MoreYears.news Evidence map

Cancer screening · claim–evidence map

Cancer screening claim–evidence map

Trace 18 governed claims from three randomized screening programs to the exact records that support, qualify, or bound them.

What this is: a traceable projection of already published, source-reviewed claims. It does not score studies, rank interventions, or recommend care.

Browse all governed claims →

Overview

Evidence at a glance

Counts describe this governed map, not evidence strength.

Analyses
3
Claims
18
Source records
16
Correction flags
8

How relationships are labeled

Direct supportContradictionIndirect contextInsufficient evidence

These labels describe a claim–source relationship. They are not grades or rankings.

Connected analysis

Colonoscopy invitation and 13-year outcomes

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Indirect contextclaim:c63-col-01

NordICC randomized an invitation to one colonoscopy, not guaranteed completion; 42.0% participated in the earlier report.

Evidence role
design-and-uptake
Population or model
84,583 men and women age 55–64 in Norway, Poland and Sweden
Comparator
Invitation to one screening colonoscopy versus no screening invitation
Outcome
program offer and participation
Design and maturity
Randomized invitation trial with corrected 13-year follow-up
Result
NordICC randomized an invitation to one colonoscopy, not guaranteed completion; 42.0% participated in the earlier report.
Boundary
Does not show everyone invited underwent colonoscopy or that per-protocol analysis preserves randomization.
Limitations
Intention-to-screen includes nonparticipation.
Funding and conflicts
Public and cancer-organization funding; author research support and endoscopy-industry consulting, honoraria or equipment relationships.
Correction state
PMID 42102826 has published erratum PMID 42119586; only core current-record outcomes are authorized and subgroup/location claims are excluded.
Exact source identities and links
  • source:pmid-4210282642102826 · peer-reviewed-primary-randomized-follow-upCorrection state: published-erratum-linked-pmid-42119586
  • source:pmid-3621459036214590 · peer-reviewed-primary-randomized-trialCorrection state: none-found
  • source:nct-00883792NCT00883792 · trial-registryCorrection state: not-applicable
Direct supportclaim:c63-col-02

At 13 years, colorectal-cancer incidence was 375/28,217 (1.46%) versus 912/56,366 (1.80%); RR 0.81 (95% CI 0.71–0.90).

Evidence role
primary-support
Population or model
84,583 men and women age 55–64 in Norway, Poland and Sweden
Comparator
Invitation to one screening colonoscopy versus no screening invitation
Outcome
colorectal-cancer incidence
Design and maturity
Randomized invitation trial with corrected 13-year follow-up
Result
At 13 years, colorectal-cancer incidence was 375/28,217 (1.46%) versus 912/56,366 (1.80%); RR 0.81 (95% CI 0.71–0.90).
Boundary
Does not establish lower cancer mortality, all-cause mortality, healthspan or lifespan.
Limitations
Uses the current corrected record; subgroup/location claims are excluded.
Funding and conflicts
Public and cancer-organization funding; author research support and endoscopy-industry consulting, honoraria or equipment relationships.
Correction state
PMID 42102826 has published erratum PMID 42119586; only core current-record outcomes are authorized and subgroup/location claims are excluded.
Exact source identities and links
  • source:pmid-4210282642102826 · peer-reviewed-primary-randomized-follow-upCorrection state: published-erratum-linked-pmid-42119586
  • source:pmid-4211958642119586 · published-erratumCorrection state: not-applicable
Direct supportclaim:c63-col-03

At 13 years, colorectal-cancer mortality was 106/28,217 (0.41%) versus 236/56,366 (0.47%); RR 0.88 (95% CI 0.68–1.08), so reduction was not demonstrated.

