Advancing Progress in
the Development and
Implementation of
Effective, High-Quality
Cancer Screening
PROCEEDINGS OF A WORKSHOP
Erin Balogh, Sarah Domnitz, Margie Patlak, and Sharyl J. Nass,
Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by Contract No. 200-2011-38807 (Task Order No. 75D30119F00080) and Contract No. HHSN263201800029I (Task Order No. HHSN26300008) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Association of Community Cancer Centers, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Merck, National Comprehensive Cancer Network, National Patient Advocate Foundation, Novartis Oncology, Oncology Nursing Society, Pfizer Inc., Sanofi, and Society for Immunotherapy of Cancer. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-13659-4
International Standard Book Number-10: 0-309-13659-8
Digital Object Identifier: https://doi.org/10.17226/26019
Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2021 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Advancing progress in the development and implementation of effective, high-quality cancer screening: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26019.
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WORKSHOP PLANNING COMMITTEE1
NICOLE F. DOWLING (Co-Chair), Associate Director for Science, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
STANTON L. GERSON (Co-Chair), Interim Dean and Senior Vice President, Medical Affairs, School of Medicine; Director, Case Comprehensive Cancer Center; Professor of Hematological Oncology; and Director, National Center for Regenerative Medicine, Case Western Reserve University
GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; Principal Investigator, Clinical Coordinating Center, Women’s Health Initiative; and Affiliate Professor, Department of Biostatistics, University of Washington
KENNETH ANDERSON, Kraft Family Professor of Medicine; American Cancer Society Research Professor; and Clinical Research Director, Jerome Lipper Multiple Myeloma Center and LeBow Institute for Myeloma Therapeutics, Harvard Medical School and Dana-Farber Cancer Institute
EDWARD J. BENZ, JR., President and Chief Executive Officer, Emeritus, Dana-Farber Cancer Institute; and Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School
OTIS W. BRAWLEY, Bloomberg Distinguished Professor of Epidemiology and Oncology, Bloomberg School of Public Health, Sidney Kimmel Comprehensive Cancer Center, and School of Medicine, Johns Hopkins University
SUSAN CURRY, Dean Emerita, College of Public Health; and Distinguished Professor, Health Management and Policy, The University of Iowa
NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Raisebeck Endowed Chair for Collaborative Research, Senior Vice President, Director, and Professor, Clinical Research Division, Fred Hutchinson Cancer Research Center; and Head, Department of Medicine, Division of Medical Oncology, University of Washington
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
CONSTANTINE GATSONIS, Henry Ledyard Goddard University Professor of Biostatistics; Founding Director, Center for Statistical Sciences; and Founding Chair, Department of Biostatistics, Brown University
LORI HOFFMAN HŌGG, Veterans Health Administration National Program Manager for Prevention Policy, National Center for Health Promotion and Disease Prevention; and National Oncology Clinical Advisor, Office of Nursing Services, Department of Veterans Affairs
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
ALEX KRIST, Professor, Family Medicine & Population Health; Co-Director, Virginia Ambulatory Care Outcomes Research Network; and Director, Community Engaged Research, Center for Clinical and Translational Research, Virginia Commonwealth University; and Chair, United States Preventive Services Task Force
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine, Section of Hematology/Oncology; Director, Cancer Cytogenetics Laboratory; and Director, Comprehensive Cancer Center, University of Chicago
LISA RICHARDSON, Director, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
SUDHIR SRIVASTAVA, Chief, Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute
ROBERT A. WINN, Director, Massey Cancer Center, and Professor of Internal Medicine, School of Medicine, Virginia Commonwealth University
Project Staff
ERIN BALOGH, Co-Director, National Cancer Policy Forum
LORI BENJAMIN BRENIG, Research Associate
RACHEL AUSTIN, Senior Program Assistant (from November 2020)
KATHERINE HAWTHORNE, Senior Program Assistant (until September 2020)
EMILY ZEVON, Program Officer
ANNALEE GONZALES, Administrative Assistant
MICAH WINOGRAD, Senior Finance Business Partner
SHARYL NASS, Co-Director, National Cancer Policy Forum, and Senior Director, Board on Health Care Services
NATIONAL CANCER POLICY FORUM1
EDWARD J. BENZ, JR. (Chair), President and Chief Executive Officer, Emeritus, Dana-Farber Cancer Institute; and Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School
PETER C. ADAMSON, Global Head, Oncology Development & Pediatric Innovation, Sanofi
GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; Principal Investigator, Clinical Coordinating Center, Women’s Health Initiative; and Affiliate Professor, Department of Biostatistics, University of Washington
KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor; Professor of Behavioral Science; and Director, Center for Energy Balance in Cancer Prevention and Survivorship, University of Texas MD Anderson Cancer Center
SMITA BHATIA, Professor and Vice Chair of Outcomes for Pediatrics; Gay and Bew White Endowed Chair in Pediatric Oncology; Director, Institute for Cancer Outcomes and Survivorship; and Associate Director for Outcomes Research, Comprehensive Cancer Center, The University of Alabama at Birmingham
LINDA BOHANNON, President, Cancer Support Community
CHRIS BOSHOFF, Chief Development Officer, Oncology, Pfizer Inc.
