The End Of Screening For Prostate Cancer In Men Over Age 75

In a move that could lead to significant changes in medical care for older men, a national task force on Monday recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group was causing more harm than good.

The guidelines, issued by the U.S. Preventive Services Task Force and published on Tuesday in the Annals of Internal Medicine, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence.
Screening is typically performed with a blood test measuring prostate-specific antigen, or PSA, levels. Widespread PSA testing has led to high rates of detection. Last year, more than 218,000 men learned they had the disease.
Yet various studies suggest the disease is “overdiagnosed” — that is, detected at a point when the disease most likely would not affect life expectancy — in 29 percent to 44 percent of cases. Prostate cancer often progresses very slowly, and a large number of these cancers discovered through screening will probably never cause symptoms during the patient’s lifetime, particularly for men in their 70s and 80s. At the same time, aggressive treatment of prostate cancer can greatly reduce a patient’s quality of life, resulting in complications like impotency and incontinence.
Past task force guidelines noted there was no benefit to prostate cancer screening in men with less than 10 years left to live. Since it can be difficult to assess life expectancy, it was an informal recommendation that had limited impact on screening practices. The new guidelines take a more definitive stand, however, stating that the age of 75 is clearly the point at which screening is no longer appropriate.
Dr. Calonge said it was important that the guidelines not be viewed as “giving up” on older men. While the new rules should discourage routine testing of older patients, the recommendations will not prevent a man from seeking screening if he desires it, Dr. Calonge said. The new guidelines are not expected to alter Medicare’s current reimbursement for annual PSA screening of older men.
The guidelines focus on the screening of healthy older men without symptoms and will not affect treatment of men who go to the doctor with symptoms of prostate cancer, like frequent or painful urination or blood in the urine or the semen.
While the verdict is still out on younger men, the data for older men are more conclusive, experts say. The American Cancer Society and the American Urological Association both say annual PSA screening should be offered to average-risk men 50 and older, but only if they have a greater than 10-year life expectancy.
Treatments for prostate cancer can cause significant harm, rendering men incontinent or impotent, or leaving them with other urethral, bowel or bladder problems. Hormone treatments can cause weight gain, hot flashes, loss of muscle tone and osteoporosis.
Bottom Line: If you are 75 years of age or older, you probably don’t need any additional screening for prostate cancer.

This blog was excerpted from The New York Times, October 4, 2013

Screening For Colorectal Cancer

If you don’t have time to read this blog on colorectal cancer, do take the time to look at this informative and humorous video from Israel about screening colonoscopy. Click Here To View Video

Colorectal cancer is a disease in which cells in the colon or rectum become abnormal and divide without control, forming a mass called a tumor. Colorectal cancer is the third most common type of non-skin cancer in men (after prostate cancer and lung cancer) and in women (after breast cancer and lung cancer). It is the second leading cause of cancer death in the United States after lung cancer. Although the rate of new colorectal cancer cases and deaths is decreasing in this country, an estimated 141,210 new cases of colorectal cancer and 49,380 deaths from this disease are expected to occur in 2012.

Risk of Developing Colorectal Cancer
Colorectal cancer is more likely to occur as people get older. Although this disease can occur at any age, most people who develop colorectal cancer are over age 50.

Polyps are abnormal growths that protrude from the inner wall of the colon or rectum. They are relatively common in people over age 50. Most polyps are benign(noncancerous), but experts believe that the majority of colorectal cancers develop in polyps known as adenomas. Detecting and removing these growths may help prevent colorectal cancer.

A person who has already had colorectal cancer is at an increased risk of developing colorectal cancer a second time. Also, research studies have shown that some women with a history of ovarian, uterine, or breast cancer have a higher than average chance of developing colorectal cancer.

Close relatives (parents, siblings, or children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves, especially if the family member developed the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.

Ulcerative colitis is a condition that causes inflammation and sores (ulcers) in the lining of the colon. Crohn colitis (also called Crohn disease) causes chronic inflammation of the gastrointestinal tract, most often of the small intestine (the part of the digestive tract that is located between the stomach and the large intestine). People who have ulcerative colitis or

Crohn’s colitis may be more likely to develop colorectal cancer than people who do not have these conditions.
Some evidence suggests that the development of colorectal cancer may be associated with high dietary consumption of red and processed meats and low consumption of whole grains, fruits, and vegetables. Some evidence suggests that a sedentary lifestyle may be associated with an increased risk of developing colorectal cancer. In contrast, people who exercise regularly may have a decreased risk of developing colorectal cancer. Increasing evidence from epidemiologic studies suggests that cigarette smoking, particularly long-term smoking, increases the risk of colorectal cancer.

