A doctors' group is trying to clear up confusion over cancer-screening guidelines that have evolved and gotten complicated in recent years. In the recent Annals of Internal Medicine, the American College of Physicians is encouraging more discussion of the pros and cons of testing and emphasizing "high-value screening" for five types of tumors: breast, colorectal, cervical, prostate and ovarian cancer.
Too often, even the doctors who order those tests aren't sure of the latest recommendations, said Dr. Wayne J. Riley, president of the American College of Physicians, which published the advice Monday in the journal Annals of Internal Medicine.
The American Cancer Society recommends starting annual mammograms at age 40. However, the U.S. Preventive Services Task Force advises getting mammograms every other year from age 50 to 74. The task force says earlier testing brings little benefit, but should be a choice if patients are given the pros and cons.
As for colorectal cancer, the ACP advised different testing methods besides colonoscopies for people ages 50 to 74, including an annual stool test, a colonoscopy every 10 years, a sigmoidoscopy every five years or a combination of a stool test every three years and a sigmoidoscopy every five years.
The ACP discovered widespread support for a Pap test that could help identify cervical cancer every three years starting at age 21, but said screening choices vary by age. Starting at age 30, a woman may choose a combination of a Pap and HPV test. That combination lets women go five years between tests.
PSA blood tests for prostate cancer have stirred controversy, with some groups advising against them and others saying men should get them only after a discussion of the pros and cons. The ACP's recommendation is that doctors should tell men ages 50 to 69 of the pros and cons, and let them decide. Further, the ACP disclosed that a third of men who receive a PSA test don't recall being told the test was ordered.
Lastly, the ACP found leading groups all advise against blood tests and pelvic or ultrasound exams that screen for ovarian cancer in average-risk women. The ACP said that while ovarian cancer has spread by the time it's discovered, there's no proven screening for it.
Guidelines for cancer screening and treatment are always evolving and are judgment calls, experts say, and the ACP's new recommendations mostly mirror the U.S. Public Health Services Task Force, which is already the industry standard.
As more research about cancer screenings comes out, the more processes will evolve, said Dr. J. Mario Molina, CEO of Molina Healthcare in Long Beach, Calif.
“If we had a perfect test, we'd be using it,” he said.
Cost and premiums won't change, Molina said, because health insurers make the most money in pharmaceutical costs and hospital utilization, and cancer screenings bring less profit to health insurers, anyway.
The ACP's recommendation on breast cancer could cause the most controversy, Molina said, as most women believe a higher number of screening brings a greater chance of identification of a tumor.
Dr. Richard Wender of the American Cancer Society said even though it disagrees on some specifics, emphasizing areas of agreement is valuable, a starting point for those doctor-patient conversations.
Cancer screening is a balance to ensure the people who will benefit most get checked while not over-testing. After all, there are potential harms including false alarms that spark unneeded extra testing, and sometimes detection of tumors too small and slow-growing to be life-threatening.
On the other hand, the Centers for Disease Control and Prevention reported this month that too few people who clearly should be getting screened for certain cancers are. For example, 58% of people ages 50 to 75 had been recently checked for colorectal cancer; the government goal is 70.5%.