women

Getting patients and doctors to change their approach to cancer screening is hard. But a number of organizations are working on the problem

For example, in an initiative called Choosing Wisely, we are working with more than two dozen medical organizations to identify overused interventions, including screening tests such as Pap smears for women younger than 21. Other organizations, such as the Informed Medical Decisions Foundation, have developed brochures and videos in plain language to help patients navigate complex medical choices. And the U.S. Preventive Services Task Force and other groups are working to provide more nuanced, accurate information on cancer screening tests.

Getting patients and doctors to change their approach to cancer screening is hard

Getting patients and doctors to change their approach to cancer screening is hard

“Cancer turns out to be a much more complicated and unpredictable disease than we used to think,” says Virginia Moyer of the task force. “And the tests we have available to us don’t work as well as we’d hoped, and can even cause harm.

“Scientific evidence shows that some cancer-screening tests work, and people should focus on those tests rather than on screening tests that are only supported by theories and wishful thinking.”

Doctor knows best?

When it comes to cancer screening, most people do what their doctor recommends. Unfortunately, health care providers don’t always agree on which tests are necessary. In fact, research suggests that advice often varies among medical practices.

Although health care providers really publish information on the percentage of their patients who are screened for specific cancers, we were able to get that information from organizations in Massachusetts, Minnesota, and Wisconsin. Because of differences in the data collected from each organization, we can’t compare results. But the numbers illustrate the variation within states, as shown below for colon-cancer screening.

Percentage of patients offered colon-cancer screening

Percentage of patients offered colon-cancer screening

(*: A medical group is one or more medical clinics that operate as a single business.)

Bottom line.

Don’t assume that your doctor will bring up cancer screening or follow guidelines. So educate yourself using our Ratings as a starting point. If you live in one of the states shown below, you can see how practices compare on the organizations’ websites: for Massachusetts, mhqp.org; Minnesota, mnhealthscores.org; Wisconsin, wchq.org.

Three tests to get – and eight to avoid

Screening tests for cervical, colon, and breast cancers are the most effective tests available, according to our first Ratings of cancer screening tests. But most people shouldn’t waste their time on screenings for bladder, lung, oral, ovarian, prostate, pancreatic, skin, and testicular cancers.

Notes that our recommendations often differ with age. For example, colon-cancer screening gets our highest Rating for people age 50 to 75 but our lowest Rating for those 49 and younger, because the cancer is uncommon among younger people.

In addition, the Ratings are for people who are not at high risk; those who are at increased risk, as well as those who have signs or symptoms of cancer, may need the test or should be tested sooner or more often.

Our Ratings are based mainly on reviews from the U.S. Preventive Services Task Force, and independent group supported by the Department of Health and Human Services. We also considered other factors: evidence that emerged after the task force’s report; the number of people affected by the cancer; the cost of testing and treatment; and the benefits of a test beyond its ability to detect cancer.

Do the benefits of the test outweigh the harms?

Very likely

5/5

Likely

4/5

Normal

3/5

Unlikely

2/5

Very Unlikely

1/5

Get these screenings

Cervical cancer

Women age 21 to 30 should have a Pap smear every three years. Those 30 to 65 can go fice years between Pap smears if they have had HPV testing.

Women age 21 to 30 should have a Pap smear every three years. Those 30 to 65 can go fice years between Pap smears if they have had HPV testing.

  • Ratings

5/5 for women age 21 to 65

1/5 for women of all other ages

  • What’s involved

A pap smear (a microscopic analysis of cervical tissue samples) and a human papillomavirus (HPV) test, which looks for the virus that can cause the cancer

  • Who need it

Women age 21 to 30 should have a Pap smear every three years. Those 30 to 65 can go fice years between Pap smears if they have had HPV testing. High-risk women may need to be screened more often women 65 and older don’t need to be tested as long as they’ve had regular screenings when they were younger. Women under 21 don’t need to be screened because the cancer is uncommon before then and the tests are not accurate for them.

  • Risk factors

A family history of the disease, a history of HPV infection, using birth-control pills for five or more years, having three or more children, and having weakened immunity because of HIV infection or other causes.

Colon cancer

People age 50 to 75 should be regularly screened.

People age 50 to 75 should be regularly screened.

  • Ratings

5/5 for people age 50 to 75

3/5 for people 76 to 85

2/5 for people 86 and older

1/5 for people 49 and younger

  • What’s involved

Colonoscopy (exam of the entire colon with a flexible scope) every 10 years, sigmoidoscopy (exam of the lower third of the colon) every five years plus a stool test every three years, or a stool test every year.

  • Who needs it

People age 50 to 75 should be regularly screened. Older people should talk with their doctor about the benefits and harms of the test based on their health and risk factors. Younger people should consider testing only if they are at high risk, because the cancer is uncommon before age 50.

  • Risk factors

A family history of the disease or a personal history of precancerous polyps, inflammatory bowel disease, obesity, smoking, type 2 diabetes, excessive alcohol consumption, and a diet high in red or processed meats.

Breast cancer

Women age 50 to 75 should have mammograms every two years

Women age 50 to 75 should have mammograms every two years

  • Ratings

4/5 for women age 50 to 74

3/5 for women 40 to 49

2/5 for women 75 and older

1/5 for women 39 and younger

  • What’s involved

Mammogram (an X-ray of the breast)

  • Who needs it

Women age 50 to 75 should have mammograms every two years. Women in their 40s or those 75 and older should talk with their doctor to see whether the benefits outweigh the harm based on their risk factors women younger than 40 should consider testing only if they are at high risk, because the cancer is uncommon at that age

  • Risk factors

A personal or family history of the cancer, a personal history of benign breast conditions such as atypical hyperplasia, dense breasts, menstrual periods before age 12 or after age 55, not having a child before age 30, postmenopausal hormone-replacement therapy, obesity, excessive alcohol consumption, smoking, or genetic susceptibility.

 

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