Abstract for: From Evidence to Policy: System Dynamics Perspectives on the Future of Cancer Early Detection

Despite substantial advances in cancer prevention and treatment, major disparities in cancer outcomes persist across countries and population subgroups. Prostate cancer represents a particularly important challenge, with Black men experiencing disproportionately high disease burden and mortality. At the same time, current guidelines and policies vary considerably across settings and often fail to account for differences in risk, healthcare access, and implementation context. In an era of precision cancer control, there is a growing need for policy approaches that can support equitable and context-specific screening strategies for high-risk populations. Using prostate cancer screening as a case study, we integrate system dynamics modelling, evidence from the MADCaP consortium, and a systematic review of international PSA screening guidelines to explore how scientific evidence is translated into screening policy. We reviewed 3,423 records across major databases and examined temporal changes in screening recommendations, policy decision thresholds, and implementation approaches across countries and health systems. We report substantial variation in PSA screening recommendations across major clinical practice guidelines worldwide. Differences were observed in screening eligibility, age thresholds, screening frequency, and decision-making frameworks, reflecting divergent interpretations of the evidence base and differing approaches to balancing the benefits and harms of screening. Most guidelines originated from high-income settings, highlighting the limited availability of context-specific recommendations for sub-Saharan Africa and other resource-constrained regions. Findings, along with our case study provide a foundation for developing expert-guided, evidence-based recommendations and locally adapted prostate cancer early detection strategies. This work provides a historical perspective on the evolution of cancer screening policies across diverse health systems over the past four decades. The findings reveal substantial variation in how evidence is interpreted and translated into practice, with important implications for equity and policy design. We discuss lessons for developing tailored screening strategies in SSA and highlight the need for next-generation cancer models that integrate epidemiology, behaviour, health-system context, and science-to-policy translation. System Dynamics is uniquely positioned to support these challenges.