Harry de Koning, MD, PhD

Dept. of Public Health, Erasmus MC University Medical Center Rotterdam, the Netherlands

Brief summary of research

I am Deputy Head and Professor of Public Health & Screening Evaluation, Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.

My major scientific contributions are in the areas of (1) designing, running and evaluating (often large-scale) multidisciplinary population-based randomized controlled screening trials to establish the efficacy of screening, (2) evaluating active (inter-)national screening programs and clinical tests to establish effectiveness and (3) guiding public health policies on screening and primary prevention using predictions of favourable and unfavourable effects and the cost of interventions, based on micro-simulation modelling of the natural history of disease, risk-prediction modelling and cost-effectiveness and cost-utility analyses. Our multidisciplinary and international research results in recommendations on whether or not to introduce screening, surveillance or other preventive interventions for specific diseases and on policy decisions to introduce it in specific ways, either at population level or in (high risk) patients.

My PhD on the cost-effectiveness of breast cancer screening was one of the first Health Technology Assessments in the Netherlands, and one of the first on breast cancer screening in the world. It was the first to include the unfavorable effects of screening into such an analysis and led to the design and implementation of the Dutch program. I had a shared responsibility for designing the ERSPC trial on prostate cancer screening, which included establishing the screening interval, core age groups, power and monitoring plan (secretary Data Monitoring Committee), and set up and chaired the international committee charged with reviewing the primary outcome of the trial. I am PI of the NELSON lung cancer screening trial and designed the entire trial in all its facets (sole trial with different screening intervals). This trial was the first to show that lung nodules detected by CT scanning can be managed safely with conservative follow-up schedules when including volume-doubling times in the algorithm, and is the largest trial without screening in the control arm. I was PI of the sole RCT on screening for language disorders in 11,000 toddlers, and am PI of the ROBINSCA trial through an Advanced Researcher Grant (2011), to assess the (cost-) effectiveness of screening for cardiovascular disease.

We are further responsible for the monitoring and evaluation of the Dutch Breast, Cervical and Colorectal Cancer Screening Program, and presently have HORIZON2020-projects to evaluate breast, cervical and colorectal cancer screening in Europe (coordinator), and evaluate (and implement) vision and hearing screening in Europe (substitute coordinator). We are co-PI in 7 CISNET (NIH/NCI-funded) projects, aimed at modelling and predicting the impact of interventions in breast, prostate, lung, colorectal, esophageal, colorectal and cervical cancer. These have led to substantial influences in policy making, perhaps most prominently our recent analyses on lung cancer screening for the USPSTF, which have led to insurance coverage of low-dose CT screening according to our recommended eligibility in the US. Much of our work also has direct implications to patient care, e.g., in the guidelines of the British Thoracic Society on pulmonary nodules, legislation in screening for child abuse at emergency departments, guidelines evaluating screening for late-effects in children treated for cancer, MRI-guidelines for high risk breast patients, surveillance guidelines after adenoma detection, eligibility criteria for Active Surveillance in prostate cancer patients, trial criteria for breast cancer patients with ductal carcinoma in situ (DCIS) and prenatal screening.