Screening

Screening

Screening advances that lead to early detection have been a major contributor to better survival. Some advances in this area include routine mammography for breast cancer; colonoscopy and fecal occult blood testing for colon cancer; and Pap smears for cervical and endometrial cancers. With colon and cervical cancer screening, doctors can often identify and remove pre-cancerous lesions toprevent cancer from developing.

Recently, a major clinical trial showed that CT scanning can reduce the risk of lung cancer in heavy smokers by catching more cases early. Research is also under way to develop effective screening approaches for ovarian, pancreatic, kidney, and other cancers. 

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2012

Experts caution against unnecessary PSA screenings for prostate cancer

Experts caution against unnecessary PSA screenings for prostate cancer

Debate continues on the value of prostate-specific antigen (PSA) testing for prostate cancer screening.

In May, the U.S. Preventative Services Task Force (USPSTF) recommends against PSA screening, concluding that it does little to reduce the number of deaths from prostate cancer and can lead to unnecessary biopsies and treatment.

Later that year, however, ASCO issues guidance recommending that physicians discuss the benefits and risks of PSA testing with their otherwise healthy male patients who have life expectancies of greater than 10 years. The guidance notes that PSA testing may still offer important benefits for this group of men, but that the risks outweigh the benefits for men with shorter life expectancies.

2010

CT scanning reduces lung cancer deaths among heavy smokers

CT scanning reduces lung cancer deaths among heavy smokers

Results from a large clinical trial show that annual screening with low-dose spiral CT (LDCT) scans reduces the risk of lung cancer death by 20 percent, compared to annual chest X-rays, in current and former heavy smokers.

The National Lung Screening Trial, funded by the National Cancer Institute, compared LDCT scanning to standard chest X-rays in this group of people at high risk for developing lung cancer. This finding marks the first-ever lung cancer screening approach that has been shown to reduce lung cancer mortality. The debate about the appropriate use of LDCT screening for lung cancer among the general population, however, continues.

2009

Men urged to discuss routine PSA testing with doctors

Men urged to discuss routine PSA testing with doctors

Three large, randomized trials provide conflicting results on the use of PSA screening and lead experts to question whether this screening method translates into improved survival and actually saves men's lives. Initial results from two of the trials indicate that PSA testing has a minimal effect on overall survival and leads to the diagnosis and treatment of slow-growing cancers that are unlikely to be life-threatening. The third study finds that PSA testing every two years among men age 60 and older reduces the risk of prostate cancer death by 40 percent. Given the conflicting evidence, leading medical societies urge men to discuss the risks and benefits of screening with their doctors.

Adequate bowel preparation essential for effective colonoscopy

Adequate bowel preparation essential for effective colonoscopy

Researchers show that proper bowel cleansing is essential to ensure the quality of results provided by routine colonoscopies. This cleansing includes adhering to a clear liquid diet and taking a bowel prep (involving a laxative or enema) the day before the procedure. Incomplete preparation is a fairly common problem, due to the dietary restrictions and the potential inconvenience involved.

2008

Flat colon growths more likely to be cancerous than more obvious ones
Microscopic examination improves accuracy of skin cancer screening

Microscopic examination improves accuracy of skin cancer screening

A review of published studies finds that a procedure called dermoscopy – involving direct, microscopic examination of moles and skin lesions – is more accurate than a doctor's visual examination for identifying potential melanomas on the surface of the skin. The review emphasizes the importance of using dermoscopy, which has been available since the 1990s, to ensure that more cancers are detected at an early stage when they are most responsive to treatment.

Specialized CT scan improves bladder cancer detection

Specialized CT scan improves bladder cancer detection

The so-called CT urograph emerges as an effective, non-invasive strategy for detecting new and recurring cancers. The test, which is done externally, evaluates both the upper and lower tracts of the bladder and nearby lymph nodes. CT urography can help determine which patients need more invasive diagnostic procedures, sparing those who do not.

2007

MRI screening recommended for women at high risk of breast cancer

MRI screening recommended for women at high risk of breast cancer

Based on new studies demonstrating its effectiveness, the American Cancer Society releases guidelines recommending routine MRI screening for women at increased risk of developing breast cancer, in combination with standard mammography. MRI is more sensitive than mammography for finding breast lesions, particularly in women with dense breast tissue that is difficult to assess using traditional mammography. Routine MRI is not recommended for the general population of women (those not at increased risk), due to its high cost and the likelihood that it will detect abnormalities that are not cancerous.

2006

Taking more time to perform colonoscopy increases screening accuracy

2005

Conventional colonoscopy established as optimal screening method

Conventional colonoscopy established as optimal screening method

Two studies show that conventional colonoscopy is better able to detect colon cancer than other, less invasive screening techniques such as "virtual colonoscopy," barium enema or fecal DNA testing. Researchers demonstrate that colonoscopy detects 98 to 99 percent of tumors – about twice as many as virtual colonoscopy (the use of CT scanning to provide a three-dimensional image of the colon) or barium enema. Current medical guidelines state that colonoscopy is the superior colorectal cancer screening tool, but emphasize that some form of screening with any of these tests is better than going without screening.

Digital mammography more accurate than standard mammography in younger women

Digital mammography more accurate than standard mammography in younger women

A study of more than 42,000 women reports that digital mammography is more sensitive than traditional film mammography for women under age 50, who are more likely to have dense breast tissue, which is more difficult to assess. Digital mammography enables the radiologist to alter features such as brightness and contrast, improving the detection of abnormalities in breast tissue.

Right-sided colon cancers present a challenge for colonoscopy

Right-sided colon cancers present a challenge for colonoscopy

Researchers find that undergoing a colonoscopy every 10 years reduces the risk of cancer on the left side of the colon, but not on the right side. Subsequent studies confirm that right-sided colon cancers are more likely than those on the left to be missed during the screening procedure because it is harder to reach the right side of the colon and right-sided lesions may be flat and harder to detect.

2004

Screening program for people at high-risk can detect potentially operable pancreatic tumors

Screening program for people at high-risk can detect potentially operable pancreatic tumors

Researchers begin using a combination of screening technologies – CT scan and endoscopic imaging – to screen for pancreatic tumors in patients with a strong family history or genetic predisposition to pancreatic cancer. The goal is to identify cancers at early stages so they can be removed surgically and are potentially curable. Because this screening program is expensive, involves invasive procedures, and has not yet been shown to be cost-effective, it is not appropriate for the general population.

2000

Trial improves management of abnormal Pap test results

Trial improves management of abnormal Pap test results

Ongoing results from a large clinical trial – called the ASCUS-LSIL Triage Study (ALTS) – provide important guidance on managing the mild abnormalities that often show up on Pap tests. These findings help doctors more accurately determine which women need further procedures, such as colposcopy (office procedure using a device that enables a physician to closely examine the cervix for abnormalities) and biopsy to detect pre-cancer or cancer, and which women can be spared from these procedures.