High-Value Screening Recommendations for 5 Common Cancers

With studies showing that patients overestimate the benefits of cancer screening and are misinformed about the potential harms, the American College of Physicians (ACP) has issues advice for screening adults with average risk and no symptoms for 5 common cancers: breast, colorectal, ovarian, prostate, and cervical.

Annals of Internal Medicine

ACP reviewed its own guidelines and evidence as well as those from the US Preventive Services Task Force, the American Academy of Family Physicians, the American Cancer Society, the American Congress of Obstetrics and Gynecology, the American Gastroenterological Association, and the American Urological Association, and published the recommendations in .

According to Tanveer Mir, MD, MACP, chair of ACP’s Board of Regents and a member of ACP’s High Value Care Task Force, which developed the papers, there was much agreement among the organizations on what is high-value care screening.

“ACP wants smarter screening by informing people about the benefits and harms of screening and encouraging them to get screened at the right time, at the right interval, with the right test,” Wayne J. Riley, MD, MPH, MBA, MACP, president of ACP, said in a statement. “Many people have a lack of understanding about the trade-offs of screening. Study after study has consistently shown that patients and many physicians overestimate the benefits and are unaware of and/or downplay the potential harms of cancer screening.”

ACP defined high-value care as the delivery of services providing benefits that make their harms and costs worthwhile. For instance, screening average risk adults between the ages of 50 and 75 years for colorectal cancer with high sensitivity fecal occult blood testing every year is high value. However, screening women without a cervix for cervical cancer is low value.

• Screening is not just a single test—it is actually a cascade of events.

• Cancers are heterogeneous and the optimal intensity screening strategies seek to find that subset of abnormalities that has the greatest probability of progressing to cause health problems.

• Individuals are also heterogeneous and the optimal intensity screening strategies focus on people who not only have sufficient risk of cancer, but who also have low competing health risks from other causes.

• Screening can lead to important benefits for some cancers and people, but can also lead to significant harms for many more people.

• Determining the value of screening strategies is complex, but not impossible.

In an accompanying framework paper published, ACP speculate about pressure that encourage overly intensive low-value screening and outlined 5 general concepts:

“The largest harm that can result from overly intense screening is over-diagnosis and overtreatment,” Dr Riley said. “The more sensitive the test we use or lower the threshold we establish for an abnormality the more abnormalities we find—many of which will never lead to health problems. But because doctors cannot know which of these would or would not cause problems, we tend to treat them. Treatment for cell and tissue abnormalities that will likely not cause health problems cannot provide benefits.”