Timothy J. Wilt, MD, MPH; Russell P. Harris, MD, MPH; Amir Qaseem, MD, PhD, MHA; for the High Value Care Task Force of the American College of Physicians (*)
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Financial Support: Financial support for the development of this guideline comes exclusively from the ACP operating budget.
Disclosures: Authors followed the policy regarding conflicts of interest described at www.annals.org/article.aspx?articleid=745942. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2326. A record of conflicts of interest is kept for each High Value Care Task Force meeting and conference call and can be viewed at http://hvc.acponline.org/clinrec.html.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Current Author Addresses: Dr. Wilt: Minneapolis Veterans Affairs Health Care System and the Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417.
Dr. Harris: Research Center for Excellence in Clinical Preventive Services, Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King Jr. Boulevard, CB 7590, Chapel Hill, NC 27599.
Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Author Contributions: Conception and design: T.J. Wilt, R.P. Harris, A. Qaseem.
Analysis and interpretation of the data: T.J. Wilt, R.P. Harris, A. Qaseem.
Drafting of the article: T.J. Wilt, R.P. Harris, A. Qaseem.
Critical revision of the article for important intellectual content: T.J. Wilt, R.P. Harris, A. Qaseem.
Final approval of the article: T.J. Wilt, R.P. Harris, A. Qaseem.
Statistical expertise: T.J. Wilt, A. Qaseem.
Obtaining of funding: T.J. Wilt, A. Qaseem.
Administrative, technical, or logistic support: T.J. Wilt, R.P. Harris, A. Qaseem.
Collection and assembly of data: T.J. Wilt, R.P. Harris.
Cancer screening is one approach to reducing cancer-related morbidity and mortality rates. Screening strategies vary in intensity. Higher-intensity strategies are not necessarily higher value. High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs. When cancer screening leads to benefits, an optimal intensity of screening maximizes value. Some aspects of screening practices, especially overuse and underuse, are low value.
Screening strategies for asymptomatic, average-risk adults for 5 common types of cancer were evaluated by reviewing clinical guidelines and evidence syntheses from the American College of Physicians (ACP), U.S. Preventive Services Task Force, American Academy of Family Physicians, American Cancer Society, American Congress of Obstetricians and Gynecologists, American Gastroenterological Association, and American Urological Association. “High value” was defined as the lowest screening intensity threshold at which organizations agree about screening recommendations for each type of cancer and “low value” as agreement about not recommending overly intensive screening strategies. This information is supplemented with additional findings from randomized, controlled trials; modeling studies; and studies of costs or resource use, including information found in the National Cancer Institute's Physician Data Query and UpToDate.
The ACP provides high-value care screening advice for 5 common types of cancer; the specifics are outlined in this article. The ACP strongly encourages clinicians to adopt a cancer screening strategy that focuses on reaching all eligible persons with these high-value screening options while reducing overly intensive, low-value screening.
Table 1. High- and Low-Value Screening Strategies for 5 Types of Cancer
Appendix Table 1. Cancer Screening Recommendations of the ACP, USPSTF, AAFP, ACS, and Professional Societies
Table 2. Future Directions to Reduce Screening Intensity That May Further Enhance Cancer Screening Value
Appendix Table 2. Future Evidence Required Before Implementation of, and Selected Current Evidence Supporting, Reduced Screening Intensity That May Further Enhance Cancer Screening Value
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ACP's clinical advice for screening average-risk adults without symptoms for breast, colorectal, ovarian, prostate, and cervical cancer.
Wilt TJ, Harris RP, Qaseem A, for the High Value Care Task Force of the American College of Physicians. Screening for Cancer: Advice for High-Value Care From the American College of Physicians. Ann Intern Med. 2015;162:718–725. doi: 10.7326/M14-2326
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Published: Ann Intern Med. 2015;162(10):718-725.
Cancer Screening/Prevention, Guidelines, Hematology/Oncology, High Value Care, Prevention/Screening.
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