Which cancer screenings do you need?
Mammograms at 40 or 50? Every year
or every other year? What’s the best colon check? Screening for cancer
has gotten more complicated in recent years with evolving guidelines
that sometimes conflict. Attempts by a group of American doctors to ease
some confusion - and encourage more discussion of testing’s pros and
cons - with what they call advice on ‘high-value screening’ for five
types of tumours is relevant here in Sri Lanka as it is in the USA.
Doctors weigh in on the 5 most important procedures
Too often, even the doctors who order the tests aren’t sure of the
latest recommendations, says Dr. Wayne J. Riley, president of the
American College of Physicians (ACP), which published the advice Monday
(May 18) in the journal Annals of Internal Medicine.
“We
want to make sure that folks get the right test at the right time for
the right conditions,” says Riley, adding, “We also want our physician
colleagues to try to avoid the customary, knee-jerk reaction to just
test without having some sort of dialogue” about the right choice for
each patient.So the ACP, internal medicine specialists, reviewed leading
cancer screening guidelines to find the least intensive testing
strategies with the broadest expert consensus.
Cancer screening is a balance to ensure the people who will benefit
most get checked while not over-testing. After all, there are potential
harms including false alarms that spark unneeded extra testing, and
sometimes detection of tumours too small and slow-growing to be
life-threatening.
On the other hand, the studies have also routinely revealed that too
few people who clearly should be getting screened for certain cancers
are screened. For example, 58 percent of people ages 50 to 75 in the USA
had been recently checked for colorectal cancer; the US overnment goal
is 70.5 percent.
The American College of Physicians’ advice:
Breast cancer
The American Cancer Society has long recommended annual mammograms
starting at age 40. The US Preventive Services Task Force, which advises
the government, says to get mammograms every other year from age 50 to
74, and says starting at age 40 brings little benefit but should be a
personal choice if women are told the pros and cons.
The ACP sided with the more conservative approach, saying even
experts who prefer mammograms at 40 agree that women should be fully
informed of the pros and cons to help them decide for themselves.
Routine screening isn’t for 30-somethings, and more expensive MRI
scans aren’t for screening average-risk women, yet the ACP said doctors
sometimes order both.
Colorectal cancer
Colonoscopies, which allow doctors to see precancerous growths in the
colon, get the most attention.
But the ACP advised people ages 50 to 74 to choose from equally good
screening choices: a stool test every year; a colonoscopy every 10
years; a sigmoidoscopy, which views the lower colon, every five years;
or a combination of a stool test every three years and a sigmoidoscopy
every five years. The ACP said 60 percent of adults have colonoscopies
more frequently than needed, adding no medical value but lots of cost.
Cervical cancer
Screening choices vary by age. The ACP found widespread support for a
Pap test every three years starting at age 21. Starting at age 30, women
may choose a combination of Pap and a test for the HPV virus that causes
cervical cancer, a combination that lets them go five years between
tests. There’s little value in continuing to test women older than 65 if
they were properly screened and had no problems; and HPV tests aren’t
recommended before age 30 because HPV is so common in younger women.
Prostate cancer
PSA blood tests are highly controversial, with some groups
recommending against them and others saying men should get them only
after a discussion of the pros and cons. The ACP’s advice: Doctors
should tell men ages 50 to 69 about the pros and cons, and order the
test for those who then request it.
A third of men having PSA testing don’t recall even being told the
test was ordered, the ACP said.
Ovarian cancer
The new review found leading medical groups all recommend against
blood tests and pelvic or ultrasound exams to screen for ovarian cancer
in average-risk women.
While this cancer often has spread by the time it’s discovered, there
is no proven screening test for it. |