Home Articoli
Screening oncologici: il nuovo approccio basato sul value

Position Statement GIMBE

Screening oncologici: il nuovo approccio basato sul value
Antonino Cartabellotta

Evidence 2015;7(12): e1000127 doi: 10.4470/E1000127

Pubblicato: 9 dicembre 2015

Copyright: © 2015 Cartabellotta. Questo è un articolo open-access, distribuito con licenza Creative Commons Attribution, che ne consente l’utilizzo, la distribuzione e la riproduzione su qualsiasi supporto esclusivamente per fini non commerciali, a condizione di riportare sempre autore e citazione originale.

1. Cause di morte. In: Relazione sullo stato sanitario del Paese 2011-2013. Ministero della Salute xx, 2015. Disponibile a: www.rssp.salute.gov.it/rssp2012/paginaParagrafoRssp2012.jsp?sezione=statoSalute&capitolo=struttura&id=4059. Ultimo accesso 9 dicembre 2015.
4. Owens DK, Qaseem A, Chou R, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154:174-80.
5. Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, et al. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med 2012; 156:147-9.
6. Fisher ES, Welch HG. Avoiding the unintended consequences of growth in medical care: how might more be worse? JAMA 1999; 281:446-53.
7. Woolf SH, Harris R. The harms of screening: new attention to an old concern. JAMA 2012;307:565-6.
8. Porter ME. What is value in health care? N Engl J Med 2010;363:2477-81.
9. Smith RA, Manassaram-Baptiste D, Brooks D, Doroshenk M, Fedewa S, Saslow D, et al. Cancer screening in the United States, 2015: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2015;65:30-54.
10. Curry SJ, Byers T, Hewitt M, eds. Fulfilling the Potential of Cancer Prevention and Early Detection. Washington, DC: National Academies Press; 2003.
11. Kapp JM, Yankaskas BC, LeFevre ML. Are mammography recommendations in women younger than 40 related to increased risk? Breast Cancer Res Treat. 2010;119:485-90.
12. Stout NK, Nekhlyudov L, Li L, Malin ES, Ross-Degnan D, Buist DS, et al. Rapid increase in breast magnetic resonance imaging use: trends from 2000 to 2011. JAMA Intern Med. 2014;174:114-21.
13. Walter LC, Schonberg MA. Screening mammography in older women: a review. JAMA. 2014;311:1336-47.
14. Berkowitz Z, Saraiya M, Sawaya GF. Cervical cancer screening intervals, 2006 to 2009: moving beyond annual testing. JAMA Intern Med. 2013;173:922-4.
15. Sirovich BE, Welch HG. Cervical cancer screening among women without a cervix. JAMA. 2004;291:2990-3.
16. Baldwin LM, Trivers KF, Matthews B, Andrilla CH, Miller JW, Berry DL, et al. Vignette-based study of ovarian cancer screening: do U.S. physicians report adhering to evidence-based recommendations? Ann Intern Med. 2012;156:182-94.
17. Stormo AR, Hawkins NA, Cooper CP, Saraiya M. The pelvic examination as a screening tool: practices of U.S. physicians. Arch Intern Med. 2011;171:2053-4.
18. Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, et al. Impact of age and comorbidity on colorectal cancer screening among older veterans. Ann Intern Med. 2009;150:465-73.
19. Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S. Overuse of health care services in the United States: an understudied problem. Arch Intern Med. 2012;172:171-8.
20. Sheffield KM, Han Y, Kuo YF, Riall TS, Goodwin JS. Potentially inappropriate screening colonoscopy in Medicare patients: variation by physician and geographic region. JAMA Intern Med. 2013;173:542-50.
21. Partin MR, Powell AA, Bangerter A, Halek K, Burgess JF Jr, Fisher DA, et al. Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration. J Gen Intern Med. 2012;27:1618-25.
22. Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies. JAMA. 2006;296:2336-42.
23. Schwartz LM, Woloshin S, Welch HG. Not so silver lining. Arch Intern Med. 2011;171:489-90.
24. Ransohoff DF, McNaughton Collins M, Fowler FJ. Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback. Am J Med 2002;113:663-7.
25. Schwartz LM, Woloshin S, Fowler FJ Jr, Welch HG. Enthusiasm for cancer screening in the United States. JAMA. 2004;291:71-8
26. Emanuel EJ, Fuchs VR. The perfect storm of overutilization. JAMA 2008;299:2789-91.
27. Moyer VA. What we don’t know can hurt our patients: physician innumeracy and overuse of screening tests. Ann Intern Med. 2012;156:392-3.
28. Sirovich BE, Woloshin S, Schwartz LM. Too little? Too much? Primary care physicians’ views on US health care: a brief report. Arch Intern Med. 2011;171:1582-5.
29. Herndon MB, Schwartz LM, Woloshin S, Anthony D, Gallagher P, Fowler FJ, et al. Older patients perceptions of “unnecessary” tests and referrals: a national survey of Medicare beneficiaries. J Gen Intern Med. 2008;23:1547-54.
30. Colla CH. Swimming against the current—what might work to reduce low-value care? N Engl J Med 2014;371:1280-3.
31. LeFevre ML. Swimming upstream: doing less in health care is hard: comment on “No Papanicolaou tests in women younger than 21 years or after hysterectomy for benign disease” and “Cervical cancer screening intervals, 2006 to 2009”. JAMA Intern Med 2013;173:856-8.
32. Hoffmann TC, Del Mar C. Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA Intern Med 2015;175:274-86.
33. Gawande AA, Colla CH, Halpern SD, Landon BE. Avoiding low-value care. N Engl J Med 2014;370:e21.
34. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L; U.S. Preventive Services Task Force. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2009;151:727-37.
35. Whitlock EP, Lin JS, Liles E, Beil TL, Fu R. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008;149:638-58.
36. Whitlock EP, Vesco KK, Eder M, Lin JS, Senger CA, Burda BU. Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2011;155:687-97.
37. Kovalchik SA, Tammemagi M, Berg CD, Caporaso NE, Riley TL, Korch M, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 2013;369:245-54.
38. Hubbard RA, Kerlikowske K, Flowers CI, Yankaskas BC, Zhu W, Miglioretti DL. Cumulative probability of false-positive recall or biopsy recommendation after 10 years of screening mammography: a cohort study. Ann Intern Med 2011;155:481-92.
39. Morioka-Douglas N, Hillard PJ. No Papanicolaou tests in women younger than 21 years or after hysterectomy for benign disease. JAMA Intern Med. 2013;173:855-6.
40. Robertson DJ, Burke CA, Welch HG, Haile RW, Sandler RS, Greenberg ER, et al. Using the results of a baseline and a surveillance colonoscopy to predict recurrent adenomas with high-risk characteristics. Ann Intern Med. 2009;151:103-9.
41. Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, et al; Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med 2009;151:738-47.
42. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegooijen M, Kuntz KM. Evaluating test strategies for colorectal cancer screening: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2008;149:659-69.
43. Kulasingam SL, Havrilesky L, Ghebre R, Myers ER. Screening for cervical cancer: a decision analysis for the U.S. Preventive Services Task Force. AHRQ Publication No. 11-05157-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2011.
44. de Koning HJ, Meza R, Plevritis SK, ten Haaf K, Munshi VN, Jeon J, et al. Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med 2014;160:311-20.
45. Harris R. Overview of screening: where we are and where we may be headed. Epidemiol Rev 2011;33:1-6.
46. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst 2010;102:605-13.
47. Harris R, Sawaya GF, Moyer VA, Calonge N. Reconsidering the criteria for evaluating proposed screening programs: reflections from 4 current and former members of the U.S. Preventive Services Task Force. Epidemiol Rev 2011;33:20-35.
48. Welch HG, Passow HJ. Quantifying the benefits and harms of screening mammography. JAMA Intern Med 2014;174:448-54.
49. Harris RP, Sheridan SL, Lewis CL, Barclay C, Vu MB, Kistler CE, et al. The harms of screening: a proposed taxonomy and application to lung cancer screening. JAMA Intern Med 2014;174:281-5.
50. Brewer NT, Salz T, Lillie SE. Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med 2007;146:502-10.
51. Brodersen J, Siersma VD. Long-term psychosocial consequences of false-positive screening mammography. Ann Fam Med 2013;11:106-15.
52. Rychetnik L, Carter SM, Abelson J, Thornton H, Barratt A, Entwistle VA, et al. Enhancing citizen engagement in cancer screening through deliberative democracy. J Natl Cancer Inst 2013;105:380-6.
53. Snyder L; American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med 2012;156:73-104.
54. Wilt TJ, Harris RP, Qaseem A; High Value Care Task Force of the American College of Physicians. Screening for cancer: advice for high-value care from the American College of Physicians. Ann Intern Med 2015;162:718-25.
55. Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146:511-5.
56. American Academy of Family Physicians. Summary of Recommendations for Clinical Preventive Services. 2015. Accessed at www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/cps-recommendations.pdf on 3 April 2015.
57. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26.
58. National Cancer Institute. Breast Cancer Screening (PDQ). Bethesda, MD: National Cancer Institute; 2014. Accessed at www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional on 7 October 2014.
59. O’Donoghue C, Eklund M, Ozanne EM, Esserman LJ. Aggregate cost of mammography screening in the United States: comparison of current practice and advocated guidelines. Ann Intern Med. 2014;160:145.
60. Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311:1327-35.
61. Gross CP, Long JB, Ross JS, Abu-Khalaf MM, Wang R, Killelea BK, et al. The cost of breast cancer screening in the Medicare population. JAMA Intern Med. 2013;173:220-6.
62. Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O’Brien S, Walter LC. Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ. 2013;346:e8441.
63. Howard DH, Richardson LC, Thorpe KE. Cancer screening and age in the United States and Europe. Health Aff (Millwood). 2009;28:1838-47.
64. Moyer VA; U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;156:880-91.
65. Sawaya GF, Kulasingam S, Denberg T, Qaseem A; Clinical Guidelines Committee of the American College of Physicians. Cervical cancer screening in average-risk patients: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015;162:851-9.
66. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627-37.
67. Levin B, Lieberman DA, McFarland B, Andrews KS, Brooks D, Bond J, et al; American Cancer Society Colorectal Cancer Advisory Group. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570-95.
68. Qaseem A, Denberg TD, Hopkins RH Jr, Humphrey LL, Levine J, Sweet DE, et al; Clinical Guidelines Committee of the American College of Physicians. Screening for colorectal cancer: a guidance statement from the American College of Physicians. Ann Intern Med. 2012;156:378-86.
69. Winawer SJ, Zauber AG, Fletcher RH, Stillman JS, O’Brien MJ, Levin B, et al. Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the U.S. Multi-Society Task Force on Colorectal Cancer and the American Cancer Society. CA Cancer J Clin 2006;56:143-59
70. Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev. 2011;33:88-100.
71. Warren JL, Klabunde CN, Mariotto AB, Meekins A, Topor M, Brown ML, et al. Adverse events after outpatient colonoscopy in the Medicare population. Ann Intern Med. 2009;150:849-57.
72. Knudsen AB, Lansdorp-Vogelaar I, Rutter CM, Savarino JE, van Ballegooijen M, Kuntz KM, et al. Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the Medicare population. J Natl Cancer Inst. 2010;102:1238-52.
73. Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, et al; PLCO Project Team. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305:2295-303.
74. Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161:67-72.
75. Moyer VA; U.S. Preventive Services Task Force. Screening for ovarian cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2012;157:900-4.
76. Moyer VA; U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:120-34.
77. Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med. 2013;158:761-9.
78. Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, et al. Early Detection of Prostate Cancer: AUA Guideline. Accessed at www.auanet.org/education/guidelines/prostate-cancer-detection.cfm on 16 March 2015.
79. Ma X, Wang R, Long JB, Ross JS, Soulos PR, Yu JB, et al. The cost implications of prostate cancer screening in the Medicare population. Cancer 2014;120:96-102.
80. Pataky R, Gulati R, Etzioni R, Black P, Chi KN, Coldman AJ, et al. Is prostate cancer screening cost-effective? A microsimulation model of prostate-specific antigen-based screening for British Columbia, Canada. Int J Cancer 2014;135:939-47.
81. Shteynshlyuger A, Andriole GL. Cost-effectiveness of prostate specific antigen screening in the United States: extrapolating from the European study of screening for prostate cancer. J Urol 2011;185:828-32.

