Cancer Screening Guidelines for Organ Transplant Recipients Inconsistent

Cancer screening recommendations for organ transplant recipients are inconsistent across international clinical practice guidelines, according to a study published in the American Journal of Transplantation.

“Given the limited available evidence for cancer screening in solid organ transplant recipients, most recommendations generally parallel the guidelines available for the general population,” wrote study author Nancy Baxter, MD, PhD, of the Institute of Health Policy at the University of Toronto in Canada, and colleagues.

Cancer screening is important for organ transplant recipients as this population is at higher risk of developing and dying of cancer compared to the general population.

“Although early cancer diagnosis may improve cancer outcomes in this population,” the authors wrote, “the reduced life expectancy and multiple comorbidities that exist in solid organ transplant recipients make cancer screening controversial.”

The authors identified 13 international clinical practice guidelines that included cancer screening recommendations-five of the guidelines analyzed were for kidney transplants, three focused on liver transplants, and one focused on heart transplants.

Only transplant experts-and not oncologists, primary care physicians, or public health experts-were involved in authoring the screening recommendations found among the guidelines analyzed.

Among the 13 guidelines, screening for skin cancer was most frequently recommended (10 guidelines), followed by cervical cancer (8), prostate cancer (7), and breast cancer (6).

“More studies are required to inform cancer screening recommendations in solid organ transplant recipients, and guideline development should involve transplant patients, oncologists, and cancer screening specialists,” concluded the authors.

According to a statement by Baxter, none of the cancer screening guidelines were based on clinical trial data, and that trials are unlikely to occur given that the overall transplant patient population is relatively small.

In a prior published analysis, Baxter and colleagues showed that those who receive an organ transplant are three times more likely to die of cancer compared to non-organ recipients, the leading cause of death among those who receive a transplant.

“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 Baxter, in the statement. “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.”