Limitations to SOC Screening

It’s important to distinguish between cancer screening and diagnostics tests.1-3 Diagnostic tests are performed after a patient presents with symptoms or abnormal findings. Recommended cancer screening tests, on the other hand, are mostly designed to detect only one type of cancer in average-risk and asymptomatic individuals.1-6 Without any warning signs and in the absence of regular screening, cancer detection is delayed to a point where the disease is advanced and difficult to treat.7-9 Learn more about the limitations in current cancer screening below.

USPSTF recommendations for early screening are available only for five cancer subtypes5,6,10-16

Sensitive single-organ screenings are “rule-out” tests only (e.g., mammography for breast cancer)17

False positives or false negatives translate into unnecessary procedures, anxiety, overdiagnosis, or missed diagnoses4,5

Even for cancers that have guideline-recommended screening tests, the invasive and uncomfortable nature of screening modalities can lead to low participation (learn more about such barriers to screening here and explore screening rates for individual cancer subtypes).4,18

Routine screening exists for approximately one-third of US cancer deaths6,a

Donut chart illustrating that approximately 70% of US cancer deaths had no standard of care screening tests available while approximately 30% did have standard of care screenings available.

Patients undergoing single-cancer screening tests have a higher likelihood of being diagnosed with a different cancer in the same year6

Patients undergoing single-cancer screening tests have a higher likelihood of being diagnosed with a different cancer in the same year

Incidence rate of cancers not targeted by screening is higher than that of cancers targeted by existing guideline-recommended screening6

Notable trends from deployment of screening approaches resulting in early detection of some cancers19

Donut chart illustrating that approximately 50% of cancers are detected at an advanced stage.

Now diagnosed less frequently at later stages19

Breast
Colorectal
Cervical

Diagnosed at advanced stages when prognosis is poor19

Esophageal
Pancreatic
Ovarian

These limitations underscore the need for better screening tests to find cancer earlier, especially for cancers that do not have existing guidelines.6 Overcoming these limitations is also critical in attainment of health equity in access and availability of cancer screening.4,20

Related Topics

Footnotes

  1. Cancers that have SOC screening: breast, cervical, colorectal, and lung (high-risk). US deaths, ages 50-79 in 2021.

List of Definitions

SOC: standard of care; USPSTF: United States Preventive Services Task Force.


References

  1. Maxim LD, Niebo R, Utell MJ. Screening tests: a review with examples. Inhal Toxicol. 2014;26(13):811-828.
  2. Streiner DL. Diagnosing tests: using and misusing diagnostic and screening tests. J Pers Assess. 2003;81(3):209-219.
  3. Ma ZQ, Richardson LC. Cancer screening prevalence and associated factors among US adults. Prev Chronic Dis. 2022;19:E22.
  4. American Association for Cancer Research. AACR Cancer Disparities Progress Report 2022. American Association for Cancer Research: Philadelphia. Accessed April 18, 2023. https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2022/06/AACR_CDPR_2022.pdf
  5. Brill JV. Screening for cancer: the economic, medical, and psychosocial issues. Am J Manag Care. 2020;26(14 Suppl):S300-S306.
  6. Braunstein GD, Ofman JJ. Criteria for evaluating multi-cancer early detection tests. touchREVIEWS Oncol Haematol. 2021;17(1):3-6.
  7. Al-Azri MH. Delay in cancer diagnosis: causes and possible solutions. Oman Med J. 2016;31(5):325-326. doi:10.5001/omj.2016.65
  8. Late-stage cancer detection in the USA is costing lives. Lancet. 2010;376(9756):1873. doi:10.1016/S0140-6736(10)62195-2
  9. National Opinion Research Center, University of Chicago. Only 14% of cancers are detected through a preventive screening test. Accessed April 18, 2023. https://www.norc.org/PDFs/GRAIL/State-Specific%20PCDSs%20chart%201213.pdf
  10. Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2019: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019;69(3):184-210.
  11. American Cancer Society. American Cancer Society Guidelines for the Early Detection of Cancer. Accessed August 15, 2022. https://www.cancer.org/healthy/find-cancer-early/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html
  12. Siu AL; U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296.
  13. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(7):674-686.
  14. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for lung cancer: US Preventive Services Task Forcerecommendation statement. JAMA. 2021;325(10):962-970.
  15. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for colorectal cancer: US Preventive Services TaskForce recommendation statement. JAMA. 2021;325(19):1965-1977.
  16. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901-1913.
  17. Lee WC. Selecting diagnostic tests for ruling out or ruling in disease: the use of the Kullback-Leibler distance. Int J Epidemiol. 1999;28(3):521-525. doi:10.1093/ije/28.3.521
  18. Croswell JM, Ransohoff DF, Kramer BS. Principles of cancer screening: lessons from history and study design issues. Semin Oncol. 2010;37(3):202-215.
  19. Crosby D, Bhatia S, Brindle KM, et al. Early detection of cancer. Science. 2022 Mar 18;375(6586):eaay9040. doi: 10.1126/science.aay9040. Epub2022 Mar 18.
  20. President's Cancer Panel. Advisors to the President on the National Cancer Program. Closing gaps in cancer screening: connecting people, communities, and systems to improve equity and access. Accessed April 20, 2023. https://prescancerpanel.cancer.gov/report/cancerscreening/part2goal2.html