Changes to Cancer Screening Guidelines
By Tiffany Svahn, MD
Let me start with some good news…. In the US, the death rate from cancer is declining. We attribute this reduction in part to more effective and aggressive screening guidelines. The bad news is that people still get cancer. In fact, our lifetime probability of developing cancer (all sites) for men is 1-in-2 and for women the probability is 1-in-3. Recently, my colleagues and I were asked to give a cancer screening guidelines update talk to local physicians. Allow me to summarize our presentation in efforts to help you manage medical care for yourself and your loved ones.
Lung Cancer Screening
According to early trials, chest x-ray screening does not show overall survivor benefit. Instead, a large randomized trial showed that low dose, non-contrast CT in high risk individuals yielded a mortality benefit of 20 percent. Therefore, in 2013 the recommendations changed and now call for an annual low dose CT scan screening
for high risk individuals. High risk is defined as ages 55 to 80 with 30 pack year history of smoking and current smoker or quit within the past 15 years.
Breast Cancer Screening
The recommendation is that all women receive mammograms at age 40 and continue annually until age 70 or older, depending on overall health, life expectancy, and ability to tolerate treatment. It is also recommended for women ages 20-39 to have a clinical breast exam (by a medical professional) at least every three years and for women 40 and over to have this exam annually. Routine ultrasound for dense breasts is not currently recommended as it showed no survival benefit. However, the decision to order an ultrasound should be an individualized decision. The surprise recommendation is that self breast exams are discouraged and not recommended unless taught correctly. Most important is for women to know how their breasts normally feel and report any changes to their health care provider.
Prostate Cancer Screening
Here is where it gets controversial. Several reputable organizations recommend PSA and digital rectal exams(
DRE) for prostate cancer screening, while other reputable organizations do not recommend screening. In those who support screening, their recommendation is to obtain DRE and PSA baseline at 45-49 years of age. If PSA is over one, repeat every 1-2 years. If under one, repeat at age 50. If PSA is under three at age 50 and over, repeat the test every 1-2 years. If PSA is over three at age 50 and over, with a suspicious DRE and/or individual at excess risk based on multiple factors (family history, ethnicity, risk calculators), obtain a biopsy.
Colon Cancer Screening
The average risk individual should be screened at age 50 with a fecal occult blood or immunohistochemical
test (annually) and a flexible sigmoidoscopy (every five years) or colonoscopy (every 10 years). However, some experts recommend starting the screening process at age 45 for African Americans since they are at a higher risk. Individuals with a family history of colon cancer or polyps should be screened at age 40 and those with a personal history of colon polyps should be screened every five years. Individuals with history
of ulcerative colitis should be screened every 1-2 years after age 8-15 years. Lynch syndrome individuals should be screened at age 20, every 1-2 years.
Cervical Cancer Screening
For women at average risk of cervical cancer
, the US guidelines recommend screening be initiated at age 21. The preferred screening test for ages 21-29 is the Pap test, and should be performed every three years. For ages 30-65, the HPV and Pap tests should be performed every 3 years. Women can stop screening at age 66 if the last 2-3 HPV and Pap tests have been negative. However, high risk groups (HIV infection, immunosuppressant
, previous CIN2, CIN3 or cervical cancer) should be screened more frequently.
Now, back to the good news…… cancer is much more treatable and curable when detected early, which is why screening is so important.
Dr. Svahn is a Medical Oncologist & Hematologist with Diablo Valley Oncology. She sees patients in Pleasant Hill and San Ramon. Dr. Svahn can be reached at 925-677-5041.
Tags: Breast Cancer
, Colon Cancer
, Gynecological Cancer
, Prostate Cancer