Why screening is important? Screening is checking for health problems before they cause symptoms. Colorectal cancer screening can detect cancer; polyps; nonpolypoid lesions, which are flat or slightly depressed areas of abnormal cell growth; and other conditions.

Screening Methods Your doctor may suggest one or more of the following tests for colorectal cancer screening: Fecal occult blood test (FOBT) checks for hidden blood in fecal material (stool). The guaiac FOBT, uses the chemical guaiac to detect blood in samples of stool.

Colonoscopy—examines the colon using a lighted instrument called a colonoscope. During colonoscopy, precancerous and cancerous growths throughout the colon can be found and either removed or biopsied. This procedure is usually done in the doctor’s office or in an ambulatory treatment center. Most patients are sedated during the procedure.

Bottom Line: People should talk with their health care provider about when to begin screening for colorectal cancer, what tests to have, the benefits and risks (potential harms) of each test, and how often to schedule appointments.

To Screen Or Not Screen-That’s the Question, What’s the Answer?

Annual cancer tests are becoming a thing of the past. New guidelines for cervical cancer screening have experts at odds over some things, but they are united in the view that the common practice of getting a Pap test for cervical cancer every year is too often and probably doing more harm than good.
A Pap smear once every three years is the best way to detect cervical cancer. Recently it was recommended against prostate cancer screening with PSA tests, which many men get every year.
Two years ago, it said mammograms to check for breast cancer are only needed every other year starting at age 50, although the American Cancer Society still advises annual tests starting at age 40. A large study found more false alarms for women getting mammograms every year instead of every other year.
It’s a fact that the more tests that you do, the more likely you are to be faced with a false-positive test that leads to unnecessary biopsies and possible harm. We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen from screening.
Those benefits are substantial. Cervical cancer has declined dramatically in the United States, from nearly 15 cases for every 100,000 women in 1975 to nearly 7 per 100,000 in 2008. About 12,200 new cases and 4,210 deaths from the disease occurred last year, most of them in women who have never been screened or not in the past five years.
The cancer society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, could improve screening. Instead, reaching women who are not being adequately screened now probably could save more lives.
Bottom Line: Patients need to be informed about the benefits vs. the risks of screening. By being knowledgeable about the screening tests and having a discussion with your doctor is the best way to come to a decision about screening in your situation.

WSYDD-What Should Your Doctor Do?-Suggestions For Dialog With Your Primary Care Doctor

According to the National Physicians Alliance, these are five guidelines that your primary care physician should follow:

 

1. Don’t do imaging for low back pain within the first six weeks.  Although low back pain is the fifth most common reason for all physician visits, X-rays of the lumbar spine before six weeks does not improve outcomes but does increase costs.

 

2. Don’t obtain blood chemistry panels (glucose, calcium, uric acid) or urinalyses for screening in asymptomatic, healthy adults.  It is recommended to do lipid screening (cholesterol, triglycerides) which yields significant numbers of positive results even among asymptomatic patients.  It is appropriate to screen for diabetes with a glucose test in asymptomatic adults with hypertension

3. Don’t order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.  There is little evidence that detection of heart disease in asymptomatic patients at low risk for coronary heart disease improves health outcomes.  False positive results are common and false-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment, and misdiagnosis

4. Use only generic statins (Mevacor^® (lovastatin) Pravachol^® (pravastatin),Zocor^® (simvastatin) when initiating lipid-lowering drug therapy.  All statins are effective in decreasing mortality, heart attacks, and strokes when dose is titrated to effect appropriate LDL-cholesterol reduction.  It is acceptable to switch to more expensive brand-name statins (atrovastatin [Lipitor] or rosuvastatin [Crestor]) only if generic statins cause clinical reactions or do not achieve LDL-cholesterol goals

5. Don’t use DEXA screening (test for bone mineral density) for osteoporosis in women under age 65 or men under 70 with no risk factors.  This test is not cost effective in younger, low-risk patients, but is cost effective in older patients

Bottom Line: So What Should Your Doctor Do?  He or she should weight the potential harms of routine annual screening to make sure the harms are much less than the potential benefit.  Only with a meaningful dialog should routine testing and screening be performed in asymptomatic young men and women.