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Posted By: Beth Sandy, MSN, CRNP
January 24, 2020
We now have screening tools and methodologies for several of the most common types of cancer. Each year, the American Cancer Society (ACS) publishes updated survival statistics and cancer screening guidelines in its "Cancer Facts & Figures" report. Advanced practice providers—whether in primary care, oncology, or any subspecialty—should be aware of the screening guidelines so that we can offer cancer screening to appropriate patients.
Breast Cancer: Screening with mammograms has been the long-time standard of care, and thanks to many well-funded campaigns, the benefit of mammograms has been well publicized, with good compliance in the primary care community. Currently, women with average risk have the "option" of beginning annual mammography between the ages of 40 and 44 years old. Then, between ages 45 and 54, annual mammography is recommended; for ages 55 and over, women can continue with annual mammography or transition to a biennial schedule. In women at high risk for breast cancer, the ACS recommends annual MRI of the breast to accompany mammography.
Colon Cancer: Colonoscopy is now a well-established screening tool for colorectal cancer, especially since 2000, when television personality Katie Couric had a colonoscopy on live television. Currently, the ACS recommends regular colonoscopy screening starting at age 45. Once over the age of 76, a more individualized approach can be taken depending on risk factors. However, if any precancerous polyps are found, it is important to consult more specific guidelines offered by GI societies for an increased frequency of colonoscopy screening. Stool testing is a less invasive option, and stool cards can be used at home and mailed into a laboratory. However, stool testing may be a less sensitive screening tool than colonoscopy.
Lung Cancer: Lung cancer screening guidelines have only recently been offered by oncology organizations, based on long-term data from the National Lung Screening Trial. An annual, non-contrast, low-dose CT scan of the chest is now recommended for high-risk patients. A high-risk patient is defined as: age 55 to 74, current or former smoker (quit within past 15 years) who has smoked at least 30 pack-years, and has consented to screening after a documented visit with a doctor or advanced practice provider that included discussion of screening risks as well as smoking cessation counseling. Lung cancer screening is approved and covered by most insurances; however, we have not seen nearly as much utilization as with other cancer screening tools. This may be due to several factors such as stigma or fear of lung cancer, lack of public education on the topic, and provider bias about lung cancer screening.
Prostate Cancer: Prostate-specific antigen (PSA) is a biomarker that may be checked in men via blood test. The ACS recommends starting PSA testing at age 50 for men at an average risk of prostate cancer, or between ages 40 and 45 for men at high risk. However, no other organization currently recommends routine prostate cancer screening due to high rates of overdiagnosis, which is described as "detecting disease that would never have caused symptoms or harm." PSA testing should be discussed with an "informed decision-making" approach for men to understand the implications.
The 2020 guidelines also include screening recommendations for other types of cancer, such as skin exams for melanoma or certain tumor-markers for gynecologic cancers, however not all of these recommendations are backed by strong survival data and therefore their impact on patient survival rate is unclear. In general, screening for cancer in healthy individuals is a personal decision for each patient and their health care provider to make, depending on their current health status, family history, and life expectancy.
Further information about cancer screening and cancer survival can be found in "Cancer Facts & Figures 2020."
- American Cancer Society. Cancer Facts & Figures 2020. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf. Accessed January 13, 2020.