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, the lifetime probability of developing cancer (all sites) is 1 in 2 for men and 1 in 3 for women. 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 an effort 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, noncontrast CT in high-risk individuals yielded a mortality benefit of 20%. Therefore, in 2013 the recommendations changed and now call for annual, low dose CT scan screening for high-risk individuals. High risk is defined as being between the ages of 55 to 80 with a 30 pack per year history of smoking and being a current smoker or quitting within the past 15 years.
Breast Cancer Screening
The recommendation is that all women should 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 that women ages 20-39 have clinical breast exams (by a medical professional) at least every three years and women 40 and over have this exam annually. Routine ultrasound for dense breasts is not currently recommended, as it showed no survival benefit. However, the decision to orderan 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. The recommendation by those who support screening is to obtain DRE and PSA baseline at 45-49 years of age. If PSA is over 1, repeat every 1-2 years. If under 1, repeat at age 50. If PSA is under 3 at age 50 and over, repeat the test every 1-2 years. If PSA is over 3 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 5 years) or colonoscopy (every10 years). However, some experts recommend starting the screening process at age 45 for African Americans since they are at a higher risk. Individuals with family history of colon cancer or polyps should be screened at age 40, and those with personal history of colon polyps should be screened every 5 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 recommends screening initiated at age 21. The preferred screening test for ages 21-29 is the Pap test and should be performed every 3 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.