Study Highlights Inconsistent Cancer Screening Guidelines Among High-Risk Transplant Patients

Organ transplant recipients are highly vulnerable to developing cancer, in addition to other healthcare issues. Now, results of a new study published in the American Journal of Transplantation has found that international guidelines lack standardization on screening recommendations for solid organ transplant recipients (SOTRs).

Previous work by the authors had found that organ transplantation caused a 3-fold increase in the risk for developing cancer and it was also the leading cause of death in these patients.

For their current analysis, the authors searched databases and gray literature and chose 13 international clinical practice guidelines for assessment of quality using the globally accepted evaluation tool AGREE II. Screening recommendations, along with the supporting evidence, were extracted for this study. Clinical practice guidelines for kidney recipients were the most commonly encountered source for this analysis—kidneys being the most common organ for transplant—and recommendations for skin cancer screening were frequently presented.

Quite interesting was the fact that a majority of these screening recommendations were independently developed by transplant physicians without collaborating with oncologists, primary care doctors, or public health experts. Additionally, due to the small number of the transplant population, the guidelines could not be based on evidence from clinical trials. Overall, the guidelines did not specifically recommend different screening procedures for transplant recipients compared with the general population. While most guidelines recommended that the recipients be screened for skin cancer, they were inconsistent in their recommendations for other cancer types such as breast, cervical, and colorectal cancers.

“Transplant recipients should be aware they have a heightened risk of developing and dying from cancer and should advocate with their healthcare providers to be screened for cancer,” Nancy Baxter, MD, PhD, chief of the General Surgery Department at St. Michael’s Hospital and senior author on the study, said in a statement. "Even though transplant recipients often have other serious medical conditions that could shorten their life expectancy, they also need to be screened for cancer to ensure early detection."

Based on their findings, the authors recommend the need for additional studies to inform cancer screening recommendations for SOTRs, and that guideline development should be a collaborative effort among transplant patients, oncologists, and cancer screening specialists.