Study finds gaps in reporting harms from U.S. cancer screenings

Reporting on the physical and psychological harms from cancer screenings is inconsistent, making it hard to compare risks with rewards and potentially exposing patients to unnecessary hazards, according to new research published Monday in the Annals of Internal Medicine.

Why it matters: Assessing the tradeoffs is critical, because most of the people screened won't have a detectable disease at the time of screening and will not benefit from early detection.

• "If the potential for severe harm is great, or there is a low likelihood of detecting a cancer earlier when it can be treated more successfully, then screening may do more harm than good," said study co-author Paul Doria-Rose, chief of the health care assessment research branch at the National Cancer Institute.

State of play: Guidance on screenings has generally played up the health benefits, the authors wrote.

• But they noted there also are immediate and longer-term burdens, including the potential for diagnoses or additional procedures. For example, a biopsy may be accompanied by risk of bleeding, infection, or by patient anxiety over a possible future illness.

Details: The study focused on screenings for breast, cervical, colorectal, lung and prostate cancer and compared guidelines from multiple health organizations.

• When looking at the frequency of risk reporting, researchers "saw inconsistency" in how harms were reported for different organ types.
• Minor and moderate harms like dizziness, fainting, bleeding and bruising were mentioned in less than 50% of guidelines for breast, lung and prostate cancer.

• At the same time, serious harms — such as hospitalization and death — from screenings were mentioned in less than 50% of guidelines for breast, colorectal or lung cancer.
• Reporting on consequences was most complete for prostate cancer screening and least complete for colorectal cancer screening.

Zoom in: The study also considered whether the magnitude of the consequences were recorded and if numerical measures were used.

• Researchers recommend that cancer screening guidelines include quantitative estimates because they are "more informative and precise than terms like "high" or "low."

What they're saying: "Thorough reporting of harms alongside benefits provides clinicians and patients with more complete information to support decisions about screening," Doria-Rose said.