CATHY J. BRADLEY, Grohne Chair for Cancer Prevention and Control Research; Professor and Associate Dean for Research, Colorado School of Public Health; and Deputy Director, University of Colorado Cancer Center
OTIS W. BRAWLEY, Bloomberg Distinguished Professor of Epidemiology and Oncology, Bloomberg School of Public Health, Sidney Kimmel Comprehensive Cancer Center, and School of Medicine, Johns Hopkins University
CYNTHIA BROGDON, Head, U.S. Oncology Portfolio Strategy, Bristol Myers Squibb
WILLIAM G. CANCE, Chief Medical and Scientific Officer, American Cancer Society
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
CHRISTINA CHAPMAN, Assistant Professor of Radiation Oncology, University of Michigan
K. ANDREW CRIGHTON, Chief Executive Officer, CEO Roundtable on Cancer
GWEN DARIEN, Executive Vice President, Patient Advocacy and Engagement, National Patient Advocate Foundation
NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Raisebeck Endowed Chair for Collaborative Research, Senior Vice President, Director, and Professor, Clinical Research Division, Fred Hutchinson Cancer Research Center; and Head, Department of Medicine, Division of Medical Oncology, University of Washington
GEORGE D. DEMETRI, Professor of Medicine and Director, Ludwig Center, Harvard Medical School; Senior Vice President for Experimental Therapeutics; Director, Center for Sarcoma and Bone Oncology; Quick Family Chair for Medical Oncology, Dana-Farber Cancer Institute; and Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center
JAMES H. DOROSHOW, Director, Division of Cancer Treatment and Diagnosis; Deputy Director for Clinical and Translational Research; and Head, Oxidative Signaling and Molecular Therapeutics Group, National Cancer Institute
NICOLE F. DOWLING, Associate Director for Science, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
SCOT W. EBBINGHAUS, Vice President and Therapeutic Area Head, Oncology Clinical Research, Merck Research Laboratories
KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine; and Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania
STANTON L. GERSON, Interim Dean and Senior Vice President, Medical Affairs, School of Medicine; Director, Case Comprehensive Cancer Center; Professor of Hematological Oncology; and Director, National Center for Regenerative Medicine, Case Western Reserve University
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
CHANITA HUGHES-HALBERT, Associate Dean for Assessment, Evaluation, and Quality Improvement, College of Medicine; Professor, Department of Psychiatry and Behavioral Sciences; Distinguished AT&T Endowed Chair for Cancer Equity, Hollings Cancer Center, Medical University of South Carolina
MIMI HUIZINGA, Vice President and Head, U.S. Oncology Medical, Novartis Oncology
ROY A. JENSEN, Professor of Pathology and Laboratory Medicine, Anatomy and Cell Biology, and Cancer; Director, The University of Kansas Cancer Center; William R. Jewell, M.D., Distinguished Masonic Professor; and Director, Kansas Masonic Cancer Research Institute, University of Kansas
RANDY A. JONES, Professor of Nursing, University of Virginia School of Nursing; and Assistant Director for Community Outreach Engagement, University of Virginia Emily Couric Cancer Center
BETH Y. KARLAN, Vice Chair, Women’s Health Research; Professor, Department of Obstetrics and Gynecology, David Geffen School of Medicine; and Director, Cancer Population Genetics, Jonsson Comprehensive Cancer Center, University of California, Los Angeles
LISA KENNEDY SHELDON, Clinical and Scientific Affairs Liaison, Oncology Nursing Society; and Oncology Nurse Practitioner, St. Joseph Hospital
SAMIR N. KHLEIF, Director, Jeannie and Tony Loop Immuno-Oncology Lab; Biomedical Scholar and Professor of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center; and Member, Society for Immunotherapy of Cancer
KAREN E. KNUDSEN, President, Association of American Cancer Institutes; Executive Vice President, Oncology Services; Enterprise Director, Sidney Kimmel Cancer Center, Jefferson Health
MIA LEVY, Sheba Foundation Director, Rush University Cancer Center; Associate Professor of Medicine, Division of Hematology and Oncology; and System Vice President, Cancer Services, Rush System for Health
SCOTT M. LIPPMAN, Director, Moores Cancer Center; Professor of Medicine, Senior Associate Dean, and Associate Vice Chancellor for Cancer Research and Care; Chugai Pharmaceutical Chair in Cancer, University of California, San Diego
NEAL MEROPOL, Vice President and Head of Medical and Scientific Affairs, Flatiron Health; and Adjunct Professor, Case Comprehensive Cancer Center
