 3-26, Fall.
    2. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    3. Jonathan Skinner & Weiping Zhou, 2004. "The Measurement and Evolution of Health Inequality: Evidence from the U.S. Medicare Population," NBER Working Papers 10842, National Bureau of Economic Research, Inc.
    4. Lee, David S. & Card, David, 2008. "Regression discontinuity inference with specification error," Journal of Econometrics, Elsevier, vol. 142(2), pages 655-674, February.
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    Cited by:

    1. Marianne P. Bitler & Christopher S. Carpenter & Danea Horn, 2021. "Effects of the Colorectal Cancer Control Program," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2667-2685, November.
    2. Marianne Bitler & Christopher Carpenter, 2019. "Effects of Direct Care Provision to the Uninsured: Evidence from Federal Breast and Cervical Cancer Programs," NBER Working Papers 26140, National Bureau of Economic Research, Inc.
    3. Liran Einav & Amy Finkelstein & Tamar Oostrom & Abigail Ostriker & Heidi Williams, 2020. "Screening and Selection: The Case of Mammograms," American Economic Review, American Economic Association, vol. 110(12), pages 3836-3870, December.
    4. Amanda E Kowalski, 2023. "Behaviour within a Clinical Trial and Implications for Mammography Guidelines," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 90(1), pages 432-462.
    5. Elek, Péter & Fadgyas-Freyler, Petra & Váradi, Balázs & Mayer, Balázs & Zemplényi, Antal & Csanádi, Marcell, 2022. "Effects of lower screening activity during the COVID-19 pandemic on breast cancer patient pathways: Evidence from the age cut-off of organized screening," Health Policy, Elsevier, vol. 126(8), pages 763-769.
    6. Kim, Hyuncheol Bryant & Lee, Sun-mi, 2017. "When public health intervention is not successful: Cost sharing, crowd-out, and selection in Korea's National Cancer Screening Program," Journal of Health Economics, Elsevier, vol. 53(C), pages 100-116.

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