Each year, the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection along with a report on data and trends in cancer screening rates and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines. The latest data on utilization of cancer screening from the National Health Interview Survey (NHIS) also is described, as are several issues related to screening coverage under the Affordable Care Act, including the expansion of the Medicaid program. Read the complete version of Cancer screening in the United States, 2015 in CA: A Cancer Journal for Clinicians. CA Cancer J Clin 2015;65:30–54.
Cancer Screening Guidelines Overview and Processes
The American Cancer Society has issued cancer screening guidelines since 1980. ACS processes and recommendations for the early detection of specific cancer types have evolved with new scientific data, as new screening technologies became available, and as standards for creating guidelines changed. The guidelines published in 1980 were based on a review of the evidence led by Dr. David Eddy, an early pioneer in evidence-based medicine. The introduction of that methodology influenced future guideline updates. The ACS guidelines methodology underwent a review and update in 1997 to formalize a process that included the core stages of guideline development, implementation, and evaluation. The ACS protocol included nine steps to be followed for developing or revising guidelines:
- A multidisciplinary Guideline Development Panel to oversee the process
- Defined objectives on the cancer type, target groups and how the guidelines will be used
- An outcome model which described how the guideline will influence outcomes
- A procedure for documenting the rationale for each recommendation
- Review of the scientific evidence
- Defining the specific types of evidence to be considered in the creating the guideline
- Peer review of the draft recommendation by the experts and intended user groups before publication
- Evaluation of peer review comments and creation of final guideline
- Evaluation and periodic revision of the guideline
The revised process established a more formal method for which screening recommendations for all cancer types should follow.
Although previous approaches resulted in highly credible and useful guidelines, it was recognized that the process could be improved in terms of consistency, transparency, scientific rigor, and communications. In 2011, the American Cancer Society evaluated its own process for creating cancer screening guidelines and made adjustments so its process would be more aligned with the new Institute of Medicine (IOM) standards. A report on the new changes is published in the December 14, 2011 issue of the Journal of the American Medical Association. This new process implemented by the ACS covers 8 principles highlighted by the IOM:
- Transparency (explaining how guidelines are created and funded)
- Conflicts of interest disclosure for those creating guidelines
- Guideline development panel of individuals with appropriate expertise in clinical screening and a patient advocate
- Independent systematic review of evidence
- Grading strength of each recommendations by explaining the level of confidence in each guideline
- Clear articulation of recommendations
- External review of the proposed guidelines from outside experts and revising as needed
- Timely updating of guidelines when there is new evidence
For more information on the ACS guidelines development process, contact us at ACS.Guidelines@cancer.org.
ACS guidelines for the early detection of cancer in average-risk adults endorse screening for breast cancer, cervical cancer, and colorectal cancer. ACS recommends informed and/or shared decision-making for adults considering prostate cancer screening based on the uncertainty of the balance of benefits and harms, and the new lung cancer screening guidelines also stress shared decision-making. This table provides a summary of ACS recommendations for the early detection of cancer in average-risk, asymptomatic individuals.
This provides a summary of the current recommendations in lay language that can be used to discuss these guidelines with your patients.
In 2011, the American Cancer Society made adjustments to its process for creating cancer screening guidelines and incorporated policies and practices to be more consistent with the new Institute of Medicine standards. Read the complete version of the ACS new process for creating cancer screening guidelines here.
An overview of the history of ACS guideline recommendations for the early detection of certain cancer types is available in these tables.
As part of the new process for creating cancer screening guidelines, the ACS Board of Directors appointed a Cancer Screening Guideline Development Group (GDG) to create all ACS cancer screening guidelines. Learn more here.