American Cancer Society Won't Use Specialists For Screening Guidelines

The American Cancer Society has revised its process for creating cancer screening guidelines to improve consistency.


Some of the key changes include the creation of a single group of generalist experts to develop all guidelines; the use of systematic reviews as the basis of all guidelines; and clear articulation of benefits and harms of various screening tests, according to Tim Byers, MD, MPH, of the Colorado School of Public Health in Aurora, and colleagues.


Byers is chair of the society's guidelines process work-group. The new process was described in the December 14 issue of the Journal of the American Medical Association.


"This new process should ensure that ACS cancer screening guidelines will continue to be a trustworthy source of information for both healthcare practitioners and the general public to guide clinical practice, personal choice, and public policy about cancer screening," the authors wrote.


Cancer screening guidelines written by different organizations can differ, even when based on the same evidence. That can lead to confusion among healthcare professionals, the general public, and policy makers, and reduce the credibility of the recommendations and the groups that issue them, according to Byers and colleagues.


In March, the Institute of Medicine (IOM) issued two reports to establish a framework for developing more trustworthy guidelines and for conducting systematic evidence reviews.


After the IOM released the reports, the ACS, which had already begun revising its methods for making cancer screening guidelines, ensured that their new process would be consistent with that laid out by the institute.


Futures ACS guidelines will be issued by general health care professionals and patient advocates, rather than cancer subspecialists, whom the ACS said may have financial incentives to recommend more tests.


"The conflict is that they know the most about it, but they also have the most self-interest in it," said Byers.


The U.S. Preventive Services Task Force, another recommending organization, has drawn criticism for recommending healthy men not get blood tests for prostate cancer, and that women in their 40s and 50s not get routine mammograms.


Byers said ACS decisions will be transparent as to their reasons. He said some tests, like mammography or colonoscopy, have saved lives, but they have drawbacks, too, such as increased costs, anxiety, and complications resulting from false alarms. He said specialists will still have an advisory role in the recommendations, but will not make decisions or vote.