Cancer Screening

There is a panel of medical experts who work for the United States government call the USPSTF – United States Preventative Service Task Force. It is their job to decide who lives and who dies. No, not really, but kind of. It is their job to decide, amongst other things, which screening tests for cancer make sense and which don’t. Their decisions are based on a variety of factors (check out the USPSTF website for complete details.) These include but are not limited to, prevalence of the cancer, cost of the test to society, risk of the test to the patient, accuracy of the test and the potential benefit that can be gained with an early diagnosis. Doctors use this information but more importantly, insurance companies, who sadly outrank doctors in many instances, use this information to allot their funds. Today the list summarizes these screening recommendations. I have also tried to note where specialist groups differ in their recommendations. Remember that your body has not read the textbook. Each patient is different and your health care provider may suggest following a different course, usually based on your risk factors and family history.

1. Breast Cancer – You may remember that the mammography screening guidelines were all over the news last year, people were up in arms and rightfully so. For more breast cancer information, check in tomorrow.
Current guidelines:
USPSTF – biennial (yes, I looked it up and it DOES mean every two years) mammography from the age of 50 to the age of 75 (after that, you’re on your own.)
– no self-breast exams
– genetic testing if there is a strong family history of breast and ovarian cancer
ACOG (American College of Obstetrics and Gynecology) – mammography every 1-2 years starting at age 40 and every year after age 50.
– as far as I can tell, they still believe in self breast exams (Why not? How often do you have an excuse?)

2. Cervical Cancer
USPSTF – pap smears beginning within 3 years of sexual activity (or at 21 years old b/c they must agree with Dr. House that all patients lie) every 3 years.
ACOG – pap smears every 2 years starting at age 21. Over the age of 30, if you have had 3 negative consecutive paps, you can space out to every 3 years.
Please, please, please, please know that paps screen only for cervical cancer. They tell us nothing about uterine or ovarian cancer.

3. Colon Cancer
USPSTF – fecal occult blood testing (it is just what it sounds like), sigmoidoscopy (examination of just the lower part of the colon and the rectum) or colonoscopy routinely from the age of 50 to 75
AGA (American Gastroenterological Association) – fecal occult blood testing starting at the age of 50. The age of 50 used to seem so far away but already, I can practically taste the liquid colon cleanser.
– sigmoidoscopy starting at the age of 50, every 5 years unless you have a colonoscopy
– colonoscopy at age 50 and every 10 years thereafter
* Cat Scan imaging can also be used to screen for colon cancer and doesn’t that sound SO much more pleasant? The greatest upside to colonoscopy though, is that your physician can treat you while he is doing the test. If you have a pre-cancerous polyp, he or she can remove it immediately.

4. USPSTF cannot find significant evidence to recommend screening for prostate (AUA recommends PSA testing in 40 year olds and over), skin or oral cancer.

5. USPSTF, based on evidence, recommends against screening for ovarian, pancreatic and testicular cancer (When my sons get older, I will recommend self exams for testicular cancer. What’s the difference? Their hands are always there anyway. They may as well be useful.

Again, you are an individual with individual screening needs. These are just guidelines. You have to take responsibility for your own health and well-being. Remember too, that knowing is always better than not knowing. This is true for both infidelity AND cancer. In both cases, you want to find out with enough time to kick the bum out.
And, there you have it — a very dry martini … I mean, topic. Boring but important, that’s why I throw a few olives in mine

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