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Cancer Prevention and Screening

Cancer screening is a powerful and important aspect of primary care. It permits for early detection of pre-cancers and asymptomatic cancers allowing for early intervention and potentially improved survival. Recommendations regarding different cancers as well as the associated screening modalities are frequently updated and published by various professional societies and by the United State Preventive Service Task Force (USPSTF). The US Preventive Service Task Force is an independent, volunteer panel of national experts in disease prevention and evidence based medicine.

Colorectal cancer is an important example of cancer screening. It is generally recommended that all patients undergo screening at age 50 although some patients may need earlier screening. Screening can be accomplished by several methods including specialized tests that check for blood or proteins in the stool or endoscopy which has the added advantage of visualizing the colon and removal of abnormalities.

Another cancer that is commonly screened for is breast cancer which is the most common skin cancer in women with a cumulative lifetime risk of 12% for American women. Typically, screening with mammograms begin at age 50 however certain women may be at higher risk and therefore should start screening earlier or use alternative techniques in place of or in conjunction with mammograms.

In addition to breast cancer screening, the United States Preventive Service Task Force recommends women between the ages of 21 to 65 undergo cervical cancer screening with Pap Smear and in some cases HPV testing. The interval between screenings is dependent on the patient’s age as well as the tests performed and the results of the previous testing. On the other hand, men are often faced with the controversial issue of screening for prostate cancer.

Currently, the US Preventive Service Task Force does not recommend screening for prostate cancer with a blood test known as Prostate Specific Antigen (PSA). This recommendation is an update from previously where PSA was recommended and this addendum was due to the potential for false positives and the associated complications that come from the treatment of low grade cancers. However, some patients may wish to proceed with screening and therefore it is important to have a detailed discussion about the risk factors for prostate cancer as well as the potential risks and benefits of testing.

Recently, the USPSTF recommended low-dose computed tomography (CT Scans) of the chest in adults between the ages of 55 and 80 who have a significant smoking history and are still smoking or have recently quit.

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References:

Weinberg DS and Schoen RE. In The Clinic: Screening for Colorectal Cancer. Ann Intern Med. 2014. May 6; 160 (9)

Nattinger AB and Mitchell JL. In The Clinic: Breast Cancer Screening and Prevention. Ann Intern Med. 2016. Jun 7; 164 (11)

Talcott JA. In The Clinic: Prostate Cancer. Ann Intern Med. 2015. Dec 1; 163 (11)