title: Presentation of Benefits and Harms in US Cancer Screening and Prevention Guidelines: Systematic Review.
abstract: BACKGROUND
  Cancer prevention and screening guidelines are ideally suited to the task of providing high-quality benefit-harm information that informs clinical practice. We systematically examined how US guidelines present benefits and harms for recommended cancer prevention and screening interventions.
  
  
  METHODS
  We included cancer screening and prevention recommendations from: 1) the United States Preventive Services Task Force, 2) the American Cancer Society, 3) the American College of Physicians, 4) the National Comprehensive Cancer Network, and 5) other US guidelines within the National Guidelines Clearinghouse. Searches took place November 20, 2013, and January 1, 2014, and updates were reviewed through July 1, 2015. Two coders used an abstraction form to code information about benefits and harms presented anywhere within a guideline document, including appendices. The primary outcome was each recommendation's benefit-harm "comparability" rating, based on how benefits and harms were presented. Recommendations presenting absolute effects for both benefits and harms received a "comparable" rating. Other recommendations received an incomplete rating or an asymmetric rating based on prespecified criteria.
  
  
  RESULTS
  Fifty-five recommendations for using interventions to prevent or detect breast, prostate, colon, cervical, and lung cancer were identified among 32 guidelines. Thirty point nine percent (n = 17) received a comparable rating, 14.5% (n = 8) received an incomplete rating, and 54.5% (n = 30) received an asymmetric rating.
  
  
  CONCLUSIONS
  Sixty-nine percent of cancer prevention and screening recommendation statements either did not quantify benefits and harms or presented them in an asymmetric manner. Improved presentation of benefits and harms in guidelines would better ensure that clinicians and patients have access to the information required for making informed decisions.
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI. tcaverly@med.umich.edu.
authors.forename: Tanner J
authors.initials: TJ
authors.lastname: Caverly
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI.
authors.forename: Elyse
authors.initials: E
authors.lastname: Reamer
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI.
authors.forename: Daniel
authors.initials: D
authors.lastname: Connochie
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI.
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI (TJC, RAH, MH, AF); Department of Internal Medicine, University of Michigan Medical School (TJC, RAH, ER, BJZF, MH, AF), Center for Bioethics and Social Science in Medicine (TJC, BJZF, DC, AF), and Department of Health Behavior and Health Education (BJZF), University of Michigan, Ann Arbor, MI.
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
mesh_terms: D003657:Decision Making; D055088:Early Detection of Cancer / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000009:adverse effects / Q000706:statistics & numerical data; D009369:Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011322:Primary Prevention / Q000379:methods* / Q000639:trends; D014481:United States / Q000453:epidemiology