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

Aruna Kamineni¹, V Paul Doria-Rose², Jessica Chubak¹, John M Inadomi³, Douglas A Corley⁴, Jennifer S Haas⁵, Sarah C Kobrin², Rachel L Winer⁶, Jennifer Elston Lafata⁷, Elisabeth F Beaber⁸, Joshua S Yudkin⁹, Yingye Zheng⁸, Celette Sugg Skinner¹⁰, Joanne E Schottinger¹¹, Debra P Ritzwoller¹², Jennifer M Croswell², Andrea N Burnett-Hartman¹²

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, Washington (A.K., J.C.).
² Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.).
³ Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah (J.M.I.).
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, California (D.A.C.).
⁵ Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.S.H.).
⁶ Department of Epidemiology, University of Washington, Seattle, Washington (R.L.W.).
⁷ Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and Henry Ford Health System, Detroit, Michigan (J.E.L.).
⁸ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.F.B., Y.Z.).
⁹ University of Texas Health Science Center at Houston, Houston, Texas (J.S.Y.).
¹⁰ Department of Population and Data Sciences, University of Texas Southwestern Medical Center, and Simmons Comprehensive Cancer Center, Dallas, Texas (C.S.S.).
¹¹ Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (J.E.S.).
¹² Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (D.P.R., A.N.B.).

PMID: 36162112
PMCID: PMC9903969
DOI: 10.7326/M22-1139

Review

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

Aruna Kamineni et al. Ann Intern Med. 2022 Nov.

. 2022 Nov;175(11):1582-1590.

doi: 10.7326/M22-1139. Epub 2022 Sep 27.

Authors

Affiliations

¹ Kaiser Permanente Washington Health Research Institute, Seattle, Washington (A.K., J.C.).
² Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D., S.C.K., J.M.C.).
³ Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah (J.M.I.).
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, California (D.A.C.).
⁵ Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (J.S.H.).
⁶ Department of Epidemiology, University of Washington, Seattle, Washington (R.L.W.).
⁷ Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, and Henry Ford Health System, Detroit, Michigan (J.E.L.).
⁸ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.F.B., Y.Z.).
⁹ University of Texas Health Science Center at Houston, Houston, Texas (J.S.Y.).
¹⁰ Department of Population and Data Sciences, University of Texas Southwestern Medical Center, and Simmons Comprehensive Cancer Center, Dallas, Texas (C.S.S.).
¹¹ Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (J.E.S.).
¹² Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado (D.P.R., A.N.B.).

PMID: 36162112
PMCID: PMC9903969
DOI: 10.7326/M22-1139

Abstract

Background: Cancer screening should be recommended only when the balance between benefits and harms is favorable. This review evaluated how U.S. cancer screening guidelines reported harms, within and across organ-specific processes to screen for cancer.

Objective: To describe current reporting practices and identify opportunities for improvement.

Design: Review of guidelines.

Setting: United States.

Patients: Patients eligible for screening for breast, cervical, colorectal, lung, or prostate cancer according to U.S. guidelines.

Measurements: Information was abstracted on reporting of patient-level harms associated with screening, diagnostic follow-up, and treatment. The authors classified harms reporting as not mentioned, conceptual, qualitative, or quantitative and noted whether literature was cited when harms were described. Frequency of harms reporting was summarized by organ type.

Results: Harms reporting was inconsistent across organ types and at each step of the cancer screening process. Guidelines did not report all harms for any specific organ type or for any category of harm across organ types. The most complete harms reporting was for prostate cancer screening guidelines and the least complete for colorectal cancer screening guidelines. Conceptualization of harms and use of quantitative evidence also differed by organ type.

Limitations: This review considers only patient-level harms. The authors did not verify accuracy of harms information presented in the guidelines.

Conclusion: The review identified opportunities for improving conceptualization, assessment, and reporting of screening process-related harms in guidelines. Future work should consider nuances associated with each organ-specific process to screen for cancer, including which harms are most salient and where evidence gaps exist, and explicitly explore how to optimally weigh available evidence in determining net screening benefit. Improved harms reporting could aid informed decision making, ultimately improving cancer screening delivery.

Primary funding source: National Cancer Institute.

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Comment in

Cancer Screening Guidelines Are Not Simple, But They Could Be Less Complex.
Harris RP, Kinsinger LS. Harris RP, et al. Ann Intern Med. 2022 Nov;175(11):1610-1611. doi: 10.7326/M22-2599. Epub 2022 Sep 27. Ann Intern Med. 2022. PMID: 36162109 No abstract available.

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

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