Q&A: Unnecessary cancer screenings continue years after guidelines change

Key takeaways:

• It took up to 16 years to de-implement unnecessary cervical cancer screenings.
• Many men are still unnecessarily screened for prostate cancer despite a change in guidance in 2012.

Stopping unnecessary cancer screenings can take over a decade after new guidelines are introduced, according to a review published in BMJ Quality & Safety.

“Excessive screening opens the door for a lot of negative consequences,” Jennifer H. LeLaurin, PhD, an assistant professor of health outcomes and biomedical informatics at the University of Florida, said in a press release. “These guidelines are based on what the benefits and harms are. If the harms outweigh the benefits for a particular test, then they recommend against it.”

LeLaurin and colleagues assessed six U.S. Preventive Services Task Force cancer screening recommendations and measured the time between guideline publication and de-implementation, defined as a 50% reduction in the use of the practice in routine care.

They found that the time it took to de-implement cervical cancer screening was 4 years for women aged younger than 21 years and 16 years for women aged older than 65 years.

Meanwhile, prostate screening in men aged 70 years or older has not yet reached the de-implementation mark since the task force’s 2012 guideline release.

Healio spoke with LeLaurin to learn more about the findings, how physicians can navigate ambiguous screening situations, and more.

Healio: Did any findings particularly stand out to you? What should health care providers ultimately take away from the data?

LeLaurin: One of the surprising findings was the variability in the pace of de-implementation. For example, nonrecommended cervical cancer screening under age 21 years was fairly rapid, while prostate cancer screening in older men is still very common. For HCPs, I think the takeaway is that keeping up to date on practice guidelines is critical, but on a larger scale we need other strategies to effectively change practice. This might include media campaigns, quality measures, changes to reimbursement policies and other multilevel strategies.

Healio: If the USPSTF no longer recommends a certain screening, what are the implications for insurance coverage? Would it deter providers from referring patients to those screenings?

LeLaurin: While USPSTF Grade D recommendations can influence insurance coverage, it isn’t always consistently aligned. For example, Medicare covers prostate cancer screening for men over 50, without an upper age limit. So, while lack of coverage may deter some referrals, it’s often not sufficient to stop low-value practices on its own.

Healio: What should physicians do in situations where a patient does not meet screening requirements but still wants to undergo screening?

LeLaurin: This is an important opportunity for shared decision-making. While evidence-based guidelines advise against screening in certain age groups, decisions about screening should still be individualized based on patient values, concerns and health history. Physicians should listen to patients’ concerns but also educate them on the balance of benefits and harms, like false positives and unnecessary invasive procedures. Emphasizing that not screening is supported by strong evidence can help reframe the decision not to screen as evidence-based practice rather than denial of care. Tools like decision aids may help navigate these conversations.

Healio: Where does research on unnecessary cancer screenings, and strategies for reducing these, go from here?

LeLaurin: We need better infrastructure for measuring and monitoring low-value care over time. Current data systems tend to focus on underuse of recommended services rather than overuse of low-value ones. Expanding national surveillance and integrating more low-value care measures into quality metrics could help. Also, more implementation research is needed to understand which strategies, such as clinical decision support tools and performance monitoring, are most effective in promoting de-implementation of specific practices.

Healio: Anything else you’d like to add?

LeLaurin: It’s important to emphasize that the USPSTF guidelines we examined in this study only apply to patients who are asymptomatic. If a patient presents with symptoms consistent with prostate, cervical or other cancers, physicians should follow appropriate diagnostic procedures. Our work also underscores that de-implementation is not simply the opposite of implementation. It requires its own set of strategies, informed by evidence, context and stakeholder engagement.

References:

• Cancer screenings continue years after guidelines change to limit unnecessary tests, study finds. Available at: https://www.eurekalert.org/news-releases/1086614. Published June 9, 2025. Accessed June 17, 2025.
• LeLaurin JH, et al. BMJ Qual Saf. 2025;doi:10.1136/bmjqs-2025-018558.

For more information:

Jennifer H. LeLaurin, PhD, can be reached at primarycare@healio.com.