For nearly 2,500 years, nonmaleficence, or “do no harm,” has been a fundamental tenet of medical ethics. Yet none of today’s U.S. breast, cervical, colorectal, lung, or prostate cancer screening guidelines report all of the harms associated with screening tests, researchers said in study results published in Annals of Internal Medicine.
Although screening tests can identify cancers early, when they’re easier and more effective to treat, they can also cause harms, including physical discomfort or injury, worry and stress, inaccurate results, and unnecessary follow-up procedures. For the current study, researchers reviewed 33 breast, cervical, colorectal, lung, and prostate cancer screening guidelines from more than 10 medical organizations, including the American Cancer Society, National Comprehensive Cancer Network, and U.S. Preventive Services Task Force.
They found that none of the guidelines reported all of the potential harms associated with screening for that type of cancer, and that when the guidelines did disclose harms, the information lacked conceptualization and qualitative evidence. However, the researchers said that the amount of missing information varied by cancer type, with prostate cancer screening guidelines reporting the most complete information and colorectal cancer screening guidelines the least.
In a subsequent interview, the researchers challenged guideline developers to “do deeper dives before they update their guidelines the next time, to make sure that they're really using the best possible evidence to make their recommendations” about harms versus benefits.
Some of the harms associated with cancer screening include:
- Minor (e.g., bruising, discomfort) or serious (e.g., colonic perforation) physical harm
- Radiation exposure
- False-negative or -positive results
- Overdiagnosis of harmless cancers
- Psychological implications
- Incidental diagnoses of other diseases
Like all patient care, the healthcare team should individualize cancer screening and early detection recommendations for each patient, including them in a discussion of risks versus benefits. Oncology nurses can use their patient education skills to help individuals understand their individual risks and make informed choices about their cancer prevention and early detection practices—both with survivors as they build their survivorship care plans and out in their local community as public health advocates.