Summaries for Patients are a service provided by Annals and the ACP Center for Patient Partnership in Healthcare to help patients better understand the complicated and often mystifying language of modern medicine.
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The full report is titled “Screening for Cancer: Advice for High-Value Care From the American College of Physicians.” It is in the 19 May 2015 issue of Annals of Internal Medicine (volume 162, pages 718-725). The authors are T.J. Wilt, R.P. Harris, and A. Qaseem, for the High Value Care Task Force of the American College of Physicians.
Screening for Cancer. Ann Intern Med. 2015;162:I-25-I-26. doi: 10.7326/P15-9020
Download citation file:
Published: Ann Intern Med. 2015;162(10):I-25-I-26.
Screening strategies are often used to find cancer before there are symptoms. Many different strategies are available. Screening strategies require balancing tradeoffs among benefit, harms, and costs. Some cancer screening strategies are simple and effective and cause few harms. However, other screening strategies may not be needed, are ineffective, or offer too few benefits for the associated harms and costs. It is important for patients to understand the benefits and harms of screening strategies and discuss these with their doctor.
The American College of Physicians (ACP) reviewed clinical guidelines and research from different organizations. The authors looked at data about deaths and illnesses from cancer and harms related to screening strategies. Using this information, they gave advice about which strategies should be used to screen for common types of cancer in adults.
• High-value screening strategy: a strategy that offers benefits that make the harms and costs worthwhile. For a strategy to be high-value, it must also lead to better outcomes, such as reducing cancer deaths. For some patients, finding cancer early with screening does not necessarily mean that their lives will be extended or cancer death will be prevented.
• Low-value screening strategy: a strategy in which benefits do not outweigh the harms and costs.
Value is not the same as cost. For example, a screening strategy with a high cost may be high-value because it provides large benefits and few harms. Some low-cost strategies are lower-value because they do not provide enough benefits and may even be harmful. Personal values or preferences may also influence the value of a screening strategy to that person.
The ACP provides advice statements for screening for 5 common types of cancer. Doctors and patients should consider the value of screening strategies and choose high-value options. The following high-value screening advice is for patients with average risk (no family history or previous abnormal screening test results) and no symptoms. It does not offer information for patients with a higher risk for cancer.
• Breast cancer: Women aged 50 to 74 years who are in good health should be encouraged to have a mammogram every 2 years. Women aged 40 to 49 years should discuss the benefits and harms of screening with their doctor and get a mammogram every 2 years, if they decide to do so. Women older than 75 years should not be screened for breast cancer.
• Cervical cancer: Women aged 21 to 29 years should have testing (with Papanicolaou [Pap] test) every 3 years. Women aged 30 to 65 years should have a Pap test every 3 years or a Pap test with human papillomavirus (HPV) testing every 5 years. Women younger than 21 years or older than 65 years should not be screened for cervical cancer. Women of any age who have had their cervix removed should not be screened for cervical cancer.
• Colorectal cancer: Adults aged 50 to 75 years who are in good health should be screened with 1 of 4 possible strategies. Clinicians and patients should discuss the options to decide which strategy is best for each patient. Adults younger than 50 years or older than 75 years should not be screened for colorectal cancer.
• Ovarian cancer: Women with average risk should not be screened for ovarian cancer.
• Prostate cancer: Men aged 50 and 69 years who are in good health should discuss the benefits and harms of prostate cancer screening with their doctor and get screened if they decide to do so. Men younger than 50 years or older than 69 years should not be screened. Prostate cancer screening is done with the prostate-specific antigen (PSA) blood test every 2 to 4 years.
Patients and clinicians should discuss the different options and what they involve. Decisions for screening strategies should reflect patient goals and preferences.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Hematology/Oncology, Cancer Screening/Prevention, Prevention/Screening.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only