Are Top Cancer Centers Misleading on Screening?

 You are 50 years old, otherwise healthy, and have not yet undergone any cancer screening. Recently however, you hear some of your colleagues at work discussing cancer screening tests, and how cancer incidence has been increasing. This news makes you feel a bit uneasy, and you begin to contemplate if you should also get tested, even though you have no symptoms. 

On the way home, you see a billboard for a nearby cancer center that says, “Ranked Among the Top 10 Cancer Centers in the Country, Five Years in a Row!” You think, “Wow, this is one of the best cancer centers in the country. Thank God, I live nearby, I could be treated here if I got cancer one day.” 

Once home, you reflect on the day and check out the cancer center’s website, hoping to get more information. But are you getting unbiased information on screening? Is this a reliable source for when to start and stop screening, what screening tests to use, and how often? Is the website providing enough information on the benefits and harms of screening for you to make an informed decision on the matter?

That’s what we aimed to discover in our research project — the results of which have just been published. In the paper, we compare the screening recommendations for lung, colorectal, breast, prostate, and cervical cancers at the Top Ten US Cancer Centers with those of the US Preventive Services Task Force (UPSTSF) — an independent organization of multi-disciplinary national experts in disease prevention and evidence-based medicine. The USPSTF publishes evidence-based recommendations on screening tests for various conditions, including cancer. Unlike other society-specific recommendations — such as the American College of Gastroenterology colonoscopy screening guidelines, for example — USPSTF experts have no conflicts of interest influencing their recommendations and the USPSTF screening recommendations are considered the gold standard. 

Here's what our analysis revealed: The screening recommendations from the Top Ten US Cancer Centers often differ from the USPSTF recommendations. This discordance was almost always in the direction of the cancer centers recommending more screening than the USPSTF. The difference was most notable for prostate and breast cancers and to a lesser extent colorectal and cervical cancers. Lung cancer screening recommendations from cancer centers were generally congruent with USPSTF guidance.

What does it mean that top cancer centers recommend more screening? These elite centers either recommend starting screening at an earlier age and stopping at a later age or not stopping at all. The centers often listed more modalities than USPSTF recommended for screening, such as MRI as well as mammogram when a mammogram is sufficient and less expensive. Many of these centers also promoted executive physicals that include several cancer screening tests under a flat-fee package, with costs ranging from $1700 to $10,000.

A major issue with recommending more screening is that all screening tests come with harms. These harms can manifest, for instance, as overdiagnoses. Overdiagnoses occur when the screening test detects false positives — lesions that look like cancer but are not, in fact, cancers. False positives not only lead to overtreatment but also unnecessary anxiety. Patients ultimately receive unnecessary medical interventions — biopsy, surgery, chemotherapy, radiation, for instance — to assess or treat lesions that don't need to be treated. 

Despite the potential harms of screening that need to be considered alongside the benefits, the Top Ten Cancer Center websites primarily focused on the importance of getting screened, with only one center also highlighting the potential harms of breast cancer screening.

Furthermore, we found that very few of these websites referred patients to the USPSTF recommendations, and none included metrics on the benefits vs risks of screening — such as the number needed to screen or the number needed to harm — to help people understand the trade-offs.

This discordance and lack of transparency matters, especially if these cancer centers are being promoted as the cream of the crop. Because these centers are viewed by the public as trustworthy resources, when their screening recommendations don't align with the gold standard, it exacerbates public misunderstanding of the risks and benefits of screening and can foster mistrust of the system.

I have observed this misunderstanding in my own practice. I have been treating a 82-year-old patient with metastatic colon cancer who is on her third line of chemotherapy. One day, she tells me she cannot make her chemotherapy appointment the following week because she has a mammogram on the same day. Not only is this patient beyond the recommended age for a mammogram, but the likelihood that detecting a breast tumor would affect her prognosis during her treatment for metastatic colon cancer is as low as it can be in medicine. 

This type of confusion is not unusual. Studies have shown that patients often overestimate the benefits and underestimate the harms of screening. What we don't want is for top cancer centers to perpetuate these misunderstandings.

Ultimately, I think we need to ask ourselves what “Top Ten” even means. The phrase indicates top quality, but if accurate guidance on cancer screening is a metric, then these centers fail. 

It is also clear that there is a huge conflict of interest at play here — recommending more tests and doing more screening generates more revenue, but is that in the best interest of the public? 

Our society rewards doing more, but in medicine, oftentimes, less is more. And doing more with no benefit should be considered a poor performance metric, not plugged as the right care. It definitely does not speak of “Top Quality.”

https://www.medscape.com/viewarticle/are-top-cancer-centers-misleading-screening-2025a10009oy