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Personalized risk info helps with screening decision

By Genevra Pittman

NEW YORK (Reuters Health) - People make more educated decisions about screening tests when they're given a personalized assessment of their own risk, rather than one-size-fits-all information, according to a new review of past studies.

Those personalized evaluations take into account factors such as age, race, gender, weight, lifestyle and family history to determine an individual's chances of developing a certain type of cancer, for example.

The new review paper, published in the Cochrane Library, also covered decisions by parents-to-be about whether to undergo genetic screening for their fetus.

"Knowing your individual risk for a particular health problem may help you make an informed choice about what screening services you might be interested in," said Dr. Michael LeFevre, co-vice chair of the government-backed U.S. Preventive Services Task Force.

The USPSTF makes recommendations for disease prevention, which are typically gender- and age-specific. But the evidence isn't always there to make guidelines more personalized than that, he said.

"Over time, what would be ideal is that we're able to make more specific, individualized recommendations and fewer population recommendations," added LeFevre, who is also a family doctor at the University of Missouri School of Medicine in Columbia and wasn't involved in the new review.

For their analysis, researchers looked at 41 studies, including almost 29,000 people, which compared some form of personalized risk assessment with a standard message about the effects of a given screening test.

Some risk assessments gave participants a numerical estimate of their chance of developing a certain condition and others simply separated them into low-, medium- or high-risk groups.

Three studies specifically measured how informed people were after receiving risk information. They found 45 percent of study volunteers in the personalized-risk group made informed choices about screening, compared to 20 percent of those who were given generic risk data.

Other studies showed a trend toward more patient knowledge and a more accurate understanding of screening risks following personalized assessments.

"There is progress in the screening field, which is moving away from just trying to maximize the uptake of screening tests," said Adrian Edwards, who led the review at Cardiff University in the UK.

"There is an awareness that screening tests have both pros and cons, and what we're wanting and encouraging is for people to make informed choices about whether or not to have the screening tests," he told Reuters Health.

Edwards gave the example of prostate specific antigen (PSA) testing for prostate cancer.

Recent data from two large studies suggest that about one life will be saved for every 1,300 men screened, he said. But a total of 48 of those 1,300 men will be diagnosed with and treated for cancer with therapies that can cause impotence and incontinence.

Despite the increase in knowledge about screening risks, Edwards said many screening programs broadcast a message that the tests are universally beneficial.

"At the moment, I think the screening programs have made it too simple, too easy," he said.

The researchers said people shouldn't be afraid to ask their doctors about the potential harms of a given screening test.

LeFevre pointed to resources where people can get personalized risk information, including the National Heart, Lung, and Blood Institute's online tool for heart disease (http://1.usa.gov/9jL3kK) and the National Cancer Institute's breast cancer risk calculator (http://1.usa.gov/6eW4G), both based on epidemiological research.

There is still a need for more studies on whether personalized assessments affect how many people ultimately choose to undergo screening, according to Edwards. In his team's analysis, the assessments were tied to a slightly higher uptake of screening.

SOURCE: http://bit.ly/bVvvzJ Cochrane Library, online February 27, 2013.

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