New Guidelines for Cancer Screening: What Tests to Get When

Confused about what cancer tests you need? The American Cancer Society (ACS) has released new guidelines for cancer screening.

The ACS updates its screening guidelines every year. This year’s list covers a wide range of cancers, including cancer of the breast, prostate, colon, rectum, cervix, and endometrium (the lining of the uterus).

Many people aren’t getting screened for cancer, write experts Robert Smith, PhD, and colleagues. Smith is the ACS director of cancer screening. Their report appears in CA: A Cancer Journal for Clinicians.

The chances of surviving cancer are often better with early detection. Routine tests can make a big difference, even for people who aren’t at high risk of cancer.

New Guidelines

The new guidelines touch on hot topics in cancer screening.

Digital mammography gets mentioned as a tool that may prove helpful, needs more study, and isn’t yet widely available. No cancer test is perfect, including mammography, but nondigital mammograms may still help, says the ACS.

Regarding prostate cancer, a prostate-specific antigen (PSA) test should be available to all men age 50 and older with a life expectancy of at least 10 more years, the guidelines state.

However, men should be told about the PSA test’s benefits and limits, and better tests for prostate cancer should be created, says the ACS.

The guidelines don’t require women to do regular breast self-exams. Such tests can be helpful, but not all cancers can be felt early on, and many breast lumps aren’t cancerous, so a doctor’s exam is a must for any new breast symptoms.

What Tests, and When

Here’s a quick look at the guidelines, which target people at average risk for cancer. Those with a higher cancer risk many need earlier screening.

• Breast cancer: Women should get a clinical breast exam at least every three years, starting in their 20s, and get an annual mammogram starting at 40. Breast self-exams are optional. See a doctor about any breast symptoms.
• Colorectal cancer: Starting at age 50, men and women should get colonoscopy every 10 years or other tests more often (double-contrast barium enema every five years; annual fecal occult blood test or fecal immunochemical test; flexible sigmoidoscopy every five years, with or without a fecal occult blood test or fecal immunochemical test).
• Prostate cancer: Digital rectal exam and prostate-specific antigen (PSA) test should be available annually for men age 50 and older with a life expectancy of at least 10 more years. Doctors and patients should discuss the pros and cons of the PSA test.
• Cervical cancer: Women should get annual Pap tests starting about three years after first vaginal intercourse or by age 21, whichever comes first. At or after age 30, women who have three normal Pap tests may get screened every two or three years. After 70, screening may stop for women who’ve had three normal Pap tests in a row and no abnormal Pap tests for a decade.
• Endometrial (uterine) cancer: At menopause, women should be told about endometrial cancer’s warning signs and urged to tell their doctors if they have any unexpected bleeding or spotting.

Special appointments aren’t necessary to check for some cancers. Doctors can screen for skin cancer, oral cancers, and thyroid cancers anytime instead of requiring an extra appointment, the ACS notes.

Falling Short

America’s record on cancer screening has room for improvement, the ACS notes.

Consider these 2004 ACS statistics, published along with the guidelines:

Fewer than six in 10 women aged 40 and older got a mammogram in the last year. Half of men aged 50 and older got a digital rectal exam in the past year. Barely half (52 percent) of adults aged 50 and older got tested for colon cancer in the past five years.

The most utilized test was the Pap test, which checks for irregularities in the cervix that may (or may not) be cancerous. More than eight in 10 eligible women got a Pap test in 2004, reports the ACS.

Those numbers are based on a national health survey.

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: Smith, R. CA: A Cancer Journal for Clinicians, January/February 2006; vol 56: pp 11-25. News release, American Cancer Society.

Screening For Prostate Cancer May Not Reduce Men's Risk Of Death

Screening men for prostate cancer may not reduce their risk for dying, according to a new study in the January 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

More men will have been diagnosed with prostate cancer than any other cancer in 2005 and more than 30,000 men will have died from the disease, according to background information in the article. Men can be screened for prostate cancer by measuring prostate-specific antigen (PSA) levels in the blood and performing digital rectal examination. However, there is little evidence of these tests' effectiveness in reducing death, the authors report. In this context, medical groups differ on screening guidelines; for instance, the American Cancer Society states that doctors should offer the PSA blood test and digital rectal exam annually to men age 50 years or older, whereas the U.S. Preventive Services Task Force has found insufficient evidence to recommend screening and the American College of Physicians advises physicians to counsel men about its benefits and risks.

