To provide guidance on high-value cancer care screening strategies, the American College of Physicians (ACP) recently reviewed clinical guidelines issued by various medical organizations for screening strategies in five common cancers for asymptomatic, average-risk adults. The five cancers focused on in the study include breast, cervical, colorectal, ovarian, and prostate.
In the study, high value was defined as the delivery of services providing benefits that make their harms and costs worthwhile; low-value screening strategies were defined as those that return disproportionately small health benefits for the harms and costs incurred. The study by Wilt et al is published in the Annals of Internal Medicine.
Study Methodology
The screening strategies for asymptomatic, average-risk adults for five common cancer types were evaluated by reviewing clinical guidelines and evidence synthesis from the American College of Physicians, U.S. Preventive Services Task Force, American Academy of Family Physicians, American Cancer Society, American Congress of Obstetricians and Gynecologists, American Gastroenterological Association, and the American Urological Association. To evaluate costs associated with cancer screening strategies, the study authors reviewed data from the National Cancer Institute’s Physician Data Query system, UpToDate, modeling studies from the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network, and MEDLINE for articles about the costs and resource use of cancer screening published over the last 5 years.
For each of the five cancer types, the authors listed the least intensive screening strategies that all organizations recommend—defined as high-value care—and strategies that organizations either did not recommend or recommended against—defined as low-value care. They then used the information to develop high-value care advice statements.
Advice for High-Value Cancer Screening
The American College of Physicians offers the following advice for high-value screening in asymptomatic, average-risk adults in these five cancers.
Breast Cancer
Cervical Cancer
Colorectal
For average-risk adults aged 50 to 75, clinicians should encourage one of the four following strategies:
Ovarian
Prostate
Overly Intensive, Low-Value Screening Is Common
According to the study, overly intensive, low-value screening is common. For example, 20% of women aged 30 to 39 received a physician recommendation for mammography, 23% to 35% in this age group had mammography, and most women who have mammography have it annually. In addition, one-third of surveyed primary care physicians screen with ultrasonography and magnetic resonance imaging as well as mammography in women not at an increased risk for breast cancer.
“We advise clinicians to consider value when discussing cancer screening with their patients. Implementation of high-value strategies and avoidance of the overly intensive, low-value strategies that we outlined as widely agreed-on would increase cancer screening value,” concluded the study authors.
Timothy Wilt, MD, MPH, of the Minneapolis Veterans Affairs Health Care System and the Center for Chronic Disease Outcomes Research, Minneapolis, is the corresponding author for the Annals of Internal Medicine article.
The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.