Bibliografia appendice


1. Osservatorio Nazionale Screening. Undicesimo Rapporto, anno 2015. Epidemiologia & Prevenzione 2015;39 (Suppl. 1):1-125. Disponibile a: www.osservatorionazionalescreening.it/sites/default/files/allegati/ONS_2015_full.pdf. Ultimo accesso 9 dicembre 2015.
2. Ministero della Salute. Verifica adempimenti LEA 2013. Disponibile a: www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=2408. Ultimo accesso 9 dicembre 2015.
3. Piano per lo Screening del Cancro del Seno, della Cervice Uterina e del Colon-retto triennio 2007-2009. Disponibile a: www.ccm-network.it/screening/files/documenti/Piano_screening_07-09.pdf. Ultimo accesso 9 dicembre 2015.
4. Ministero della Salute. Trend 2001-2012 indicatori Griglia LEA. Disponibile a: www.salute.gov.it/portale/temi/p2_6_Lea.jsp?lingua=italiano&id=3990&menu=lea&idP=1302. Ultimo accesso: 9 dicembre 2015.
5. Carrozzi G, Sampaolo L, Bolognesi L, et al for the regional and local PASSI coordinators. Cancer screening uptake: association with individual characteristics, geographic distribution, and time trends in Italy. Epidemiol Prev 2015;39(Suppl 1): 9-18.
6. Ministero della Salute. Piano Nazionale per la Prevenzione 2014-2018. Disponibile a: www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=2285,. Ultimo accesso: 9 dicembre 2015.