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Making Sense of Cancer Screening Updates

December 21, 2011
By

TUESDAY, Dec. 20 (HealthDay News) — As experts alter course on
guidelines for cancer screenings such as mammograms and the
prostate-specific antigen test, the general public is understandably
confused.

Women at age 40 wonder if they should have a mammogram to look for
breast cancer or wait until 50, as one U.S. organization suggests. Men of
an age when prostate cancer develops may be told to forgo the
prostate-specific antigen (PSA) test, contrary to standard past practice.
And sexually active women may not feel safe from cervical cancer if they
wait years between Pap tests.

“It’s difficult to accept that having less testing is either as good or
even better than having more,” said Dr. Robert Mayer, faculty vice
president for academic affairs at the Dana-Farber Cancer Institute in
Boston.

Based on new research, some major cancer groups are advising the
medical profession to be more judicious about who gets tested and when.

“I don’t think the data are as conclusive that screening is as bad or
as good as we had hoped,” said Dr. David Penson, professor of urologic
surgery and director of surgical quality and outcomes research at
Vanderbilt University in Nashville.

Probably the most controversial recommendation came from the U.S.
Preventive Services Task Force (USPSTF), a government body that publishes
screening guidelines. It set off a furor two years ago when it announced
that mammograms may not benefit women in their 40s, while women aged 50 to
74 could safely undergo screening once every two years instead of
annually.

This year, the Canadian Task Force on Preventive Health Care came out
with similar recommendations on breast cancer screening, suggesting that
women aged 40 to 49 at average risk for breast cancer not get routine
mammograms.

This, of course, runs counter to long-standing conventional wisdom that
all women over the age of 40 should undergo a yearly mammogram.

These organizations reasoned that mammograms can result in false
positives and unnecessary biopsies, harm that in some instances may
outweigh the benefits of this type of screening. Soaring health costs may
also weigh in the decision-making.

However, the American Cancer Society and the American College of
Obstetricians and Gynecologists still advocate screening starting at age
40.

“I don’t see a trend of backing away from endorsement for screening
among many organizations,” said Robert Smith, senior director of cancer
control at the American Cancer Society. “Frankly, I see it in one.”

But the medical establishment is backing away from PSA screening for
prostate cancer, because the test is far from perfect, resulting in many
unnecessary biopsies.

Increased PSA levels can indicate cancer, but they are not a foolproof
measure. PSA levels rise naturally as men age, explained Mayer. Levels can
also rise if men have had two or three sexual experiences in the prior few
days.

“There are an enormous number of false positives,” Mayer added. “How
does one then say what’s good for everybody?”

And not all prostate cancers are created equal, some being highly
aggressive and others very slow-growing. Invasive treatment may be more
harmful than watching and waiting, some doctors say.

“We know that less than 10 percent of men with prostate cancer ever die
of the disease,” Mayer said. “That’s very different from colon cancer,
where 40 to 50 percent die from it, or breast cancer, where 30 to 40
percent die from it.”

The bottom line for both breast and prostate cancers: Check with your
health care provider on what is the best screening schedule for you.

Cervical cancer screening guidelines have also evolved over the years.

In October, three groups, including the American Cancer Society,
jointly created guidelines calling for women to get fewer cervical cancer
screenings over their lifetime.

The guidelines also call for combination Pap testing and HPV (human
papillomavirus) testing in women aged 30 and older, placing stronger
emphasis on HPV testing than guidelines officially released at the same
time from the USPSTF.

But the issue here is less controversial. “We have more sensitive tests
in our ability to detect what is a slow-growing disease,” said Smith.

More information

Visit the U.S. National Cancer Institute for more on cancer
screening tests.

Article source: http://news.yahoo.com/making-sense-cancer-screening-updates-140212600.html

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