Evidence role
primary-support
Population or model
84,583 men and women age 55–64 in Norway, Poland and Sweden
Comparator
Invitation to one screening colonoscopy versus no screening invitation
Outcome
colorectal-cancer mortality
Design and maturity
Randomized invitation trial with corrected 13-year follow-up
Result
At 13 years, colorectal-cancer mortality was 106/28,217 (0.41%) versus 236/56,366 (0.47%); RR 0.88 (95% CI 0.68–1.08), so reduction was not demonstrated.
Boundary
Does not establish benefit, harm or all-cause longevity effect.
Limitations
Lower-than-expected mortality reduced event information; no demonstrated difference is not proof of equivalence.
Funding and conflicts
Public and cancer-organization funding; author research support and endoscopy-industry consulting, honoraria or equipment relationships.
Correction state
PMID 42102826 has published erratum PMID 42119586; only core current-record outcomes are authorized and subgroup/location claims are excluded.
Exact source identities and links
  • source:pmid-4210282642102826 · peer-reviewed-primary-randomized-follow-upCorrection state: published-erratum-linked-pmid-42119586
  • source:pmid-4211958642119586 · published-erratumCorrection state: not-applicable
Indirect contextclaim:c63-col-04

Per-protocol estimates were RR 0.55 (95% CI 0.33–0.81) for incidence and RR 0.70 (95% CI 0.26–1.25) for colorectal-cancer mortality.

Evidence role
secondary-context
Population or model
84,583 men and women age 55–64 in Norway, Poland and Sweden
Comparator
Invitation to one screening colonoscopy versus no screening invitation
Outcome
modeled outcomes under per-protocol assumptions
Design and maturity
Randomized invitation trial with corrected 13-year follow-up
Result
Per-protocol estimates were RR 0.55 (95% CI 0.33–0.81) for incidence and RR 0.70 (95% CI 0.26–1.25) for colorectal-cancer mortality.
Boundary
Does not prove the causal effect every individual would receive from colonoscopy.
Limitations
Depends on compliance and modeling assumptions.
Funding and conflicts
Public and cancer-organization funding; author research support and endoscopy-industry consulting, honoraria or equipment relationships.
Correction state
PMID 42102826 has published erratum PMID 42119586; only core current-record outcomes are authorized and subgroup/location claims are excluded.
Exact source identities and links
  • source:pmid-4210282642102826 · peer-reviewed-primary-randomized-follow-upCorrection state: published-erratum-linked-pmid-42119586
  • source:pmid-4211958642119586 · published-erratumCorrection state: not-applicable
Indirect contextclaim:c63-col-05

The 10-year report recorded 15 major bleeding events after polyp removal and no perforation or screening-related death within 30 days.

Evidence role
safety-context
Population or model
84,583 men and women age 55–64 in Norway, Poland and Sweden
Comparator
Invitation to one screening colonoscopy versus no screening invitation
Outcome
short-term screening harms
Design and maturity
Randomized invitation trial with corrected 13-year follow-up
Result
The 10-year report recorded 15 major bleeding events after polyp removal and no perforation or screening-related death within 30 days.
Boundary
Does not prove colonoscopy is risk-free or quantify personalized risk.
Limitations
Dated 10-year context and 30-day window do not capture every downstream or uncommon harm.
Funding and conflicts
Public and cancer-organization funding; author research support and endoscopy-industry consulting, honoraria or equipment relationships.
Correction state
PMID 42102826 has published erratum PMID 42119586; only core current-record outcomes are authorized and subgroup/location claims are excluded.
Exact source identities and links
Indirect contextclaim:c63-col-06

At 10 years, all-cause mortality was 11.03% versus 11.04% (RR 0.99, 95% CI 0.96–1.04); no 13-year all-cause claim is authorized.

Evidence role
boundary-and-guidance-context
Population or model
84,583 men and women age 55–64 in Norway, Poland and Sweden
Comparator
Invitation to one screening colonoscopy versus no screening invitation
Outcome
all-cause mortality and current guidance
Design and maturity
Randomized invitation trial with corrected 13-year follow-up
Result
At 10 years, all-cause mortality was 11.03% versus 11.04% (RR 0.99, 95% CI 0.96–1.04); no 13-year all-cause claim is authorized.
Boundary
Does not establish longer life or select a strategy for an individual.
Limitations
Earlier follow-up only; guidance includes multiple screening options.
Funding and conflicts
Public and cancer-organization funding; author research support and endoscopy-industry consulting, honoraria or equipment relationships.
Correction state
PMID 42102826 has published erratum PMID 42119586; only core current-record outcomes are authorized and subgroup/location claims are excluded.
Exact source identities and links

Connected analysis

Low-dose CT screening outcomes

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Indirect contextclaim:c63-lung-01

NLST studied selected high-risk current/former smokers, not the general population or never-smokers.

