For instance, research the USPSTF used as the basis for its prostate cancer screening recommendations has shown that widespread screening led to increased diagnosis and treatment of prostate cancer – without a corresponding increase in prostate cancer survival. Some prostate cancers are extremely aggressive, but others are so slow-growing, they may never cause problems.
Prostate cancer specialists agree the current practice of providing curative therapy for all men diagnosed through screening has resulted in over-treatment for a significant number of patients. However, many argue the fundamental problem in the risk/benefit ratio is not disease detection, but the indiscriminate use of aggressive therapy in men who are unlikely to die from their disease. Medical College of Wisconsin urologic oncologist William See, MD, comments: “Clearly, there are men identified through screening who need treatment. To argue against screening effectively relegates these individuals to death from disease. Rather than eliminating screening, urologic cancer leaders believe the focus should be on better selection of patients for treatment with curative intent.”
Individualized Input
It’s important to recognize that published cancer screening guidelines are just that: guidelines. Your personal physician should help you determine what cancer screening tests may be important for you given your age, sex, lifestyle and family and medical history.
“There are different risk levels within groups that may be impacted by certain lifestyle or family history issues,” Dr. Walker said. “It’s really critical that you engage your own physician; have a conversation to determine what tests are most appropriate for you.”
While most patients begin that conversation with a primary care physician, some patients at high risk for cancer seek out the expertise of specialists at the Froedtert & The Medical College of Wisconsin Clinical Cancer Center. “Some patients want to talk to a specialist to get his or her viewpoint on the recommendations and to learn about our approach here,” Dr. Walker said. The Clinical Cancer Center includes a Cancer Genetics Screening Program for patients with a strong family history of cancer, a Breast Cancer High Risk Assessment service, which helps women determine and manage their personal risk for breast cancer, as well as a High Risk Pancreatic Cancer Clinic for individuals who need a similar resource for pancreatic cancer.
Doctors and nurses from the Clinical Cancer Center also share the latest information about cancer screening with members of the community at outreach events,
Dr. Walker said. “For example, grants to the Froedtert Hospital Foundation from the National Breast Cancer Foundation, Inc., and the American Cancer Society, are making it possible for us to provide culturally sensitive breast health education to minority women.”
CURRENT RECOMMENDATIONS
Not sure what the current recommendations are? Here are the latest from the American Cancer Society and the USPSTF. The bottom line: These are guidelines only; a frank and early discussion with your physician is important to put in place a screening plan individualized to your own medical and family history.
Breast Cancer: The USPSTF recommends screening mammography every other year for women ages 50 to 74, while the American Cancer Society continues to recommend annual mammograms starting at age 40. Discuss your personal situation with a physician to determine a screening regimen that fits your needs.
Prostate Cancer: The American Cancer Society recommends that starting at age 50, men should talk to a doctor about the pros and cons of testing so they can decide if it’s right for them. African American men or those with a family history of prostate cancer before age 65 (father, brother), should discuss screening with a doctor at age 45. If men decide to be tested, they should have the PSA blood test with or without a rectal exam.
Colorectal Cancer: For most men and women, screening for colorectal cancer should begin at age 50. For those with a family history of colorectal cancer or polyps, screening may begin at an earlier age. Screening generally involves a colonoscopy, although there are other effective and non-invasive methods available. Talk with your primary care physician to determine when screening should begin, the appropriate interval between tests, and which screening test is most suitable.
Cervical Cancer: PAP tests remain the most effective method for finding abnormalities that should be assessed for cervical cancer. The American Cancer Society recommends beginning cervical cancer screening at age 21. Women ages 21-29 should have a PAP test every three years. Between ages 30 and 65, women should have a PAP test every three years, or a PAP plus an HPV test every five years. Women older than 65 who have followed the recommended screening schedule and have had normal PAP results – and those who have had a complete hysterectomy – do not need to be screened. Due to their personal health history, some women may need to have a different screening schedule for cervical cancer.
Screenings Evolve and Improve
Expect the cancer screening recommendations to evolve and change in the years to come as scientists and physicians discover new screening methods. For example, stool DNA tests are currently being investigated as a possible screening for colon cancer.
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