Annals of Internal Medicine
Summaries for P atients
Screening for Cancer The full report is titled
W hat is th e p rob lem and w h a t is k n ow n ab ou t it so far?
"Screening for Cancer:
Screening strategies are often used to find cancer before there are symptoms. Many d ifferen t strategies are available. Screening strategies require balancing tradeoffs am ong benefit, harms, and costs. Some cancer screening strategies are sim ple and effective and cause few harms. However, o the r screening strategies may not be needed, are ineffective, or offer to o few benefits fo r the associated harms and costs. It is im p orta nt fo r patients to understand the benefits and harms o f screening strategies and discuss these with th e ir doctor.
Advice for High-Value Care From the American College of Physicians." It is in the 19 May 2015 issue of Annals o f 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.
H ow d id th e ACP d evelop th is advice? The Am erican C ollege o f Physicians (ACP) reviewed clinical guidelines and research from d ifferen t organizations. The authors looked at data about deaths and illnesses from cancer and harms related to screening strategies. Using this inform ation, they gave advice about which strategies should be used to screen fo r com m on types of cancer in adults.
H ow do w e k n o w w h eth er can cer scr een in g is o f h igh v a lu e to a p erson ? • High-value screening strategy: a strategy th a t offers benefits that make the harms and costs w orthw hile. For a strategy to be high-value, it must also lead to better outcomes, such as reducing cancer deaths. For some patients, fin d in g cancer early with screening does not necessarily mean th a t th e ir lives w ill be extended or cancer death will be prevented. • Low-value screening strategy: a strategy in which benefits do not outw eigh 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 o f a screening strategy to th a t person. acp
C enter fo r Patient Partnership in Healthcare
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 ad vice 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 educa tional purposes only. Any other uses must be approved by the American College of Physicians.
W h at d o es th e ACP ad vise th at p a tien ts and d octors do? The ACP provides advice statements fo r screening fo r 5 com m on types o f cancer. D octors and patients should consider the value o f screening strategies and choose high-value options. The fo llo w in g high-value screening advice is fo r patients with average risk (no fam ily history or previous abnorm al screening test results) and no symptoms. It does not offer inform ation fo r patients with a higher risk fo r cancer. • Breast cancer: W om en aged 50 to 74 years who are in g o o d health should be encouraged to have a m am m ogram every 2 years. W om en aged 40 to 49 years should discuss the benefits and harms o f screening with th e ir d o c to r and g et a m am m ogram every 2 years, if they decide to do so. W om en o ld e rth a n 75 years should not be screened fo r breast cancer. • Cervical cancer: W om en aged 21 to 29 years should have testing (with Papanicolaou [Pap] test) every 3 years. W om en aged 30 to 65 years should have a Pap test every 3 years or a Pap test with human papillom avirus (HPV) testing every 5 years. W om en younger than 21 years or o ld e r than 65 years should not be screened fo r cervical cancer. W om en o f any age w ho have had th e ir cervix rem oved should not be screened fo r cervical cancer. (continued on next page) Ann Intern Med. 2015; 162:1-25-1-26. doi: 10.7326/P15-9020 © 2015 American College of Physicians 1-25
S ummaries for P atients Screening for Cancer
Continued
• C olorectal cancer: Adults aged 50 to 75 years who are in g oo d health should be screened with 1 o f 4 possible strategies. Clinicians and patients should discuss the options to decide which strategy is best fo r each patient. A dults younger than 50 years or o ld e r than 75 years should not be screened fo r colorectal cancer. • Ovarian cancer: W om en with average risk should not be screened fo r ovarian cancer. • Prostate cancer: Men aged 50 and 69 years w ho are in g o o d health should discuss the benefits and harms o f prostate cancer screening with th e ir d o c to r and get screened if they decide to do so. Men younger than 50 years or o ld e r than 69 years should not be screened. Prostate cancer screening is done with the prostate-specific antigen (PSA) blo od test every 2 to 4 years. Patients and clinicians should discuss the d ifferen t options and w hat they involve. Decisions fo r screening strategies should reflect patient goals and preferences.
1-26 Annals of Internal Medicine • Vol. 162 No. 10 • 19 May 2015
www.annals.org
Copyright © American College of Physicians 2015.