Evidence role
design-and-population
Population or model
53,454 adults age 55–74 with at least 30 pack-years who currently smoked or had quit within 15 years
Comparator
Three annual low-dose CT screens versus chest radiography
Outcome
eligibility and external validity
Design and maturity
Large randomized screening trial with extended mortality follow-up
Result
NLST studied selected high-risk current/former smokers, not the general population or never-smokers.
Boundary
Does not generalize benefit outside a validated eligibility envelope.
Limitations
Original eligibility was narrower than current USPSTF eligibility.
Funding and conflicts
NCI/NIH-sponsored; ACRIN/NCI/NIH institutional grants and named outside relationships including LUNGevity, Siemens and Veracyte.
Correction state
No correction, retraction or expression of concern found; comments are not corrections.
Exact source identities and links
Direct supportclaim:c63-lung-02

Original lung-cancer mortality was 247 versus 309 per 100,000 person-years; relative reduction 20.0% (95% CI 6.8%–26.7%).

Evidence role
primary-support
Population or model
53,454 adults age 55–74 with at least 30 pack-years who currently smoked or had quit within 15 years
Comparator
Three annual low-dose CT screens versus chest radiography
Outcome
lung-cancer mortality
Design and maturity
Large randomized screening trial with extended mortality follow-up
Result
Original lung-cancer mortality was 247 versus 309 per 100,000 person-years; relative reduction 20.0% (95% CI 6.8%–26.7%).
Boundary
Does not show a 20% all-cause mortality reduction or individual benefit.
Limitations
Comparator was chest radiography; relative results need absolute rates and extended follow-up.
Funding and conflicts
NCI/NIH-sponsored; ACRIN/NCI/NIH institutional grants and named outside relationships including LUNGevity, Siemens and Veracyte.
Correction state
No correction, retraction or expression of concern found; comments are not corrections.
Exact source identities and links
  • source:pmid-2171464121714641 · peer-reviewed-primary-randomized-trialCorrection state: none-found
  • source:pmid-3199568331995683 · peer-reviewed-independent-randomized-trialCorrection state: none-found
Indirect contextclaim:c63-lung-03

The original absolute lung-cancer mortality rates were 247 and 309 deaths per 100,000 person-years.

Evidence role
absolute-result-context
Population or model
53,454 adults age 55–74 with at least 30 pack-years who currently smoked or had quit within 15 years
Comparator
Three annual low-dose CT screens versus chest radiography
Outcome
absolute lung-cancer mortality rate
Design and maturity
Large randomized screening trial with extended mortality follow-up
Result
The original absolute lung-cancer mortality rates were 247 and 309 deaths per 100,000 person-years.
Boundary
Does not supply a personalized absolute benefit.
Limitations
Person-year rates are not an individual's cumulative probability.
Funding and conflicts
NCI/NIH-sponsored; ACRIN/NCI/NIH institutional grants and named outside relationships including LUNGevity, Siemens and Veracyte.
Correction state
No correction, retraction or expression of concern found; comments are not corrections.
Exact source identities and links
Indirect contextclaim:c63-lung-04

Across rounds, 24.2% of LDCT and 6.9% of radiography screens were positive; 96.4% and 94.5% of positives were false positives under the trial definition.

Evidence role
harm-and-diagnostic-context
Population or model
53,454 adults age 55–74 with at least 30 pack-years who currently smoked or had quit within 15 years
Comparator
Three annual low-dose CT screens versus chest radiography
Outcome
positive and false-positive screens
Design and maturity
Large randomized screening trial with extended mortality follow-up
Result
Across rounds, 24.2% of LDCT and 6.9% of radiography screens were positive; 96.4% and 94.5% of positives were false positives under the trial definition.
Boundary
Does not mean 96.4% of all screened people had a false positive or that modern rates are identical.
Limitations
Trial definitions and management predate current protocols.
Funding and conflicts
NCI/NIH-sponsored; ACRIN/NCI/NIH institutional grants and named outside relationships including LUNGevity, Siemens and Veracyte.
Correction state
No correction, retraction or expression of concern found; comments are not corrections.
Exact source identities and links
Indirect contextclaim:c63-lung-05

At median 12.3 years, lung-cancer deaths were 1,147 versus 1,236 (RR 0.92, 95% CI 0.85–1.00); all-cause difference 4.2 per 1,000 (95% CI −2.6 to 10.9).

