Guidelines for Cancer Screening In the United States, guidelines for cancer screening are carefully developed by groups of subject matter experts and professional societies. For example, an independent group of experts convened by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services carefully evaluates data regarding the benefits and potential harms of different approaches to disease prevention, including cancer screening tests, genetic testing, and preventive therapeutics, to make evidence-based recommendations about the use of these in primary care settings. These volunteer experts form the U.S. Preventive Services Task Force (USPSTF). During the development of cancer screening recommendations, USPSTF is supported by researchers from the Evidence-based Practice Center (EPC) program, a U.S. Agency for Healthcare Research and Quality initiative (see Figure 11, p. 58). When developing cancer screening guidelines, subject matter experts such as those who make up USPSTF consider gender and age, as well as additional characteristics that are specific to individuals or population groups for whom the screening guidelines are being developed. These considerations include whether or not a person has a particular organ (e.g., for cervical cancer screening, whether an individual never had a cervix or had a hysterectomy with cervix removal); has a smoking history (e.g., for lung cancer screening); has an all-negative prior screening history (e.g., for cervical cancer screening); has other health-related issues that may reduce life expectancy (e.g., for The Process Used by the U.S. Preventive Services Task Force to Develop Cancer Screening Guidelines Developing guidelines for cancer screening is a multistep process. Panels of subject matter experts, such as those who make up the U.S. Preventive Services Task Force (USPSTF), meticulously review the available evidence and carefully weigh benefits of cancer screening against any potential harms before recommending if and at what age and risk level a person should start or stop cancer screening, for which cancer type, how frequently, and by which method. In the multistep process used by USPSTF for developing screening guidelines, anyone can nominate a new topic for review at any time. USPSTF reviews, selects, and prioritizes nominated topics based on relevance to and impact on disease prevention, primary care, and public health. USPSTF develops a research plan and posts a draft research plan on its website for public comments. USPSTF and Evidence-based Practice Center (EPC) review public comments and revise the research plan as needed. USPSTF posts the final research plan on its website. USPSTF assesses EPC-gathered evidence, weighing effectiveness and benefits/harms, and develops a draft recommendation statement, which is posted on the website, along with EPC evidence review, for public comments. Both the draft recommendation and evidence review are revised and finalized based on public comments and published in a journal and on the USPSTF website. Indicated in green are cancer types for which USPSTF is at various stage of developing screening recommendations. There are some differences in the process used by different organizations, but all organizations aim for the same rigor to ensure maximal benefit and minimal harm to public health. Developed from (4). FIGURE 11 Reviewing Topic Nominations Developing Draft Research Plan Reviewing Public Comments and Finalizing Research Plan Reviewing Evidence and Developing Draft Recommendation Reviewing Public Comments & Finalizing Recommendation Under development for anal cancer, infection with Helicobacter pylori Being updated for cervical cancer Being finalized for breast cancer AACR Cancer Progress Report 2023 Screening for Early Detection 58
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