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American Cancer Society Changes Its Screening Guideline Process

Article date: December 13, 2011

By Stacy Simon

The American Cancer Society has revised the process it uses to create guidelines for cancer screening to make the guidelines more clear and consistent and to help people better understand how such decisions are made.

Guidelines advise people about what screenings they should get and when they should get them. Some screening tests can find growths and remove them before they have a chance to turn into cancer. Other screening tests can find cancer early when it’s easier to treat. Guidelines also explain the limitations and risks of screenings.


Many people in the general public and health care profession, as well as policy makers and insurance companies, use American Cancer Society screening guidelines to make important health decisions. Other organizations, however, also write cancer screening guidelines. And sometimes these different guidelines conflict, even when they’re based on the same information. That can be confusing. So the Institute of Medicine (IOM), a respected independent, nonprofit organization, established new standards for how guidelines should be developed. The goal was to increase the quality of guidelines and make them more trustworthy.

At the same time, the American Cancer Society evaluated its own process for creating cancer screening guidelines and decided to make its process consistent with the new IOM standards. A report on the new changes is published in the December 14, 2011 issue of the Journal of the American Medical Association. Both the IOM’s recommendations and the American Cancer Society’s new process cover 8 principles:

• Transparency (explaining how guidelines are created and funded)

• Conflicts of interest

• Guideline group composition

• Systematic review of evidence

• Grading strength of recommendations (explaining the level of confidence in each guideline)

• Articulation of recommendations (explaining the guidelines clearly)

• External review (getting reviews and comments on the proposed guidelines from outside experts and revising as needed)

• Updating (revising guidelines when there is new evidence)

Some of the most significant changes for the American Cancer Society will be in the areas of group composition and conflict of interest. Historically, Society staff and volunteer leaders have appointed screening guidelines groups that included mostly specialists and experts in the cancer type being discussed. This was done in an effort to create the most credible and clinically useful guidelines. But a problem with that approach is that any guideline developed by people advising greater use of a procedure they are paid to deliver can give the appearance of conflict of interest. The Society’s solution is to create a 12-person panel of multidisciplinary experts in clinical screening, including a patient advocate.

Another change to the guidelines process is in the area of external review. National and international experts and professional organizations will have the opportunity to provide review and comment on Society guidelines before they’re published. Even though the Society may still develop guidelines that differ from those of other organizations, asking for input before publication makes it more likely for there to be agreement.

Tim Byers, MD, MPH, of the Colorado School of Public Health co-authored the new report, along with the Society’s chief medical officer, Otis Brawley, MD.

Dr. Byers said, “This new process should ensure that ACS will remain the national leader in creating and communicating trustworthy information to guide clinical practice, personal choices, and public policy about cancer screening.”

Reviewed by: Members of the ACS Medical Content Staff

ACS News Center stories are provided as a source of cancer-related news and are not intended to be used as press releases.

Citation: New American Cancer Society Process for Creating Trustworthy Cancer Screening Guidelines. Published in the December 14, 2011 issue of the Journal of the American Medical Association (Vol. 306, No. 22). First author: Otis Brawley, MD, American Cancer Society, Atlanta, Ga.

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