Evidence role
extended-follow-up
Population or model
53,454 adults age 55–74 with at least 30 pack-years who currently smoked or had quit within 15 years
Comparator
Three annual low-dose CT screens versus chest radiography
Outcome
lung-cancer and all-cause mortality
Design and maturity
Large randomized screening trial with extended mortality follow-up
Result
At median 12.3 years, lung-cancer deaths were 1,147 versus 1,236 (RR 0.92, 95% CI 0.85–1.00); all-cause difference 4.2 per 1,000 (95% CI −2.6 to 10.9).
Boundary
Does not demonstrate a precise all-cause or longevity benefit.
Limitations
Adjusted estimates are secondary; the all-cause interval includes no difference.
Funding and conflicts
NCI/NIH-sponsored; ACRIN/NCI/NIH institutional grants and named outside relationships including LUNGevity, Siemens and Veracyte.
Correction state
No correction, retraction or expression of concern found; comments are not corrections.
Exact source identities and links
  • source:pmid-3126083331260833 · peer-reviewed-extended-randomized-follow-upCorrection state: none-found
  • source:pmid-2171464121714641 · peer-reviewed-primary-randomized-trialCorrection state: none-found
Indirect contextclaim:c63-lung-06

Current 2021 USPSTF guidance covers age 50–80, at least 20 pack-years, current smoking or quitting within 15 years, and stop conditions—different from NLST.

Evidence role
current-guidance-context
Population or model
53,454 adults age 55–74 with at least 30 pack-years who currently smoked or had quit within 15 years
Comparator
Three annual low-dose CT screens versus chest radiography
Outcome
dated population recommendation
Design and maturity
Large randomized screening trial with extended mortality follow-up
Result
Current 2021 USPSTF guidance covers age 50–80, at least 20 pack-years, current smoking or quitting within 15 years, and stop conditions—different from NLST.
Boundary
Does not prescribe screening or replace an individual clinical decision.
Limitations
Guidance can change and considers preference, health status and ability to undergo treatment.
Funding and conflicts
NCI/NIH-sponsored; ACRIN/NCI/NIH institutional grants and named outside relationships including LUNGevity, Siemens and Veracyte.
Correction state
No correction, retraction or expression of concern found; comments are not corrections.
Exact source identities and links

Connected analysis

PSA screening tradeoffs

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Indirect contextclaim:c63-psa-01

The 21-year focal evidence is the Rotterdam ERSPC section using repeated PSA-based screening about every four years.

Evidence role
design-and-scope
Population or model
42,376 men age 55–74 in ERSPC Rotterdam; primary analysis in 34,831 men age 55–69
Comparator
Invitation to PSA-based screening about every four years versus control
Outcome
section-specific screening program
Design and maturity
Randomized screening program with long section-specific follow-up
Result
The 21-year focal evidence is the Rotterdam ERSPC section using repeated PSA-based screening about every four years.
Boundary
Does not establish the effect of one PSA test or a modern MRI-led pathway.
Limitations
Center protocols and contamination differed; this is not a uniform multicenter 21-year estimate.
Funding and conflicts
Dutch Cancer Society, Netherlands Organisation for Health Research and Development, Dutch Cancer Research Foundation, and an unconditional Beckman-Coulter-Hybritech grant; focal paper reports no author conflicts.
Correction state
No correction, retraction or expression of concern found; a later comment is not a correction.
Exact source identities and links
  • source:pmid-3702907437029074 · peer-reviewed-primary-randomized-section-follow-upCorrection state: none-found
  • source:pmid-2510888925108889 · peer-reviewed-multicenter-randomized-follow-upCorrection state: none-found
  • source:pmid-3082429630824296 · peer-reviewed-multicenter-randomized-follow-upCorrection state: none-found
Indirect contextclaim:c63-psa-02

In the primary age group, prostate-cancer mortality RR was 0.73 (95% CI 0.61–0.88) and metastatic prostate cancer RR was 0.67 (95% CI 0.58–0.78).

