The American Cancer Society today takes a major step in improving its cancer screening guidelines. It has announced an important update to its guideline formation process to stress greater transparency, consistency, and rigor in creating guidance about cancer screening.
The new methods bring the ACS’s process into line with new principles from the Institutes of Medicine (IOM) by creating a single generalist group for writing the guidelines, commissioning systematic evidence reviews, and clearly articulating the benefits, limitations, and harms associated with cancer screening tests. The new process is outlined in a Special Communication in the December 14, 2011 issue of the Journal of the American Medical Association.
The new process stresses transparency: ongoing activities and timelines will be posted publicly on the American Cancer Society web site; the process will separate expert input from the writing of the guideline by having an independent writing group be responsible for the guidelines after receiving appropriate input from specialists in the relevant field. These will help protect the process from the appearance of professional conflict of interest.
The process will incorporate a systematic evidence review that will use methods consistent with IOM standards, and the guidelines group will grade the strength of its recommendations. The guidelines will explicitly describe potential benefits and harms of screening and will articulate any differences between its recommendations and those of other groups and the reasons for those differences.
The new process will conclude with a formal review that will include opportunities for experts and professional organizations to comment on draft guidelines. Finally, the guideline process itself will be reviewed periodically by an independent advisory group to assure clarity, utility, and influence of the guidelines. There will be a formal review and rewriting of every ACS cancer screening guideline at least every five years.
“The ACS process over the past thirty years has been one of the most respected and highly quoted in the world. But it was largely a process that gathered the opinion of experts. As science progresses and more and more knowledge is generated, there is more data to review and a critical need to separate out opinion from evidence. Our process needs to evolve with the times. We need an 21st century process for 21st century data.
“In 1990 or even in 2005, there might have been one or two critical trials that our experts would review to come to consensus and create a guideline. Today there is far more data and there are many subsets and other analyses to consider, all of which require a careful process.
“We can now begin to identify new sub-populations defined by molecular subsets who might benefit from screening. The new process will explore these possibilities, and will also rely on more advanced ways of handling large amounts of information.
“This change is about being respectful to changing science. We must assure the American public that they can rely on our organization to continue to provide them with honest, credible recommendations on which to make important screening decisions.
“Critical to this update is the extensive literature review that is now a formal part of the process, as is the fact that our guidelines group members are chosen as individuals with broad knowledge, and will not be sub-specialists who often appear to have a conflict of interest, intellectual or financial.
“I believe that people will look at this enhanced process and agree that it is evolving in the right direction, and that the recommendations we’ve created for many years will be even more trustworthy and provide reliable guidance to insurance providers, to government, to physicians, and to the public.”