Stopping the widespread use of unnecessary, potentially harmful cancer screenings may take up to 13 years and potentially longer following the implementation of new guidelines, according to a recent study published by LeLaurin et al in BMJ Quality & Safety.
Background
The U.S. Preventive Services Task Force (USPSTF) creates guidelines for screening patients for certain cancer types. Between 1996 and 2012, the USPSTF released guidelines recommending against screening for certain cancer types such as ovarian, thyroid, testicular, and pancreatic cancers in any patients without symptoms. They also limited the age groups who should be screened for cervical and prostate cancers.
Based on high-quality published research, the task force grades screening tests, with Grade D to indicate that a test should not be performed in a given group of patients because it provides little benefit or could harm patients. Unnecessary screenings may result in overdiagnosis, pain, and excessive treatment in addition to costing more money and leading to anxiety and fear.
“Excessive screening opens the door for a lot of negative consequences,” stressed lead study author Jennifer LeLaurin, PhD, Assistant Professor of Health Outcomes and Biomedical Informatics at the University of Florida (UF) and a member of the UF Health Cancer Center. “These guidelines are based on what the benefits and harms are. If the harms outweigh the benefits for a particular test, then they recommend against it,” she added.
Study Methods and Results
In the study, investigators examined whether outdated cancer screenings were still being followed. They focused on new guidelines that recommended against screening for cervical cancer in women younger than 21 years or older than 65 years as well as those against screening for prostate cancer in men aged 70 years and older.
The investigators discovered that although it took just 1 year for cervical cancer screenings to drop by 50% in young women, it took 13 years to reach the same level in women over 65 years. Despite guidelines introduced in 2012 to cease screening for prostate cancer in older men, screening rates have yet to decline by 50%—the threshold used to determine when widespread screening had ended. The investigators noted that several barriers, including inertia and the widespread interest in detecting cancers early, could be hindering the reduction in unnecessary screenings.
“To get [physicians] to stop doing something that they’ve been doing for years [is] really hard. Physicians also have patients with expectations about what tests they want. When you have screening guidelines changing frequently, it’s confusing. It’s especially confusing [for] patients,” emphasized Dr. LeLaurin.
Little data were available for ovarian, thyroid, testicular, and pancreatic cancer screenings because few mechanisms currently exist to track adherence after new guidelines are released.
“As physicians and researchers, we’re pretty good about tracking the stuff we’re supposed to be doing; [however], it’s hard to tell how often some of these screenings that are no longer recommended are happening,” Dr. LeLaurin indicated. “We need more powerful tools to potentially identify where inappropriate screening is taking place,” she suggested.
Conclusions
“We need to consider ways to disincentivize inappropriate screening and talk with patients about the benefits and risks of screening and how these guidelines exist to help them,” Dr. LeLaurin concluded.
Disclosure: The research in this study was funded by the National Cancer Institute's Consortium for Cancer Implementation Science. For full disclosures of the study authors, visit qualitysafety.bmj.com.