LARISSA NEKHLYUDOV, Professor of Medicine, Harvard Medical School; Internist, Brigham & Women’s Primary Care Associates at Longwood; Clinical Director, Internal Medicine for Cancer Survivors, Dana-Farber Cancer Institute
RANDALL A. OYER, Medical Director, Oncology, Ann B. Barshinger Cancer Institute; and Medical Director, Cancer Risk Evaluation Program, Penn Medicine Lancaster General Health
CLEO A. SAMUEL-RYALS, Associate Professor, Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
RICHARD L. SCHILSKY, Senior Vice President, Executive Vice President, and Chief Medical Officer, American Society of Clinical Oncology
JULIE SCHNEIDER, Associate Director, Research Strategy and Partnership, Oncology Center of Excellence, Food and Drug Administration
LAWRENCE N. SHULMAN, Professor of Medicine and Deputy Director for Clinical Services and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania
LARA STRAWBRIDGE, Director, Division of Ambulatory Payment Models, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
GEORGE J. WEINER, C. E. Block Chair of Cancer Research; Professor of Internal Medicine; Professor of Pharmaceutical Science Experimental Therapeutics; and Director, Holden Comprehensive Cancer Center, The University of Iowa
ROBERT A. WINN, Director, Massey Cancer Center, and Professor of Internal Medicine, School of Medicine, Virginia Commonwealth University
Forum Staff
ERIN BALOGH, Co-Director, National Cancer Policy Forum
LORI BENJAMIN BRENIG, Research Associate
RACHEL AUSTIN, Senior Program Assistant
ANNALEE GONZALES, Administrative Assistant
MICAH WINOGRAD, Senior Finance Business Partner
SHARYL NASS, Co-Director, National Cancer Policy Forum, and Senior Director, Board on Health Care Services
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DANIEL R. MASYS, University of Washington. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Nonfederal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Association of Community Cancer Centers, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Merck, National Comprehensive Cancer Network, National Patient Advocate Foundation, Novartis Oncology, Oncology Nursing Society, Pfizer Inc., Sanofi, and Society for Immunotherapy of Cancer.
The forum wishes to express its gratitude to the expert speakers whose presentations helped further the dialogue on opportunities to improve the evidence base for and delivery of high-quality cancer screening. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Boxes, Figures, and Table
BOXES
1 Suggestions from Individual Workshop Participants to Improve Cancer Screening
2 WISDOM Risk-Based Breast Cancer Screening Trial
3 Early Detection Research Network
4 Recommendation Development Process of the United States Preventive Services Task Force (USPSTF)
5 Ethical Principles That May Apply to the Evaluation of Cancer Screening
6 Cervical Cancer Screening and Follow-Up Program at the MD Anderson Cancer Center
FIGURES
1 Breast cancer is not a single disease
3 Modeling the efficiency of mammography
Acronyms and Abbreviations
AHRQ | Agency for Healthcare Research and Quality |
AI | artificial intelligence |
CDC | Centers for Disease Control and Prevention |
CLIA | Clinical Laboratory Improvement Amendments |
CMS | Centers for Medicare & Medicaid Services |
CRCCP | Colorectal Cancer Control Program |
CT | computed tomography |
EDRN | Early Detection Research Network |
ERSPC | European Randomized Study of Screening for Prostate Cancer |
FDA | Food and Drug Administration |
FQHC | federally qualified health center |
HMO | health maintenance organization |
HPV | human papillomavirus |
LEEP | loop electrosurgical excision procedure |
MPS | MyProstateScore |
MRI | magnetic resonance imaging |
MyPeBS | My Personal Breast Screening |
NCCN | National Comprehensive Cancer Network |
NCI | National Cancer Institute |
NICE | National Institute for Health and Care Excellence |
NIH | National Institutes of Health |
PET | positron emission tomography |
PLCO | Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial |
PSA | prostate-specific antigen |
RCT | randomized controlled trial |
ROC | risk of ovarian cancer |
SNP | single nucleotide polymorphism |
TMIST | Tomosynthesis Mammographic Imaging Screening Trial |
TVS | transvaginal ultrasound |
UKCTOCS | UK Collaborative Trial of Ovarian Cancer Screening |
USPSTF | United States Preventive Services Task Force |
VHA | Veterans Health Administration |
WHO | World Health Organization |
WISDOM | Women Informed to Screen Depending on Measures of Risk |