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Cancer screening rates among transplant recipients do not meet current guidelines

Patients who have received organ transplants have a low rate of cancer screening adherence, according to a study published in the American Journal of Transplantation.

The researchers suggested that PCP involvement may improve these rates.

“An important complication associated with solid organ transplantation is the development of malignancy,” Sergio Acuna, MD, lead author and PhD candidate in clinical epidemiology and health care research at St. Michael’s Hospital in Canada, and colleagues wrote. “Solid organ transplant recipients (SOTR) are at increased risk of developing and dying from malignancies compared to the general population.”

“Adherence to [cancer screening] recommendations among transplant recipients is currently unknown,” they added.

Acuna and colleagues examined the uptake of posttransplant screening for colorectal, breast and cervical cancer among SOTR in Ontario, Canada, and determine factors associated with up-to-date screening. They identified 6,392 patients aged 18 years or older who had a kidney, liver, lung or heart transplant between Jan. 1, 1997, and December 31, 2010 who were eligible for cancer screening. Of those, 4,436 were eligible for colorectal cancer screening, 2,252 for cervical cancer screening and 1,551 for breast cancer screening.

Data showed that screening tests for colorectal, cervical and breast cancer were not up-to-date in 3,436 (78%), 1,572 (70%) and 1,417 (91%) of eligible patients, respectively. The researchers noted that because they were unable to differentiate between tests conducted for screening or for diagnosis, these rates may be overestimated. Patients with fewer comorbidities had a greater likelihood of being up-to-date with cancer screening. Transplant recipients who routinely visited their PCP were also more likely to be screened for breast cancer (RR = 1.4; 95% CI, 1.12-1.76) cervical cancer (RR = 1.29; 95% CI, 1.06-1.57) and colorectal cancer (RR = 1.3; 95% CI, 1.15-1.48) than those only followed by a transplant specialist.

“We have evidence of increased incidence of cancer in transplant recipients, we have some good evidence for the performance of screening tests in transplant recipients, and although we have no direct evidence of the effect of treatment on outcomes, it is likely that early detection in this population would lead to improved outcomes,” Acuna said in a related press release.

“Increasing knowledge of cancer screening among PCPs and their involvement in posttransplant care could improve the uptake of the cancer screening recommendations,” the researchers wrote. “Moreover, enhancing communication between PCP and transplant specialist may help improve cancer screening. A framework to guide individualized cancer screening decisions in SOTR is needed.” – by Alaina Tedesco

Disclosure: The researchers report receiving support from the Canadian Institutes of Health Research.