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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.

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— 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