Ending unnecessary cancer screenings takes decades

Ending the widespread use of unnecessary and potentially even harmful cancer screenings could take up to 13 years, and even longer once new guidelines are in place, according to a new study.

These unnecessary screenings open patients up to potential overdiagnosis, pain and overtreatment, as well as cost more money and cause anxiety and fear.

With funding from the National Cancer Institute’s Oncology Research Implementation Consortium, Jennifer LeLaurin, PhD, assistant professor of health outcomes and biomedical informatics at the University of Florida and lead author of the new study, along with other researchers, analyzed data on whether outdated cancer screening methods are still being used. They focused on new guidelines that recommended no cervical cancer screening for women younger than 21 and older than 65 and no prostate cancer screening for men 70 and older.

While it took only one year to cut in half the number of cervical cancer screenings for younger women, it took 13 years for women over 65 to reach the recommendations. And despite the 2012 recommendations to stop screening for prostate cancer in older men, screening rates still haven’t dropped by 50 percent – the threshold LeLaurin team used to determine the cessation of large-scale screening.

There are a number of barriers to reducing unnecessary screening, including inertia and widespread interest in early cancer detection.

“Getting a person to stop doing something they’ve been doing for years is very difficult. Doctors also have patients with expectations about what tests they want to get. When screening recommendations change frequently, it’s confusing. It’s especially confusing for patients,” LeLaurin says.

There was little information on other types of cancer screening that the researchers wanted to study because there are few mechanisms in place to track what happens after new recommendations are released. These include ovarian, thyroid, testicular and pancreatic cancers.

“As clinicians and researchers, we’re pretty good at keeping track of what we should be doing. But it’s hard to tell how often some of these screenings that are no longer recommended are being done,” LeLaurin says. – “We need stronger tools to potentially identify where screening is being done inappropriately.

Recommendations about who should be screened for cancer and when are developed by the U.S. Preventive Services Task Force, a volunteer independent research agency supported by the U.S. Department of Health and Human Services. Based on high-quality published research, the task force grades screening tests, with a grade of “D” meaning that the test should not be performed in a given group of people because it is not beneficial or even harmful to patients.

Between 1996 and 2012, the task force issued new guidelines recommending that certain cancers, such as ovarian, thyroid, testicular, and pancreatic cancer, not be screened for in all patients without symptoms. They also limited the age groups that should be screened for cervical and prostate cancer.

“We need to look at ways to deter inappropriate screening and talk to patients about the benefits and risks of screening and how these recommendations can help them,” LeLaurin noted.