This book includes a plain text version that is designed for high accessibility. To use this version please follow this link.
askthedoctor Scheduling Tests D


There’s More New screening recom- mendations also have been developed for those at risk of lung cancer; colorectal cancer screen- ing, often to include a colonoscopy, also is encouraged widely. Talk with your health care provider and pursue screening based on your individual risk factors.


60 MILITARY OFFICER JANUARY 2016


Screening guidelines enable patients and doctors to identify risk factors or early disease so they can minimize or avoid serious complications. By Rear Adm. Joyce Johnson, D.O.


Developing screening guidelines is a complex process. Organizations in- cluding the U.S. Preventive Services Task Force (USPSTF), advocacy organizations such as the American Cancer Society (ACS), and medical professional and other organizations make recommenda- tions on many preventive practices. To develop these guidelines, they evaluate research fi ndings, assessing the benefi ts and harms of both screening and screen- ing follow-up (such as biopsies, eff ects of treatment, etcetera) to try to determine the most eff ective recommendations across the entire population. Guidelines aren’t always consistent


among organizations and can change over time. For example, “Breast Cancer” (Ask the Doctor, October 2015), cited a recom- mendation that most women begin annual mammography screening at age 40. Shortly thereafter, ACS changed its recommenda- tion to begin annual screening at age 45 for most women at “average” risk for breast cancer and then to have mammograms every other year, beginning at age 55. ACS guidelines changed because a recent analy- sis of studies found the risks of mammo- grams exceeded the benefi ts in younger age groups of “average” women. However, the new guidelines also suggest women begin talking with their health care provider about mammography at age 40, so screen- ing can begin earlier if indicated. Updated ACS guidelines also say, “Re- search does not show a clear benefi t of


physical breast exams done by either a health professional or yourself. … Still, all women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.” Individual patients, consulting with their health care providers, might fi nd an- other regimen more appropriate. Similarly, the USPSTF “recommends


against prostate-specifi c antigen (PSA)- based screening for prostate cancer,” based on the risks of follow-up of a positive result. Initial follow-up usually includes a biopsy, and if prostate cancer is found, treatment generally involves surgery or radiotherapy. Both biopsy and treatment can result in serious adverse consequences. However, some prostate cancers are slow- growing and would remain asymptomatic for a man’s lifetime. Thus, “the USPSTF concludes that there is moderate certainty that the benefi ts of PSA-based screening for prostate cancer do not outweigh the harms.” PSA screening for prostate cancer remains somewhat controversial, and many still recommend a patient and health care provider develop a specifi c screening plan based on the individual’s risk factors. Research continues, and today’s screen-


ing recommendations might well change in the future.


MO


— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at www.moaa.org/wellness. For sub- mission information, see page 6.


PHOTO: STEVE BARRETT


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96