Disease-specific mortality may underestimate the total effect of XXXX screening.

@entity1 @entity204 @entity263
OBJECTIVES: To study the difference between the disease-specific and excess mortality rate in the European Randomized Study of Screening for @entity263 section Rotterdam. METHODS: A total of 42,376 @entity1 were randomized to systematic screening or usual care. The excess number of @entity204 was defined as the difference between the observed number of @entity263 ( @entity263 ) @entity1 and the expected number of @entity204 up to 31 December 2006. The expected number was derived from mortality of all study @entity1 before a possible diagnosis with @entity263 . The disease-specific mortality rate was based on the number of @entity1 who died from @entity263 . The excess mortality rate based on the arm-specific excess number of @entity204 and the disease-specific mortality rate were compared between the two study arms. RESULTS: The overall mortality rate was not significantly different between the intervention and the control arms of the study: RR 1.02 (95% CI 0.98-1.07). The disease-specific mortality rate was 0.42 @entity1 per 1000 @entity1 -years in the intervention and 0.48 @entity1 per 1000 @entity1 -years in the control arm: RR 0.86 (95% CI 0.64-1.17). The excess mortality rate was 0.40 per 1000 @entity1 -years in the intervention arm and 0.61 @entity1 per 1000 @entity1 -years in the control arm, and the RR for excess mortality was 0.66 (95% CI 0.39-1.13). CONCLUSIONS: In contrast to the disease-specific mortality rates an increased difference in the excess mortality rates was observed between the two arms. This observation may be due to a systematic underestimation of the disease-specific @entity204 , and/or an additional disease-related mortality that is measured by an excess mortality analysis but not by a disease-specific mortality.
