Clinical and Psychological Outcomes After Monoclonal Gammopathy Screening: A Population-Based Screening Study and Subsequent Randomized Trial of Follow-Up.
Sæmundur Rögnvaldsson, Sigrún Thorsteinsdóttir, Elias Eythorsson et al.
✦ AI-curated · Sources linked
In 30 seconds
This nationwide Icelandic population-based screening study, which included a randomized trial of follow-up strategies, assessed clinical and psychological outcomes after monoclonal gammopathy screening. Of 75,422 people screened, 3,541 with MGUS were assigned to no notification, guideline-based follow-up, or intensified follow-up. After a median 4.5 years, screening was associated with a 27-fold increase in smoldering myeloma detection (8.6% v 0.3%; hazard ratio, 27.46 [95% CI, 10.21 to 73.86]; P < .001), while active malignancy rates did not differ. Intervention arms had earlier diagnoses and fewer symptomatic presentations and hospitalizations; notification was not associated with adverse psychological outcomes.
Key findings
- Smoldering myeloma detection was 8.6% v 0.3% (hazard ratio, 27.46 [95% CI, 10.21 to 73.86]; P < .001).
- Active myeloma and related malignancy rates did not differ between the no-notification control and follow-up intervention arms.
- Active malignancy was diagnosed 1 year earlier in intervention arms, with fewer symptomatic presentations and hospitalizations at diagnosis.
- MGUS notification was not associated with adverse psychological outcomes.
Why it matters
The findings suggest that population screening can identify more smoldering disease and bring forward diagnosis of active malignancy, with fewer symptomatic presentations and hospitalizations at diagnosis. The absence of detected psychological harm is relevant to weighing screening consequences, but the study does not establish a survival benefit or the cost-effectiveness of screening.
What to keep in mind
Median follow-up was 4.5 years; longer follow-up is needed to determine effects on survival and cost-effectiveness.