Cancer Screening and Prevention
from "Your Health Magazine," October 2010
As we have acquired increasing knowledge about various cancers, prevention and screening have become a bigger component of medicine.
Lung cancer is one the most preventable cancers by simple smoking cessation or avoidance. Nowadays, there are numerous smoking cessation aides ranging from chewing gums to pills to patches, hypnosis and even artificial cigarettes. Many states also have in place non smoking bans in most public places to reduce second hand smoke. As far as screening, none is still recommended since a large study with spiral CT’s was completed recently showing earlier detection but no improvement in survival.
One cancer where we have seen very effective screening and prevention is cervical cancer. Screening with pap smears had considerably increased early detection and decreased mortality. As far as prevention, there are currently two FDA approved vaccines against HPV that are recommended for all girls starting at the age of 11. The vaccine may have an impact on preventing anal cancer as well as 30% of head and neck cancer that is caused by HPV.
We are all familiar with the breast cancer screening controversy. I agree with the American Cancer Society and the ASCO recommendation of yearly screening mammograms starting at the age of 40. We now have digital mammograms that are better quality for high risk patients with BRCA mutations, LCIS, strong family history or history of radiation to the chest for Hodgkin’s lymphoma. MRI of the breast is recommended in addition to mammogram. For breast cancer prevention, we have data that decreasing the body mass index with diet and exercise helps. Tamoxifen for patients with atypical hyperplasia, DCIS, LCIS or strong family history is available, in BRCA carriers bilateral mastectomy has shown to prevent breast cancer 90%.
Colonoscopy starting at the age of 50 is the standard of care for colorectal screening in the general population. For high risk patients like HNPCC (hereditary non-polyposis colorectal cancer) or FAP (familial adenomatous polyposis) carriers it is much earlier and more frequent. As far as prevention, a diet high in fiber and low in red meat are effective for the general population and colectomy for the high risk patients.
Prostate cancer screening is still DRE and PSA starting at the age of 50 for the general population and the age of 45 for high risk patients including African American males and patients with family history of prostate cancer. Finasteride for prevention is still somewhat controversial due to the fact that some studies showed decrease in incidence of prostate cancer but the cancers that developed were very aggressive. Diet and exercise seem to benefit cancer incidence across the board.