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 Less frequent screening for some malignancies, as well as starting
tests later in life and ending them earlier in old age, may make
sense for some adults without a family history or other risk factors
for cancer, according to American College of Physicians (ACP)
guidelines published May 18 in the Annals of Internal Medicine.
"There are certain cancers that, even if you detect them, are not
going to progress in that person's lifetime to the point where they
will die of this cancer, particularly if they have other medical
problems or are already at an advanced age," said Dr. Amir Qaseem,
senior author of the recommendations and director of clinical policy
at the ACP.
The new recommendations draw on guidelines previously issued by
several medical societies for tumors of the breast, prostate, colon
and rectum, cervix and ovaries. The recommendations offer framework
to assess the value of screening and concentrate testing efforts on
situations when treatment is more likely to be necessary and
effective.
In breast cancer, for example, healthy women are generally urged to
get mammograms every one to two years starting in their 40s or 50s
and continue into their 70s.
But, based on research suggesting mammograms don't reduce the risk
of death for women in their 40s, it may make sense to start this
test later in life, the new guidelines propose. In addition, women
may be able to stop these exams sooner, by the end of their 50s or
60s, based on some research pointing to a limited benefit from
detecting this tumor in women who are only expected to live another
15 to 20 years.
"For average-risk women, we want them to understand that starting
screening earlier does not change the outcome," said Dr. Tanveer
Mir, a member of ACP's high value care task force, which developed
the new recommendations.
Instead, screening too early can set women up for a series of
invasive tests, Dr. Mir said. "Any abnormalities lead to an MRI
(magnetic resonance imaging) and more mammograms, and biopsies
depending on the nature of the lesion, and you start on a treadmill
of over-testing."
For prostate cancer, ACP also proposes halting tests when men aren't
expected to live more than another 20 years because late in life men
have a less than 1 in 1,000 chance of avoiding death by getting
screened. Because common tests for prostate tumors can ultimately
lead to side effects such as incontinence and impotence, it can be
done less often and stop by age 60.
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Even for colorectal cancer, it may be possible to screen every 15
years instead of once a decade without increasing the risk of death,
the ACP suggests.
"Most colonoscopies are unnecessary, not going to find a polyp, or
find a polyp that is not going to progress," said Dr. Ian Thompson,
director of the Cancer Therapy and Research Center at the University
of Texas Health Science Center in San Antonio.
The notion of high-value screening is a sensible way for doctors and
patients to decide whether a particular test for cancer makes sense,
said Dr. Richard Schilsky, chief medical officer for the American
Society of Clinical Oncology. He wasn't involved in crafting the ACP
recommendations.
"No screening test is perfect, and most people who get screened
don't have the disease," said Dr. Schilsky. "Most people who do have
the disease won't benefit from screening because the disease is so
aggressive that they would have died anyway, or because it is so
slow-growing they would never have symptoms."
SOURCE: http://bit.ly/SQRXAa
Ann Intern Med 2015.
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