title: Screening for cancer: advice for high-value care from the American College of Physicians.
abstract: BACKGROUND
  Cancer screening is one approach to reducing cancer-related morbidity and mortality rates. Screening strategies vary in intensity. Higher-intensity strategies are not necessarily higher value. High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs. When cancer screening leads to benefits, an optimal intensity of screening maximizes value. Some aspects of screening practices, especially overuse and underuse, are low value.
  
  
  METHODS
  Screening strategies for asymptomatic, average-risk adults for 5 common types of cancer were evaluated by reviewing clinical guidelines and evidence syntheses from the American College of Physicians (ACP), U.S. Preventive Services Task Force, American Academy of Family Physicians, American Cancer Society, American Congress of Obstetricians and Gynecologists, American Gastroenterological Association, and American Urological Association. "High value" was defined as the lowest screening intensity threshold at which organizations agree about screening recommendations for each type of cancer and "low value" as agreement about not recommending overly intensive screening strategies. This information is supplemented with additional findings from randomized, controlled trials; modeling studies; and studies of costs or resource use, including information found in the National Cancer Institute's Physician Data Query and UpToDate. The ACP provides high-value care screening advice for 5 common types of cancer; the specifics are outlined in this article. The ACP strongly encourages clinicians to adopt a cancer screening strategy that focuses on reaching all eligible persons with these high-value screening options while reducing overly intensive, low-value screening.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wilt
authors.forename: Russell P
authors.initials: RP
authors.lastname: Harris
authors.forename: Amir
authors.initials: A
authors.lastname: Qaseem
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D001943:Breast Neoplasms / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000175:diagnosis; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D055815:Young Adult