Cancer Screening Guidelines and Mortality

Abstract

The effectiveness of population-level cancer screening is a salient issue in health policy that remains unresolved. This paper investigates changes in mortality after the introduction of screening guidelines for breast and prostate cancers in the United States and United Kingdom. We use differences in the timing of guideline adoption, which ages are recommended for screening, and which cancers are detectable by screening to identify the effect of guidelines. Our quadruple-differencing strategy finds a moderately sized mortality benefit from mammography and PSA screening guidelines among recommended age groups and little change in mortality rates among age groups not recommended to receive screening. Falsification tests provide additional confirmation of our results; prostate cancer rates among men did not fall after the introduction of mammography screening and breast cancer rates among women did not fall after the introduction of the PSA test.