1. Digiulio, Sarah

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The American Cancer Society has adopted a new way of developing and writing cancer screening guidelines, which was outlined in a special communication in the Journal of the American Medical Association (2011;306:2495-2499).

ACS... - Click to enlarge in new windowACS

The new ACS standards, though independent, align with the new principles from the Institutes of Medicine for trustworthy clinical practice guidelines, namely creating a single generalist group for creating guidelines and conducting systematic evidence reviews, according to the report.


The new process calls for a single group, appointed by the ACS Board to serve a five-year term, to review related literature and write screening guidelines for all cancer sites, with independent input from groups of subspecialty experts.


Independent authors will then be commissioned by ACS to conduct systematic evidence reviews of all guidelines consistent with IOM standards. The writing group will formally grade the strength of each guideline to be able to describe variations from similar guidelines, and any harms and benefits.


All procedures and timelines for writing each new guideline will be published online by ACS throughout all stages to allow for review and comment. All screening guidelines will be formally reviewed and rewritten at least every five years, according to the report.


"There was a lot of variation in the method used to create ACS guidelines from cancer site to cancer site," said one of the coauthors, Tim Byers, MD, Associate Director for Cancer Prevention and Control at the University of Colorado Cancer Center. In the past, ACS leaders appointed ad hoc cancer screening guidelines groups (varying in size and composition of specialists versus cancer generalists) to write the old recommendations.


"The main change is going to be not having specialists from any particular site who are responsible for both reviewing the literature and writing the guidelines," he said in a telephone interview. "There's an inherent risk in guidelines being perceived as self-serving from whichever specialty might somehow benefit from that specific site."


Recognizing the importance of cancer site-specific expertise, the 12-member ACS Cancer Screening Guidelines Development Group will still be able to commission ad hoc groups of specialists to provide input and advice about any clinical specialty issues that may arise without risking conflict of interests.


The ACS's Chief Medical Officer, Otis Brawley, MD, made the decision to revamp the guideline-writing process, Dr. Byers said. Brawley and the ACS Board of Directors appointed a workgroup of physicians in 2010 to evaluate the old standards and write recommendations to the board.


"He asked us to take a look at the methods to better codify, organize, and standardize the methods that ACS used, and at the same time take a broader look at quality," Byers said.