Cervix Cancer Screening Guideline Judgments Are Not Explicit and Transparent

Abstract

To the Editor The new screening guidelines for the “prevention and early detection of cervical cancer” were jointly published by the American Cancer Society, American Society for Colposcopy and Cervical Pathology (ASCCP), and American Society for Clinical Pathology (ASCP) in the American Journal of Clinical Pathology , CA: A Cancer Journal for Clinicians , and the Journal of Lower Genital Tract Disease on March 14, 2012.1 I am asking for more transparency and more explicit disclosure of the judgments about risk and harm thresholds and trade-offs. The guideline panels used the GRADE (Grading Recommendations Assessment, Development, and Evaluation) system to provide a framework for the guideline development process. An integral aspect of the GRADE process is that the grading of the recommendations must be explicit, and that the judgments made by the panels to determine the balance between benefits and risks be explicit and not hidden. I appreciate that there are supplemental materials, including the work of the subgroups that you have made available online.2 I also appreciate that most professionals will not have time to read the entire guideline article, much less the supplemental materials, and that patients and stakeholders will likely not access these materials. The guideline publication explains the difference between strong and weak recommendations, acknowledges that both types were included in the document, but does not stipulate which recommendations were strong and which were …