Congruence of cancer screening recommendations between the USPSTF and the top ten US cancer centers: a cross sectional studyResearch in context

Abstract

Summary: Background: The United States Preventive Services Task Force (USPSTF) is an independent volunteer organization of multi-disciplinary national experts in disease prevention that publishes evidence-based guidelines for cancer screening. However, these guidelines are not binding and many individual cancer centers publish their own screening recommendations. Methods: This cross-sectional study compared the congruence of cancer screening recommendations between the USPSTF and the Top Ten US Cancer Centers as per the U.S News and World Report 2022–2023 for colorectal (CRC), lung (LC), cervical (CC), prostate (PC), and breast cancers (BC) in average risk patients. The evaluated variables included screening tests, recommendation direction, strength, frequency, age of start, age of end, and discussion/quantification of risks and benefits. Findings: Our study identified substantial variability between the screening recommendations from the Top Ten US Cancer Centers and the evidence based USPSTF guidelines for BC, PC, and CC. The discordance was almost always in the direction of the cancer centers recommending more screening beyond the USPSTF's recommendations, and without discussion of potential risks and harms. For LC and CRC, the guidelines were generally concordant between the cancer centers and USPSTF. Interpretation: Top Ten US Cancer Centers make screening recommendations inconsistent with those of the USPSTF recommendations, with cancer centers generally recommending more screening and omitting a nuanced discussion of benefits and risks. Given the national and international reputation of these cancer centers, their recommendations can have important population level implications, including confusion in the public. Funding: None.

Keywords

• USPSTF
• Guidelines
• Top Ten US Cancer Centers
• Cancer screening
• Cancer diagnosis
• Overdiagnosis