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Forum for Health Economics & Policy

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

Srikanth Kadiyala / Erin Strumpf
  • Corresponding author
  • McGill University, Department of Economics and Department of Epidemiology, Biostatistics and Occupational Health, 855 Sherbrooke St. West, Montreal, Quebec H3A 2T7, Canada
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Published Online: 2016-01-28 | DOI: https://doi.org/10.1515/fhep-2014-0014


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.

Keywords: cancer detection; cancer screening; regression discontinuity design

JEL: I10; I12; I18


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About the article

Corresponding author: Erin Strumpf, McGill University, Department of Economics and Department of Epidemiology, Biostatistics and Occupational Health, 855 Sherbrooke St. West, Montreal, Quebec H3A 2T7, Canada, e-mail: erin.strumpf@mcgill.ca

Published Online: 2016-01-28

Published in Print: 2016-06-01

Citation Information: Forum for Health Economics and Policy, Volume 19, Issue 1, Pages 87–139, ISSN (Online) 1558-9544, ISSN (Print) 2194-6191, DOI: https://doi.org/10.1515/fhep-2014-0014.

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