prostate cancer screening); and/or has a family history of cancer (e.g., for colorectal and breast cancer screening). For the finalized guidelines, USPSTF assigns a grade to its recommendations (see Sidebar 20, p. 59). The grade of evidence also informs which services are covered without outof-pocket costs under the Affordable Care Act. The USPSTF can assign different grades to different population groups within the same cancer type. For example, a Grade A recommendation is assigned for adults ages 50 to 75 and a Grade B for adults ages 45 to 49 to screen for colorectal cancer. USPSTF guidance for cancer screening includes recommending for screening certain individuals at certain intervals (see Sidebar 21, p. 60); recommending against screening that has been shown to be harmful; and deciding that there is insufficient evidence to make a recommendation. For example, USPSTF recently concluded that there is insufficient current evidence to support visual skin examination as a basis to screen average-risk adolescents and adults for skin cancer (281). Eligibility for Cancer Screening Cancer screening guidelines are developed for individuals who are at an average risk of being diagnosed with cancer, as well as for those who are at a higher-than-average risk of being diagnosed with cancer. Key considerations that determine who should receive cancer screening and for which cancer include gender and age. Additional factors considered for cancer screening include genetic, environmental, behavioral, and social influences. Because some of these factors are different for each person and may change throughout life, the eligibility of an individual for cancer screening may also change over time. The decision of whether someone should receive cancer screening is different for each person. Researchers are also continually evaluating accruing evidence to recommend changes to existing eligibility criteria to screen for different types of cancer. For example, studies have found that even if all those who are eligible for lung cancer screening under the current USPSTF-recommended guidelines were to undergo screening, a large proportion of lung cancers will still be missed (282). One study of nearly 2000 patients with lung cancer found that only 54 percent of patients would have been deemed eligible for screening under the current USPSTF recommendations (283). As more evidence accumulates indicating that existing recommendations need to be revised, USPSTF and other cancer-focused organizations reevaluate existing screening recommendations and make evidence-based adjustments. It is important that people empower themselves with the most up-to-date information on cancer screening eligibility by having The USPSTF Grading System for Cancer Screening Guidelines* Below are simplified definitions of the grades the U.S. Preventive Services Task Force (USPSTF) assigns to its cancer screening recommendations: GRADE RECOMMENDATION REASON Screening recommended High certainty that net benefit is substantial Screening recommended High certainty that net benefit is moderate Selective screening recommended based on professional assessment and patient preference Moderate certainty that net benefit is small Screening not recommended Moderate to high certainty that screening has no net benefit, or that the harms outweigh the benefits Not applicable Insufficient evidence to assess the balance of benefits and harms of screening *Definitions included here are based on grade definitions after July 2012. A complete description for each grade, and the definitions for the guidelines issued before July 2012, can be accessed at the USPSTF website (280). SIDEBAR 20 A B C D I Screening for Early Detection AACR Cancer Progress Report 2023 59
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