Advice for Smarter, Cost-Saving Cancer Screening

Cancer screening advice released, less frequent mammograms and Pap smears among suggestions

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Catching cancer early can save lives, but screening too often — without good reason — may be costly and harmful.

A new study from the American College of Physicians (ACP) offered some advice for doctors about screening cancer sensibly.

“The largest harm that can result from overly intense screening is over-diagnosis and overtreatment,” said Wayne J. Riley, MD, president of the ACP, in a press release. “The more sensitive the test we use or lower the threshold we establish for an abnormality the more abnormalities we find — many of which will never lead to health problems.”

The authors of this study, led by Amir Qaseem, MD, PhD, of the ACP in Philadelphia, PA, looked at five common cancers that are often screened for: breast, cervical, colorectal (colon or rectum), ovarian and prostate cancer.

Dr. Qaseem and team looked at studies from of a number of groups, such as the American Academy of Family Physicians. They compiled advice from these groups for average-risk adults without cancer symptoms.

Dr. Qaseem and team said that sometimes screenings are not needed — such as Pap smears (a test for cervical cancer) in women without a uterus, or screenings in patients who are not expected to live long. In cases like these, these screenings may even harm the patient.

These researchers recommended a mammogram or discussions about breast cancer screening take place at least every two years for women ages 40 to 74.

Dr. Qaseem and team also recommended women get their first Pap smear by age 21. Women should get a repeat Pap smear every three years after that. However, if a woman has several negative tests prior to age 65, she may discontinue her Pap smears at that age.

For colorectal cancer screening, Dr. Qaseem and team recommended men and women ages 50 to 75 have a colonoscopy every 10 years, a sigmoidoscopy every five years, and either a fecal immunochemical test (FIT) or fecal occult blood test (FOBT) every five years.

In a colonoscopy, a thin tube is inserted into the rectum to look for signs of colorectal cancer. A sigmoidoscopy is similar to a colonoscopy, but the tube does not reach as far into the colon. Both FIT and FOBT tests look for hidden blood in the stool.

Dr. Qaseem and team advised that prostate cancer be discussed with men ages 50 to 69, but screenings may not need to be routine.

This study did not advise any screening for ovarian cancer.

Dr. Qaseem and team argued that if less intense unnecessary screenings were done, more money could be given to groups that need cancer screenings and are typically underserviced. They also stressed that educating doctors and the public about less intense screening may take time.

"As the nation comes to terms with the need to reduce the harms and costs of excessively intensive medical care, we hope that advice such as this from the ACP can contribute to the understanding that lower intensity may provide greater value," these researchers wrote.

Brian D. Lawenda, MD, national director of Integrative Oncology and Cancer Survivorship at 21st Century Oncology in Las Vegas, told dailyRx News that "[This] cancer screening advice hits the nail on the head."

However, Dr. Lawenda said that the the study's advice assumes that doctors have extensive knowledge of evolving cancer screening technology, and its potential risks and side effects.

"Most busy primary care physicians simply do not have the time to sit down with patients for the 30 minutes or more needed to counsel patients on these essential points," Dr. Lawenda said. "I applaud the ACP on their excellent advice, but it has challenging implementation issues that need to be addressed before there can be widespread adoption."

The ACP stressed that this study compiled its advice from multiple groups' guidelines, but is not offering guidelines itself.

Patients should discuss all cancer screening with their doctor, as screening strategies can vary considerably based on a patient's medical history.

These articles were published May 18 in the journal Annals of Internal Medicine.

The American College of Physicians funded this research. The authors disclosed no conflicts of interest.

Review Date: 
May 17, 2015
Last Updated:
May 20, 2015