John Concato, M.D., M.P.H., from the Veterans Affairs (VA) Connecticut Healthcare System, West Haven, and Yale University, New Haven, and colleagues conducted a study to address the question of whether screening improves the chances of survival. From approximately 72,000 veterans receiving health care at any of 10 VA medical centers in New England, they identified 501 men age 50 years and older who were diagnosed with prostate cancer between 1991 and 1995 and had died by the end of 1999. A comparison group of 501 living men was also identified; each man in this control group was matched, for age and treatment at the same center, to a man with prostate cancer who had died. Medical records were reviewed to determine whether men in either group had been screened for prostate cancer.

Seventy - or 14 percent - of the men who died of prostate cancer and 65 (13%) of the men in the control group were screened with PSA. If prostate cancer screening prevented death, fewer men who died would have received screening compared to the men who were living, the authors report. In addition, screening was not found to reduce mortality among men who were younger or healthier or when digital rectal exams were also considered. According to the authors, screening tests can increase the detection of cancer, even at earlier stages, but not necessarily prolong survival.

"Optimal clinical strategies for diagnosing and treating prostate cancer remain uncertain and in need of additional investigation," they write. "Based on available evidence, including the present study, recommendations regarding screening for prostate cancer should not endorse routine testing of asymptomatic men to reduce mortality. Rather, the uncertainty of screening should be explained to patients in a process of 'verbal informed consent,' promoting informed decision making."

Spicing up protection of the prostate

Here's another way to spice up your health: Researchers from Rutgers University have found that turmeric, a spice used in curry dishes, stops prostate cancer cells from dividing in animals.

"We wanted to see whether there was a link between diet and prostate cancer," said Ah-Ng Tony Kong, a professor of pharmaceutics at Rutgers, the State University of New Jersey. Indeed, the researchers found that one month of treatment with turmeric, also known as curcumin, along with phenethyl isothiocyanate (also known as PEITC), was enough to reduce prostate tumors by 60 to 70 percent.

Each substance worked to stop the cancer growth, but they offered the most benefit together. The researchers are now designing a clinical trial to test this combination in men with prostate cancer.

"It is too early to know how much is necessary to have an effect," Kong said. Curry has also popped up in other research laboratories, where it has been tested with positive results against skin cancer cells, breast cancer cells and the sticky plaque that builds up between brain cells in patients with Alzheimer's disease in laboratory studies.

Foods that are high in PEITC include watercress, cabbage, broccoli, Brussels sprouts, kale, cauliflower, kohlrabi and turnips. "The bottom line is that PEITC and curcumin, alone or in combination, demonstrate significant cancer-preventive qualities in laboratory mice, and the combination of PEITC and curcumin could be effective in treating established prostate cancers," Kong said.

The findings were published in the latest issue of the journal Cancer Research.

The researchers injected the mice with curcumin or PEITC, alone or in combination, three times a week for four weeks, beginning a day before the introduction of the prostate cancer cells. The nutrient treatment had no effect, however, on the tumor growth in animals with advanced disease.

Dogs Get Prostate Cancer, Too

It turns out that man's best friend suffers from an affliction that strikes many men: prostate cancer.

In fact, canine cases of the disease are helping scientists learn some new tricks about treating the second deadliest cancer among men.

"The only animal that gets prostate cancer, in addition to men, are dogs," said Dr. Thomas Rosol, of the Ohio State University Comprehensive Cancer Center. "And the disease is very similar in dogs as it is in men."

Rosol has been studying prostate cancer in dogs to learn how advanced cases metastasize, or spread, to the bones. Until now, there hasn't been a good way to study that process.
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By using cancer cells taken from dogs, Rosol's research team created a new cell line - the first that closely mimics prostate cancer cells in humans, which could someday give them insights into new treatments.

"That would be really tremendous, if down the road, we can actually inhibit the bone metastasis," said Rosol. "This would be an enormous breakthrough for human medicine."

Preventing metastasis would be especially valuable for people like Jim Strecker. He's been battling prostate cancer for seven years, but he never felt any pain from it until it spread to his bones. At that point, the pain grew so severe that he couldn't sleep or enjoy his artwork.

"Even doing my sculpture downstairs, my back would get so tired and so painful that I had to stop from time to time," Strecker said.

Strecker eventually found a treatment that makes his condition less painful. But someday doctors may be able to do more than just ease the pain. With the help of man's best friend, they might be able to sculpt a treatment that stops prostate cancer in the first place.

The new cell line is significant because it allows researchers to test new prostate cancer treatments the lab, which is much faster and easier than in humans.

Source: http://www.prostate-search.com/news/prostate-cancer/key-prostate-cancer.php