TUESDAY, Dec. 20 (HealthDay News) -- As experts alter course on
guidelines for cancer screenings such as mammograms and the
prostate-specific antigen test, the general public is
Women at age 40 wonder if they should have a mammogram to look
for breast cancer or wait until 50, as one U.S. organization
suggests. Men of an age when prostate cancer develops may be told
to forgo the prostate-specific antigen (PSA) test, contrary to
standard past practice. And sexually active women may not feel safe
from cervical cancer if they wait years between Pap tests.
"It's difficult to accept that having less testing is either as good or even better than having more," said Dr. Robert Mayer, faculty vice president for academic affairs at the Dana-Farber Cancer Institute in Boston.
Based on new research, some major cancer groups are advising the
medical profession to be more judicious about who gets tested and
"I don't think the data are as conclusive that screening is as bad or as good as we had hoped," said Dr. David Penson, professor of urologic surgery and director of surgical quality and outcomes research at Vanderbilt University in Nashville.
Probably the most controversial recommendation came from the
U.S. Preventive Services Task Force (USPSTF), a government body
that publishes screening guidelines. It set off a furor two years
ago when it announced that mammograms may not benefit women in
their 40s, while women aged 50 to 74 could safely undergo screening
once every two years instead of annually.
This year, the Canadian Task Force on Preventive Health Care
came out with similar recommendations on breast cancer screening,
suggesting that women aged 40 to 49 at average risk for breast
cancer not get routine mammograms.
This, of course, runs counter to long-standing conventional
wisdom that all women over the age of 40 should undergo a yearly
These organizations reasoned that mammograms can result in false
positives and unnecessary biopsies, harm that in some instances may
outweigh the benefits of this type of screening. Soaring health
costs may also weigh in the decision-making.
However, the American Cancer Society and the American College of
Obstetricians and Gynecologists still advocate screening starting
at age 40.
"I don't see a trend of backing away from endorsement for screening among many organizations," said Robert Smith, senior director of cancer control at the American Cancer Society. "Frankly, I see it in one."
But the medical establishment is backing away from PSA screening
for prostate cancer, because the test is far from perfect,
resulting in many unnecessary biopsies.
Increased PSA levels can indicate cancer, but they are not a
foolproof measure. PSA levels rise naturally as men age, explained
Mayer. Levels can also rise if men have had two or three sexual
experiences in the prior few days.
"There are an enormous number of false positives," Mayer added. "How does one then say what's good for everybody?"
And not all prostate cancers are created equal, some being
highly aggressive and others very slow-growing. Invasive treatment
may be more harmful than watching and waiting, some doctors
"We know that less than 10 percent of men with prostate cancer ever die of the disease," Mayer said. "That's very different from colon cancer, where 40 to 50 percent die from it, or breast cancer, where 30 to 40 percent die from it."
The bottom line for both breast and prostate cancers: Check with
your health care provider on what is the best screening schedule
Cervical cancer screening guidelines have also evolved over the
In October, three groups, including the American Cancer Society,
jointly created guidelines calling for women to get fewer cervical
cancer screenings over their lifetime.
The guidelines also call for combination Pap testing and HPV
(human papillomavirus) testing in women aged 30 and older, placing
stronger emphasis on HPV testing than guidelines officially
released at the same time from the USPSTF.
But the issue here is less controversial. "We have more
sensitive tests in our ability to detect what is a slow-growing
disease," said Smith.
U.S. National Cancer Institute for more on cancer
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