Summaries for P atients
Screening for Cancer The full report is titled
W hat is th e p rob lem and w h a t is k n ow n ab ou t it so far?
"Screening for Cancer:
Screening strategies are often used to find cancer before there are symptoms. Many d ifferen t strategies are available. Screening strategies require balancing tradeoffs am ong benefit, harms, and costs. Some cancer screening strategies are sim ple and effective and cause few harms. However, o the r screening strategies may not be needed, are ineffective, or offer to o few benefits fo r the associated harms and costs. It is im p orta nt fo r patients to understand the benefits and harms o f screening strategies and discuss these with th e ir doctor.
Advice for High-Value Care From the American College of Physicians." It is in the 19 May 2015 issue of Annals o f 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.
H ow d id th e ACP d evelop th is advice? The Am erican C ollege o f Physicians (ACP) reviewed clinical guidelines and research from d ifferen t organizations. The authors looked at data about deaths and illnesses from cancer and harms related to screening strategies. Using this inform ation, they gave advice about which strategies should be used to screen fo r com m on types of cancer in adults.
H ow do w e k n o w w h eth er can cer scr een in g is o f h igh v a lu e to a p erson ? • High-value screening strategy: a strategy th a t offers benefits that make the harms and costs w orthw hile. For a strategy to be high-value, it must also lead to better outcomes, such as reducing cancer deaths. For some patients, fin d in g cancer early with screening does not necessarily mean th a t th e ir lives w ill be extended or cancer death will be prevented. • Low-value screening strategy: a strategy in which benefits do not outw eigh 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 o f a screening strategy to th a t person. acp
C enter fo r Patient Partnership in Healthcare
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 ad vice 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 educa tional purposes only. Any other uses must be approved by the American College of Physicians.
W h at d o es th e ACP ad vise th at p a tien ts and d octors do? The ACP provides advice statements fo r screening fo r 5 com m on types o f cancer. D octors and patients should consider the value o f screening strategies and choose high-value options. The fo llo w in g high-value screening advice is fo r patients with average risk (no fam ily history or previous abnorm al screening test results) and no symptoms. It does not offer inform ation fo r patients with a higher risk fo r cancer. • Breast cancer: W om en aged 50 to 74 years who are in g o o d health should be encouraged to have a m am m ogram every 2 years. W om en aged 40 to 49 years should discuss the benefits and harms o f screening with th e ir d o c to r and g et a m am m ogram every 2 years, if they decide to do so. W om en o ld e rth a n 75 years should not be screened fo r breast cancer. • Cervical cancer: W om en aged 21 to 29 years should have testing (with Papanicolaou [Pap] test) every 3 years. W om en aged 30 to 65 years should have a Pap test every 3 years or a Pap test with human papillom avirus (HPV) testing every 5 years. W om en younger than 21 years or o ld e r than 65 years should not be screened fo r cervical cancer. W om en o f any age w ho have had th e ir cervix rem oved should not be screened fo r cervical cancer. (continued on next page) Ann Intern Med. 2015; 162:1-25-1-26. doi: 10.7326/P15-9020 © 2015 American College of Physicians 1-25
S ummaries for P atients Screening for Cancer
Continued
• C olorectal cancer: Adults aged 50 to 75 years who are in g oo d health should be screened with 1 o f 4 possible strategies. Clinicians and patients should discuss the options to decide which strategy is best fo r each patient. A dults younger than 50 years or o ld e r than 75 years should not be screened fo r colorectal cancer. • Ovarian cancer: W om en with average risk should not be screened fo r ovarian cancer. • Prostate cancer: Men aged 50 and 69 years w ho are in g o o d health should discuss the benefits and harms o f prostate cancer screening with th e ir d o c to r and get screened if they decide to do so. Men younger than 50 years or o ld e r than 69 years should not be screened. Prostate cancer screening is done with the prostate-specific antigen (PSA) blo od test every 2 to 4 years. Patients and clinicians should discuss the d ifferen t options and w hat they involve. Decisions fo r screening strategies should reflect patient goals and preferences.
1-26 Annals of Internal Medicine • Vol. 162 No. 10 • 19 May 2015
www.annals.org
Copyright © American College of Physicians 2015.
