Expect and Encourage Questions About the Benefits and Harms of Cancer Screening

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Issuing advice for high-value care in screening for five common cancers, the High Value Care Task Force of the American College of Physicians (ACP) stated: “The target audience for this paper is all clinicians. The target patient population is average-risk, asymptomatic patients.”

“What we tried to do is simplify the message, not only just for physicians and clinicians, but also for patients. So if any patient picks up this document, they will be able to see that as well,” ACP task force member Amir Qaseem, MD, PhD, MHA, FACP, said in an interview with The ASCO Post. Dr. Qaseem is Director of Clinical Policy, ACP, and President Emeritus, Guidelines International Network. The screening advice was published in the Annals of Internal Medicine. The article and a summary for patients are available at acponline.org.

Team-Based Approach

“It is a team-based approach. We have to work together,” Dr. Qaseem said. “As a patient, I need to know what is happening. But as a physician, I am also responsible to educate the patient: Here are the benefits, but here are the harms. Every test is associated with false positives. Some tests may have more or less, but every test has some harms.”

The screening advice is based on guidelines from “reputable guideline groups” for breast, colorectal, ovarian, cervical, and prostate cancers, Dr. Qaseem noted, but “these are guidelines only. They are population-based, and, of course, physicians have to use their own judgment.”

“It is important for patients to become educated consumers as well. Patients should be empowered anyway,” he added, and encouraged to ask questions.

What if the Patient Persists?

What if a patient acknowledges screening may not be high value, but still wants it, to feel safer or not to break well-established routine, or for whatever reason?

“That really comes down to a physician’s responsibility to do no harm,” Dr. Qaseem said. “You need to sit down and talk to your patients, to hear them out and find out why they feel like that. There might be some reason. Maybe they have a family history” not previously disclosed. “Maybe they have heard something from their neighbor, who might have been getting screened. In that case, you would need to explain that maybe the neighbor had a family history or some other risk factor. Most patients are reasonable.” ■

Disclosure: Dr. Qaseem reported no potential conflicts of interest.


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