Risk-based screening programmes for cancer diagnosis: A systematic review with narrative synthesis.
10.47102/annals-acadmedsg.202598
- Author:
Yong Yi TAN
1
;
Sara TASNIM
1
;
Mohammad Fahmy Bin FADZIL
1
;
Xin Rong NG
2
;
Sabrina Kw WONG
1
;
Jo-Anne Elizabeth MANSKI-NANKERVIS
1
;
Joseph Jao-Yiu SUNG
1
;
Joanne NGEOW
1
Author Information
1. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
2. National Healthcare Group Polyclinics, Singapore.
- Publication Type:Review
- Keywords:
early detection of cancer;
health services and outcomes;
preventive medicine;
risk-based screening;
systematic review
- MeSH:
Humans;
Early Detection of Cancer/methods*;
Neoplasms/diagnosis*;
Risk Assessment;
Mass Screening/methods*
- From:Annals of the Academy of Medicine, Singapore
2025;54(10):644-663
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Risk-based screening (RBS) has emerged as a promising alternative to age-based cancer screening. However, evidence regarding real-world implementation outcomes remains fragmented. Thus, a systematic review was conducted to evaluate the implementation metho-dologies and outcomes of RBS programmes across different cancer types.
METHODS:MEDLINE, Embase, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials and Scopus were systematically searched from their respective dates of inception up to 8 July 2024. Prospective and rando-mised controlled trials (RCTs), which implement the RBS of cancer in an asymptomatic population, or studies retrospectively evaluating the outcomes of the same were included. Geographic distribution, population characteristics, RBS methodology, diagnostic accuracy and clinical outcomes were narratively synthesised.
RESULTS:Among the 33 included studies (i.e. 21 prospective cohort, 8 RCTs, 3 retrospective and 1 non-RCT), sample sizes ranged from 102 to 1,429,890 participants. Most RBS trials were conducted in China (n=7, 21.2%), followed by the Netherlands (n=4, 12.1%) then the US, Australia and Sweden (n=3, 9.8%). Studies predominantly examined colorectal (27.3%), breast (21.2%) and prostate cancer (18.2%). Three main stratification approaches emerged: algorithmic (48.5%), validated risk models (39.4%) and physician assessment (9.1%). Implementation outcomes showed higher uptake in moderate-risk (75.4%) compared to high-risk (71.3%) and low-risk groups (67.9%). Five studies demonstrated cost-effectiveness with increased quality-adjusted life years, while 12 studies showed superior or non-inferior cancer detection rates compared to traditional screening.
CONCLUSION:The RBS of cancer has the potential to optimise healthcare resource allocation while minimising harm and increasing receptiveness for patients. More work is needed to evaluate long-term outcomes prior to the scaling of RBS programmes.
