Review Indicates Colorectal Cancer Screening Guidelines Have Inadequate Reporting and Discussion of Screening Harms

Review Indicates Colorectal Cancer Screening Guidelines Have Inadequate Reporting and Discussion of Screening Harms

Douglas K. Rex, MD, MASGE, reviewing Kamineni A, et al. Ann Intern Med 2022 Sep 27.

Cancer screening can lead to patient-level harms from screening tests, diagnostic follow-up, and cancer treatment. This review examined U.S. screening guidelines on breast, cervical, colorectal, lung, and prostate cancer for whether they each at least mentioned patient-level harms and whether any discussion of harms was conceptual, qualitative, or quantitative. 

For overall performance, the review rated the guidelines for breast and prostate cancer as the best regarding discussion of harms, and these guidelines were particularly good with discussion of cancer treatment harms and “overarching harms,” including overdiagnosis, financial costs, and psychological effects. Treatment-related harms and overarching harms were areas of relative weakness for colorectal cancer (CRC) screening guidelines. CRC screening guidelines did better with discussion of the harms of the screening process itself and the harms of diagnostic testing (colonoscopy).

Douglas K. Rex, MD, FASGE

COMMENT

In general, this paper is an appeal for screening guidelines to be systematic and quantitative in their discussion of harms. Some results from this study seem understandable, given that the morbidity and psychological impacts of breast and prostate cancer treatment seem greater than those associated with CRC. Further, CRC screening is widely accepted as being more effective and cost-effective than screening for the other organs featured in guidelines evaluated for the study. Nevertheless, the advice to be as quantitative as possible about the risks of colonoscopy screening and subsequent diagnostic colonoscopy for positive screening tests is well taken.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Kamineni A, Doria-Rose VP, Chubak J, et al. Evaluation of harms reporting in U.S. cancer screening guidelines. Ann Intern Med 2022 Sep 27. (Epub ahead of print) (https://doi.org/10.7326/m22-1139)

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