Evidence role
primary-and-secondary-support
Population or model
42,376 men age 55–74 in ERSPC Rotterdam; primary analysis in 34,831 men age 55–69
Comparator
Invitation to PSA-based screening about every four years versus control
Outcome
cancer-specific mortality and metastatic disease
Design and maturity
Randomized screening program with long section-specific follow-up
Result
In the primary age group, prostate-cancer mortality RR was 0.73 (95% CI 0.61–0.88) and metastatic prostate cancer RR was 0.67 (95% CI 0.58–0.78).
Boundary
Does not establish lower all-cause mortality, longer life or net benefit for everyone.
Limitations
Cancer-specific mortality was primary; metastatic disease secondary.
Funding and conflicts
Dutch Cancer Society, Netherlands Organisation for Health Research and Development, Dutch Cancer Research Foundation, and an unconditional Beckman-Coulter-Hybritech grant; focal paper reports no author conflicts.
Correction state
No correction, retraction or expression of concern found; a later comment is not a correction.
Exact source identities and links
  • source:pmid-3702907437029074 · peer-reviewed-primary-randomized-section-follow-upCorrection state: none-found
  • source:pmid-2510888925108889 · peer-reviewed-multicenter-randomized-follow-upCorrection state: none-found
  • source:pmid-3082429630824296 · peer-reviewed-multicenter-randomized-follow-upCorrection state: none-found
Indirect contextclaim:c63-psa-03

The paper treated all-cause death as competing-risk context rather than demonstrating an all-cause screening effect.

Evidence role
endpoint-boundary
Population or model
42,376 men age 55–74 in ERSPC Rotterdam; primary analysis in 34,831 men age 55–69
Comparator
Invitation to PSA-based screening about every four years versus control
Outcome
endpoint hierarchy
Design and maturity
Randomized screening program with long section-specific follow-up
Result
The paper treated all-cause death as competing-risk context rather than demonstrating an all-cause screening effect.
Boundary
Does not justify a longevity headline or claim screening extends life.
Limitations
Cancer-specific benefit can coexist with harms and no measured all-cause effect.
Funding and conflicts
Dutch Cancer Society, Netherlands Organisation for Health Research and Development, Dutch Cancer Research Foundation, and an unconditional Beckman-Coulter-Hybritech grant; focal paper reports no author conflicts.
Correction state
No correction, retraction or expression of concern found; a later comment is not a correction.
Exact source identities and links
  • source:pmid-3702907437029074 · peer-reviewed-primary-randomized-section-follow-upCorrection state: none-found
Indirect contextclaim:c63-psa-04

Rotterdam reported 57 excess prostate-cancer diagnoses per 1,000 randomized to screening; across five ERSPC centers, 17.8% of screened men had at least one false positive.

Evidence role
benefit-harm-context
Population or model
42,376 men age 55–74 in ERSPC Rotterdam; primary analysis in 34,831 men age 55–69
Comparator
Invitation to PSA-based screening about every four years versus control
Outcome
excess diagnosis and false positives
Design and maturity
Randomized screening program with long section-specific follow-up
Result
Rotterdam reported 57 excess prostate-cancer diagnoses per 1,000 randomized to screening; across five ERSPC centers, 17.8% of screened men had at least one false positive.
Boundary
Does not mean every additional diagnosis is harmful or that cancer-specific benefit erases urinary, sexual and other harms.
Limitations
Excess diagnosis is not identical to overdiagnosis in every case; biopsy and treatment harms need separate evidence.
Funding and conflicts
Dutch Cancer Society, Netherlands Organisation for Health Research and Development, Dutch Cancer Research Foundation, and an unconditional Beckman-Coulter-Hybritech grant; focal paper reports no author conflicts.
Correction state
No correction, retraction or expression of concern found; a later comment is not a correction.
Exact source identities and links
Insufficient evidenceclaim:c63-psa-05

Among men randomized at age 70 or older, prostate-cancer mortality RR was 1.18 (95% CI 0.87–1.62), with no demonstrated difference.

