Effect of U.S. Cancer Screening Guidelines on Cancer Screening and Detection

Research Objective:

Cancer screening guidelines provide information on the effectiveness of screening in detecting cancer and reducing mortality. The primary objective of this study is to understand the impact of U.S. screening guidelines on breast, colorectal and prostate cancer screening and cancer detection.

Study Design:

U.S. guidelines specify an age at which screening should begin, implicitly recommending that screening not occur for asymptomatic individuals below that age. We first estimate compliance with guidelines from the difference in age-specific screening rates just below and above the ages at which clinical guidelines recommend that screening begin. We then perform instrumental variables regression analyses to estimate the effect of guideline induced screening on breast, colorectal and prostate cancer detection.

Results:

Guidelines from the American Cancer Society and U.S. Preventive Services Task Force recommend that mammography begin at age 40, colorectal screening begin at age 50, and that prostate screening(PSA test) be offered at age 50. Age-specific screening rates from national BRFSS and NHIS data indicate that U.S. breast, colorectal and prostate cancer screening rise by 55%, 88% and 29% precisely at the guideline recommend ages. Results from instrumental variables analyses of SEER data indicate substantial effects of screening on breast and colorectal cancer detection, but no identifiable effect on prostate cancer detection.

Conclusions:

This study examined the impact of cancer screening guidelines on cancer screening and detection. Large changes in breast, colorectal and prostate cancer screening at the guideline recommended ages lead to breast and colorectal cancer detection, but not prostate cancer detection.