HEALTH SCREENING UPDATES

Over the past several years there have been a number of changes in the recommendations for cancer screening tests. Cervical, breast and prostate are just a few of the cancers where recommendations for screening tests have been modified, although not without controversy.
The governmental agency involved in developing recommendations for disease prevention is the U.S. Preventive Services Task Force (USPSTF). Comprised of an independent panel of experts in primary care and prevention, this agency reviews the evidence of effectiveness for existing screening tests. Based on the current data, a decision is made to keep the present recommendation or to suggest changes. Some of the more common screenings performed that have had changes made are the PAP, mammogram and PSA tests.

The PAP test screens for cervical cancer and was performed on an annual basis for all women. Current clinical guidelines still strongly recommend routine screening for high risk individuals. However, for women who are not high risk, testing is now suggested every two years for ages 21-30 and for over 30, every three years, with the provision of three consecutive, negative results. Research suggests women above the age of 70 can discontinue cervical cancer screening altogether.

Similarly, there have been some changes in recommendations for breast cancer screening with mammography. Previous guidelines were annual mammograms. Evidence shows current modifications from annual to biennial mammograms for women aged 40-59 are enough to reduce the harm and still provide benefit. And, the age group that may benefit the most is 60-69. The harm encountered includes false-positive test results leading to unwarranted biopsies, repeated imaging and doctor’s visits, not to mention causing worry and anxiety for many women. Even though breast cancer is more prevalent in women as they age, according to the task force, there is uncertain benefit for screening mammograms in women 75 years or older. And the breast self-exam (BSE) is being discouraged where previously it was thought monthly exams were crucial.

Additionally, the benefit of measuring PSA (prostatic specific antigen) to screen for prostate cancer has come into question. Initially, annual PSA testing was thought to help detect prostate cancer in the earlier stages, therefore providing a better chance for successful treatment. However, there are reasons for high PSA levels other than cancer, which can cause the patient anxiety. Prostatitis, benign prostatic hyperplasia (BPH) and recent ejaculation are just a few. Moreover, the research is inconclusive showing that a decline in deaths can be attributed to PSA screening. With positive PSA tests comes the decision of ‘watchful waiting,’ or active surveillance. More invasive procedures may be considered such as biopsy, radical prostatectomy or radiation therapy. So, according to the USPSTF, screening for prostate cancer in men younger than 75 years may not offer any better outcome than not screening. And for men 75 years and older PSA testing is not recommended, as the harm seems to outweigh the benefit. If PSA testing in men younger than age 70 is continued, the suggestion is for every 4 years, along with a discussion of the ambiguity of the benefits and drawbacks.

Sherry LaBeck, ND