Evaluation of Harms Reporting in U.S. Cancer Screening Guidelines

Kamineni, Aruna; Doria-Rose, V. Paul; Chubak, Jessica; Inadomi, John M.; Corley, Douglas A.; Haas, Jennifer S.; Kobrin, Sarah C.; Lafata, Jennifer Elston; Beaber, Elisabeth F.; Yudkin, Joshua S.; Zheng, Yingye; Skinner, Celette Sugg; Schottinger, Joanne E.; Ritzwoller, Debra P.; Croswell, Jennifer M.; Burnett‐Hartman, Andrea N.

doi:10.7326/m22-1139

Cited by 13 publications

(7 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is particularly important for screening harms, which could be presented quantitatively, across the screening pathway and by population subgroup. 36 It is also important to present harms and benefits using the comparable metrics. 37 For example, we have shown that if specificity is presented only as additional, ultimately unnecessary, investigations that the public primarily consider to be a psychological harm, it is hard to trade off sensitivity if the public directly associate this with lives saved from cancer.…”

Section: Discussionmentioning

confidence: 99%

Public Preferences for Determining Eligibility for Screening in Risk-Stratified Cancer Screening Programs: A Discrete Choice Experiment

et al. 2023

View full text Add to dashboard Cite

Background Risk stratification has been proposed to improve the efficiency of population-level cancer screening. We aimed to describe and quantify the relative importance of different attributes of potential screening programs among the public, focusing on stratifying eligibility. Methods We conducted a discrete choice experiment in which respondents selected between 2 hypothetical screening programs in a series of 9 questions. We presented the risk factors used to determine eligibility (age, sex, or lifestyle or genetic risk scores) and anticipated outcomes based on eligibility criteria with different sensitivity and specificity levels. We performed conditional logit regression models and used the results to estimate preferences for different approaches. We also analyzed free-text comments on respondents’ views on the programs. Results A total of 1,172 respondents completed the survey. Sensitivity was the most important attribute (7 and 11 times more important than specificity and risk factors, respectively). Eligibility criteria based on age and sex or genetics were preferred over age alone and lifestyle risk scores. Phenotypic and polygenic risk prediction models would be more acceptable than screening everyone aged 55 to 70 y if they had high discrimination (area under the receiver-operating characteristic curve ≥0.75 and 0.80, respectively). Limitations Although our sample was representative with respect to age, sex, and ethnicity, it may not be representative of the UK population regarding other important characteristics. Also, some respondents may have not understood all the information provided to inform decision making. Conclusions The public prioritized lives saved from cancer over reductions in numbers screened or experiencing unnecessary follow-up. Incorporating personal-level risk factors into screening eligibility criteria is acceptable to the public if it increases sensitivity; therefore, maximizing sensitivity in model development and communication could increase uptake. Highlights The public prioritized lives saved when considering changing from age-based eligibility criteria to risk-stratified cancer screening over reductions in numbers of people being screened or experiencing unnecessary follow-up. The risk stratification strategy used to do this was the least important component, although age plus sex or genetics were relatively preferable to using age alone and lifestyle risk scores. Communication strategies that emphasize improvements in the numbers of cancers detected or not missed across the population are more likely to be salient than reductions in unnecessary investigations or follow-up among some groups. Future research should focus on developing implementation strategies that maximize gains in sensitivity within the context of resource constraints and how to present attributes relating to specificity to facilitate understanding and informed decision making.

show abstract

Section: Discussionmentioning

confidence: 99%

Public Preferences for Determining Eligibility for Screening in Risk-Stratified Cancer Screening Programs: A Discrete Choice Experiment

et al. 2023

View full text Add to dashboard Cite

show abstract

“…This has been sparsely reported even for the most commonly screened cancers (breast, cervix, colorectum, lungs, and prostate). 41 Regarding pancreatic cancer surveillance, the potential harms may be even more relevant, given the high morbidity and mortality rates associated with pancreatic surgery. On the other hand, resection of a lesion that is initially considered "low yield" may prevent further progression.…”

Section: Discussionmentioning

confidence: 99%

“…Although measuring the benefits of a surveillance program may seem relatively straightforward, ascertaining its potential harms is more difficult. This has been sparsely reported even for the most commonly screened cancers (breast, cervix, colorectum, lungs, and prostate) 41 . Regarding pancreatic cancer surveillance, the potential harms may be even more relevant, given the high morbidity and mortality rates associated with pancreatic surgery.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of Individuals at High Risk of Developing Pancreatic Cancer

Paiella,

Secchettin,

Lionetto

et al. 2023

Annals of Surgery

View full text Add to dashboard Cite

Objective: To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance. Summary Background Data: Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRI) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well-quantified. Methods: A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the CAPS goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals (PROSPERO: #CRD42022300408). Results: Twenty-three articles with 5,027 patients (median 109 patients/study, IQR 251) were included. The pooled prevalence of low-yield surgery was 2.1% [95%CI 0.9-3.7], I2 83%). In the subgroup analysis, this prevalence was non-significantly higher in studies that only included familial pancreatic cancer (FPC) subjects without known pathogenic variants (PV), compared to those enrolling PV carriers. No effect modifiers were found. Overall, the pooled prevalence of subjects under surveillance who had a pancreatic resection that contained target lesions was 0.8% [95%CI 0.3-1.5], I2 24%). The temporal analysis showed that the rate of low-yield surgeries decreased in the last decades and stabilized at around 1% (test for subgroup differences P<0.01). Conclusions: The risk of “low-yield” surgery during pancreatic cancer surveillance is relatively low but should be thoroughly discussed with individuals under surveillance.

show abstract

“…For example, a study of cancer screening guidelines found that most guidelines failed to include information about harms. Some guidelines also compared harms associated with a single procedure with benefits that accrued through multiple procedures and treatments that resulted from cancer screening [ 72 ]. As another example, we compared systematic reviews of the drug gabapentin and found that different types of harms and different effect estimates were reported across reviews that included the same primary studies [ 28 ].…”

Section: Commentarymentioning

confidence: 99%

mentioning

confidence: 99%

Conducting separate reviews of benefits and harms could improve systematic reviews and meta-analyses

Mayo‐Wilson¹,

Qureshı

2023

Syst Rev

View full text Add to dashboard Cite

Guidance for systematic reviews of interventions recommends both benefits and harms be included. Systematic reviews may reach conclusions about harms (or lack of harms) that are not true when reviews include only some relevant studies, rely on incomplete data from eligible studies, use inappropriate methods for synthesizing data, and report results selectively. Separate reviews about harms could address some of these problems, and we argue that conducting separate reviews of harms is a feasible alternative to current standards and practices. Systematic reviews of potential benefits could be organized around the use of interventions for specific health problems. Systematic reviews of potential harms could be broader, including more diverse study designs and including all people at risk of harms (who might use the same intervention to treat different health problems). Multiple reviews about benefits could refer to a single review of harms. This approach could improve the reliability, completeness, and efficiency of systematic reviews.

show abstract

Evaluation of Harms Reporting in U.S. Cancer Screening Guidelines

Cited by 13 publications

References 53 publications

Public Preferences for Determining Eligibility for Screening in Risk-Stratified Cancer Screening Programs: A Discrete Choice Experiment

Public Preferences for Determining Eligibility for Screening in Risk-Stratified Cancer Screening Programs: A Discrete Choice Experiment

Surveillance of Individuals at High Risk of Developing Pancreatic Cancer

Conducting separate reviews of benefits and harms could improve systematic reviews and meta-analyses

Contact Info

Product

Resources

About