Cancer screenings continue years after guidelines change to limit unnecessary tests, study finds

(Press-News.org) Stopping the widespread use of unnecessary, potentially even harmful, cancer screenings can take up to 13 years and potentially even longer after new guidelines are put in place, according to a new study.

Those unnecessary screenings open up patients to potential overdiagnosis, pain and excessive treatment, while costing more money and leading to anxiety and fear.

“Excessive screening opens the door for a lot of negative consequences,” said Jennifer LeLaurin, Ph.D., an assistant professor of health outcomes and biomedical informatics at the University of Florida and lead author of the new study. “These guidelines are based on what the benefits and harms are. If the harms outweigh the benefits for a particular test, then they recommend against it.”

With funding from the National Cancer Institute's Consortium for Cancer Implementation Science, LeLaurin worked with other researchers at the UF College of Medicine, including senior author Naykky Singh-Ospina, M.D., to comb through data about whether outdated cancer screenings were still being used. They focused on new guidelines that recommended against screening for cervical cancer in women younger than 21 or older than 65 and against screening for prostate cancer in men 70 and older.

While it took just a year for screening of cervical cancer to drop by half in young women, it took 13 years to reach that level in women over 65. And despite guidelines put in place in 2012 to stop screening for prostate cancer in older men, screening rates have yet to come down by 50%, the threshold LeLaurin’s team used to determine when widespread screening had ended.

There are a number of barriers to reducing unnecessary screening, including inertia and the widespread interest in catching cancers early.

“To get someone to stop doing something that they’ve been doing for years, it’s really hard. Physicians also have patients with expectations about what tests they want. When you have screening guidelines changing frequently, it’s confusing. It’s especially confusing to patients,” said LeLaurin, who is also a member of the UF Health Cancer Center.

Little information was available for other cancer screenings the researchers wanted to study, because few mechanisms exist to track what happens after new guidelines are released. These included ovarian, thyroid, testicular and pancreatic cancers.

“As physicians and researchers, we’re pretty good about tracking the stuff we’re supposed to be doing. But it’s hard to tell how often some of these screenings that are no longer recommended are happening,” LeLaurin said. “We need more powerful tools to potentially identify where inappropriate screening is taking place.”

Guidelines for who should be screened for which cancers and when are created by the United States Preventive Services Task Force, an independent, volunteer-run 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 Grade “D” indicating that a test should not be performed in a given group of people because it provides little benefit or even harms patients, on average.

Between 1996 and 2012, the task force released new guidelines recommending against screening for certain cancers, such as ovarian, thyroid, testicular and pancreatic cancer in any patients without symptoms. They also limited the age groups who should be screened for cervical and prostate cancers.

“We need to consider ways to disincentivize inappropriate screening and talk with patients about the benefits and risks of screening and how these guidelines exist to help them,” LeLaurin said

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