Inconsistent guidelines for screening transplant recipients at higher cancer risk
People who have received organ transplants are at higher risk of developing and dying of cancer than the general population. Yet a new study has found cancer screening guidelines for this group are inconsistent as is the use of these guidelines.
Researchers at St. Michael's Hospital did an international systematic review and found only 13 sets of clinical practice guidelines - recommendations for optimizing patient care generally based on evidence - for cancer screening of transplant recipients. Most were for kidney transplant recipients as kidneys are the most commonly transplanted organ.
Their findings were published online today in the American Journal of Transplantation.
Dr. Nancy Baxter, senior author of the review and chief of the General Surgery Department at St. Michael's, said the review found that most of the guidelines were written only by transplant specialists and did not involve oncologists, primary care physicians, public health officials or patients.
She said none of the guidelines were based on evidence collected during clinical trials - a situation unlikely to change given that clinical trials require large numbers of people to provide accurate data and the transplant population is relatively small.
Dr. Sergio Acuna, the study's lead author and a physician and PhD student in clinical epidemiology at St. Michael's, said the existing guidelines generally recommend that transplant recipients should receive the same level of cancer screening as the general population.
Most of the guidelines recommended transplant patients be screened for skin cancer, but varied considerably on recommendations for other types of cancer, such as breast, cervical or colorectal cancer.
Previous work by Drs. Baxter and Acuna found that people who had organ transplants were three times more likely to die from cancer than the general population and that cancer was the leading cause of death among these patients. The risk of developing and dying from cancer was highest among children.
"Transplant recipients should be aware they have a heightened risk of developing and dying from cancer and should advocate with their health-care providers to be screened for cancer," said Dr. Baxter. "Even though transplant recipients often have other serious medical conditions that could shorten their life expectancy, they also need to be screened for cancer to ensure early detection."
The authors said more studies were needed to inform cancer screening guidelines for transplant recipients and guideline development should involve transplant patients, oncologists and cancer screening specialists.
Their work relates to solid organs such as the heart, lung, liver and kidneys, but not hollow organs such as intestines or non-solid tissues such as bone marrow or blood.