Most US cancer prevention guidelines don't provide information needed for decision-making

The majority of cancer prevention and screening recommendations in the United States did not quantify benefits and harms or were unable to be presented in an even matter. These prevention and screening recommendations should be improved so that both clinicians and patients have better access to information so that they can make a more educated decision, according to a study published February 23 in the JNCI: Journal of the National Cancer Institute.

Guidelines for cancer prevention and screening are meant to help provide high-quality benefit-harm information to clinicians so that they can relay the best information to patients in order to make educated decisions regarding their care. This study aimed to assess how guidelines in the United States present benefits and harms for cancer prevention and screening interventions.

In order to determine how U.S. guidelines present benefits and harms for cancer prevention and screening interventions, Tanner J. Caverly, M.D., M.P.H., Veterans Affairs Medical Center, and colleagues looked at cancer screening and prevention recommendations from the United States Preventive Services Task Force, the American Cancer Society, the American College of Physicians, the National Comprehensive Cancer Network, and other US guidelines within the National Guidelines Clearinghouse between November 20, 2013-January 1, 2014, with updates to the guidelines reviewed through July 1, 2015. The researchers specifically looked at statements about improvements in clinically important outcomes to use as information about the benefits of the cancer screening and prevention services. The researchers then used descriptive statistics to evaluate the guideline data and how the risk/benefit information was presented.

The researchers found 55 recommendations for using interventions to prevent or detect breast, prostate, colon, cervical, and lung cancer in 32 guidelines and that of those 55 recommendations, 39% received a comparable rating, while 14.5% received an incomplete rating. 54.5% received an asymmetric rating.

"Clarity about benefits and harms would promote more accurate perceptions about important outcomes and support clinician and patient decision-making regarding whether an intervention is appropriate given the context and the patient's preferences," the authors write. "Although absolute effects are difficult to know precisely, firm recommendations should not be made without guideline developers and clinicians at least estimating how big the absolute benefits and harms are most likely to be."

In an accompanying editorial, Michael Pignone, M.D., M.P.H., Professor of Medicine and Chief, UNC Division of General Internal Medicine, writes that the findings presented by Caverly and colleagues, "could be an important root cause of inadequate patient-provider communication and low patient knowledge about cancer screening services." "If we assume that guidelines are important sources of information for communication about cancer screening, we must then ask why the presentation of information about benefits and downsides in guidelines seems to be suboptimal."

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Article: Tanner J. Caverly, M.D., M.P.H., tcaverly@med.umich.edu

Editorial: Michael Pignone, M.D., M.P.H., pignone@med.unc.edu