Evidence role
prespecified-sensitivity-boundary
Population or model
42,376 men age 55–74 in ERSPC Rotterdam; primary analysis in 34,831 men age 55–69
Comparator
Invitation to PSA-based screening about every four years versus control
Outcome
older-at-randomization cancer-specific mortality
Design and maturity
Randomized screening program with long section-specific follow-up
Result
Among men randomized at age 70 or older, prostate-cancer mortality RR was 1.18 (95% CI 0.87–1.62), with no demonstrated difference.
Boundary
Does not prove harm, equivalence or an individualized cutoff.
Limitations
Imprecise subgroup estimate from a historical screening pathway.
Funding and conflicts
Dutch Cancer Society, Netherlands Organisation for Health Research and Development, Dutch Cancer Research Foundation, and an unconditional Beckman-Coulter-Hybritech grant; focal paper reports no author conflicts.
Correction state
No correction, retraction or expression of concern found; a later comment is not a correction.
Exact source identities and links
  • source:pmid-3702907437029074 · peer-reviewed-primary-randomized-section-follow-upCorrection state: none-found
Indirect contextclaim:c63-psa-06

Current final USPSTF guidance remains the 2018 statement: individual decision-making at age 55–69 and no PSA-based screening at age 70 or older; an update is in progress.

Evidence role
current-guidance-context
Population or model
42,376 men age 55–74 in ERSPC Rotterdam; primary analysis in 34,831 men age 55–69
Comparator
Invitation to PSA-based screening about every four years versus control
Outcome
dated population recommendation
Design and maturity
Randomized screening program with long section-specific follow-up
Result
Current final USPSTF guidance remains the 2018 statement: individual decision-making at age 55–69 and no PSA-based screening at age 70 or older; an update is in progress.
Boundary
Does not provide personalized advice or guarantee the statement will remain unchanged.
Limitations
Update page last updated December 21, 2023 is not a replacement final recommendation.
Funding and conflicts
Dutch Cancer Society, Netherlands Organisation for Health Research and Development, Dutch Cancer Research Foundation, and an unconditional Beckman-Coulter-Hybritech grant; focal paper reports no author conflicts.
Correction state
No correction, retraction or expression of concern found; a later comment is not a correction.
Exact source identities and links

Sources

Exact records used on this page

Stable IDIdentifierRecord typeLinkCorrection state
source:pmid-4210282642102826peer-reviewed-primary-randomized-follow-upOpen recordpublished-erratum-linked-pmid-42119586
source:pmid-3621459036214590peer-reviewed-primary-randomized-trialOpen recordnone-found
source:nct-00883792NCT00883792trial-registryOpen recordnot-applicable
source:pmid-4211958642119586published-erratumOpen recordnot-applicable
source:uspstf-colorectal-20212021-05-18current-final-guidanceOpen recordnot-applicable
source:pmid-2171464121714641peer-reviewed-primary-randomized-trialOpen recordnone-found
source:nct-00047385NCT00047385trial-registryOpen recordnot-applicable
source:pmid-3199568331995683peer-reviewed-independent-randomized-trialOpen recordnone-found
source:pmid-3126083331260833peer-reviewed-extended-randomized-follow-upOpen recordnone-found
source:uspstf-lung-20212021-03-09current-final-guidanceOpen recordnot-applicable
source:pmid-3702907437029074peer-reviewed-primary-randomized-section-follow-upOpen recordnone-found
source:pmid-2510888925108889peer-reviewed-multicenter-randomized-follow-upOpen recordnone-found
source:pmid-3082429630824296peer-reviewed-multicenter-randomized-follow-upOpen recordnone-found
source:pmid-2178812921788129peer-reviewed-false-positive-analysisOpen recordnone-found
source:uspstf-prostate-20182018current-final-guidanceOpen recordnot-applicable
source:uspstf-prostate-update-20232023-12-21update-in-progress-recordOpen recordnot-applicable

Limitations

What this map does not do

Review history

Separate evidence and prose checks

  1. Governed evidence review

    Primary reports, registries, limitations, funding/conflicts, and correction state were locked in the source claim map before publication.

  2. Identifier and correction carry-forward

    Every rendered source ID was rejoined to one exact governed URL; duplicate IDs, missing records, and lost correction states fail validation.

  3. Orientation-prose review

    Headings, labels, and summaries were reviewed separately for neutral language, no treatment ranking, and no personal recommendation.

Generated from data/knowledge-system/sixteenth-coverage-claim-map.json. Source-review date: 2026-08-24.