New Study Highlights Lengthy Journey to Phase Out Low-Value Cancer Screenings in the US
Valid and accessible measures are needed to monitor low-value care practices and set benchmarks for de-implementation efforts, researchers reported.
Jennifer H LeLaurin, PhD
Photo courtesy of University of Florida College of Medicine
A new comprehensive review sheds light on the challenges and timelines associated with discontinuing low-value cancer screening practices in the US, emphasizing the need for enhanced monitoring and targeted de-implementation strategies.
The study, published in BMJ Quality & Safety, analyzed 6 United States Preventive Services Task Force (USPSTF) Grade D cancer screening recommendations—guidelines advising against specific screening tests in certain populations due to limited or no benefit, or potential harm. Key findings revealed that the de-implementation process for these practices varies considerably, often taking years or even decades.
For instance, reducing cervical cancer screening in women under 21 was achieved within approximately four years following guideline updates. Conversely, efforts to curb screening in women over 65 took up to 16 years, with many practices still not significantly reduced. Notably, prostate-specific antigen (PSA)-based screening in men aged 70 and older has yet to achieve a 50% reduction since the 2012 guideline release, indicating persistent overuse.
Researchers, led by Jennifer LeLaurin, PhD, assistant professor of health outcomes and biomedical informatics at the University of Florida, noted that current surveillance and measurement efforts are limited, particularly for practices beyond cervical and prostate screenings, impeding timely identification of overuse. Furthermore, the results emphasized that the slow pace of de-implementation can be attributed to barriers such as ingrained clinical norms, patient expectations, and the absence of robust, routine monitoring measures.
"Improving the systematic measurement of low-value cancer control practices is imperative for assessing the impact of de-implementation on patient outcomes, healthcare delivery and healthcare costs," investigators concluded.
The findings underscore that relying solely on clinical guidelines and published evidence is insufficient for swift practice change. Instead, targeted policies, clinician engagement, and improved data infrastructure are vital to accelerate the cessation of outdated or harmful screening practices.
Source: LeLaurin JH, Pluta K, Norton WE, Salloum RG, Singh Ospina N. Time to de-implementation of low-value cancer screening practices: a narrative review. BMJ Qual Saf. Published online May 20, 2025. doi:10.1136/bmjqs-2025-018558
