Table 1 Examples of increasing complexity in cancer screening recommendations and elements needed to allow for implementation of these recommendations into routine primary care
From: Personalized cancer screening: helping primary care rise to the challenge
Cancer screening | Examples of personalization | Elements needed for implementation in routine practice | Current implementation examples |
|---|---|---|---|
Breast | - Integration of personal preferences into whether to initiate screening and at what age - In the future, likely to have further integration of family history, screening history, and personal preferences for screening intensity | - Patient decision aids that present risk of overdiagnosis with screening - Electronic health record (EHR) decision support to allow tracking and integration of multiple patient factors | - Australian patient decision aid shown to increase informed choices [14] - Women Informed to Screen Depending on Measures of risk (WISDOM) study [22] |
Colorectal | - Use of tailored outreach and inreach to ensure that all patients have the best opportunity possible to complete screening - Integration of patient preferences to choose screening modality | - EHR that clearly identifies patients not up to date with screening - Team-based care to reach patients who do not have regular appointments - Patient decision aids that present choice between screening modalities | - Kaiser Permanente screening program [21] - Canton of Vaud colorectal cancer screening program that integrates patient preferences [15] |
Lung | - Balancing prevention messages of smoking cessation and early cancer detection - Risk stratification based on age, tobacco history, and possibly genetic and imaging findings - Integration of patient preferences when balancing potential benefits with substantial risk of overtreatment | - Recommendations that prioritize tobacco cessation ahead of lung cancer screening - EHR with structured tobacco history allowing for identification of eligible patients - Patient decision aids and conversation aids that quantify risks and benefits of screening and stimulate discussion - Reimbursement of time spent discussing screening decisions | - EviPrev recommendations that assign priority to proven effective prevention activities [17] - The Veterans Health Administration created patient decision aids and modified their EHR to support lung cancer screening [19] |
Cervical | - Individualized screening intervals based on risk human papillomavirus (HPV) status, vaccination and risk factors - Individualized outreach offering multiple screening modalities to lower barriers to screening | - EHR with searchable vaccine history and pathology results - Targeted use of mailed, home self-screening despite lower accuracy | - Pilot studies integrating in-clinic and home HPV testing into organized screening in Italy [24] |