Don’t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms.
|Rationale and Comments:||Due to high mortality among end-stage renal disease patients, routine cancer screening—including mammography, colonoscopy, prostate-specific antigen, and Pap smears—in dialysis patients with limited life expectancy, such as those who are not transplant candidates, is not cost-effective and does not improve survival. False-positive tests can cause harm: unnecessary procedures, overtreatment, misdiagnosis, and increased stress. An individualized approach to cancer screening incorporating patients’ cancer risk factors, expected survival, and transplant status is required.|
|References:||• U.S. Renal Data System. http://www.usrds.org.
• American Society of Nephrology
• American Society of Transplantation
• Archives of Internal Medicine
• Seminars in Dialysis