To Screen Or Not To Screen That Is The Question? Part One
This article is part one of a two part series. Since 2009, the United States Preventive Service Task Force (USPSTF) recommendations for screening have dramatically changed
1) Breast cancer screening with mammogram was not recommended for women age 40 to 50 and every two years was recommended for women 50 to 74 years of age.
2) Pap smears every three years for women over the age of 21 is the current recommendation from the USPSTF.
3) The latest recommendation from the USPSTF is that routine PSA screening is no longer to be performed for the men of any age with the premise that is does not affect survival or mortality.
It is very interesting that these new recommendations come in a day and age when the economy is poor and it is necessary to “save” or “budget”. I want to give you some information that can guide you in making decisions regarding your screening.
Last year the results of ERSPC (European Randomized Study of Screening for Prostate Cancer) which included > 1 million men revealed a decrease in prostate cancer death of 27% after 9 years of follow up and 56% after 14 years. The Prostate Screening Antigen or PSA test costs between $30 to $100 dollars. A biopsy of the prostate is $1500 dollars. The sensitivity of PSA is 63 83% and specificity 90%. Free PSA, PSA density and PSA velocity can improve screening sensitivity and specificity. Prostate cancer is the leading cause of cancer in the United States males and 2nd leading cause of cancer death. Early prostate cancer is curable. So, if you are “high risk” have a family history of prostate cancer, are African American or BRCA positive, you “should” be screened unless your life expectancy is very poor because of comorbidities.
Cervical cancer used to be the leading cause of cancer death for women in the United States 40 years ago but thanks to routine pap smears that can detect precancerous lesions the mortality has decreased significantly. Still >12,000 women will be diagnosed with cervical cancer and ~ 4000 will die of the disease. The lowest incidence of cervical cancer in the world is in Sweden where home kits are mailed to the entire population. HPV (human papilloma viruses) is the primary risk factor for cervical cancer and the likelihood of contracting HPV is increased with a higher number of sexual partners. Granted the HPV vaccine will help the future generations provided people comply with recommendations but let us not go back to the dark ages. If you are “not” sexually active or if you can guarantee that you are in a monogamous relationship then it is fine to have a pap smear every three years, in all other cases it should probably be more frequently, discuss your situation with your gynecologist.