Philippine Clinical Practice Guidelines for Periodic Health Examination: Screening for Neoplastic Diseases

Abstract

Background and Objective. Cancer is among the leading causes of death in the Philippines, with an age-standardized mortality rate of 100 deaths per 100,000 persons. Despite the high incidence and mortality in the country, the Philippines has yet to implement a national early detection or screening program for cancers. The goal of these clinical practice guidelines (CPGs) is to provide evidence-based recommendations on screening for specific types of cancer: retinoblastoma, nasopharyngeal cancer, liver cancer, cervical cancer, oral cancer, colorectal cancer, breast cancer, prostate cancer, lung cancer, and gastric cancer.

Methods. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended in the Department of Health Manual was followed. There were 10 clinical questions covered in this CPG, of which 9 questions involved asymptomatic or apparently healthy adults, while 1 question involved early detection of retinoblastoma among children. The evidence of net benefit or harm of cancer screening was obtained through a systematic literature search from database inception up to August 2021. Additional information on cost-effectiveness, patient values and preferences, acceptability, feasibility of screening, and its impact on equity was also obtained. The final recommendations were made through consensus by a panel of representatives from multiple stakeholder groups.

Results. There were 20 recommendations formulated. Strong recommendations were given to screen the following: patients at risk for hepatocellular carcinoma using ultrasound with alpha-fetoprotein (AFP); women aged 30 to 65 years for cervical cancer with cervical cytology alone, or high-risk Human papillomavirus (HPV)  testing alone, or visual inspection with acetic acid as alternative to Pap smear; adults aged 35 and older who are smokers or alcohol drinkers for oral cancer using visual examination, and women 50 to 69 years for breast cancer using mammography and biennial clinical breast examination. However, strong recommendations were made AGAINST screening for cervical cancer among women aged 21 to 29 years, and AGAINST screening for cervical cancer with high-risk HPV testing in combination with cytology (co-testing).

Conclusion. Through a comprehensive and systematic search of the best available evidence, the Neoplastic Diseases Task Force developed 20 recommendations on screening and risk factor assessment for 10 specific questions on neoplastic diseases. These recommendations serve as guidance on screening neoplastic diseases at the primary care level.