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December 3, 2014

Smarter Screening for CancerPossibilities and Challenges of Personalization

Author Affiliations
  • 1Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
  • 2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
  • 3Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
JAMA. 2014;312(21):2211-2212. doi:10.1001/jama.2014.13933

An important emerging model for screening and many preventive strategies is personalization. This approach uses individual patient characteristics to project the benefit of screening for a given patient and has the potential to improve cancer outcomes while reducing the probability of harm and preserving scarce health care resources. Yet all too often, the existing health care system fails to personalize screening in even the most rudimentary way. A recent study found that 75-year-old patients with severe comorbidities were nearly 2 times more likely to be screened for colorectal cancer than 76-year-old patients with no comorbidities, even though healthy 76-year-old patients tend to live longer and gain greater benefit from screening.1 In another study, 48% of primary care physicians reported that they would recommend breast cancer screening for women diagnosed with terminal lung cancer, a group of patients for whom screening cannot provide any benefit, may cause harm, and is a waste of resources.2 Although most clinicians would agree that cancer screening should focus on patients most likely to benefit, the US health care system is failing to achieve this type of personalized care.

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