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Cancer Screening

The Importance Of Being 'In The Know'

One of the goals of National Prostate Cancer Awareness Month (September) and National Breast Cancer Awareness Month (October) is to encourage people to get regular screenings, which can detect cancers in their earliest and most treatable stages. But keeping abreast of the latest recommendations for cancer screenings—particularly prostate and breast cancers—can be confusing. Screening recommendations for these types of cancer have been debated in recent years across the country, leading to large studies, ongoing research, and conflicting information provided to the public. That's why it is important for people to be aware of universal recommendations and to speak with their doctors about screenings, early detection, and risk factors including age and family history that should be considered when planning individual screening schedules. Regular screening keeps patients and their doctors informed about health statuses, and in doing so, saves lives.

Prostate Cancer Screening Recommendations

September has been designated National Prostate Cancer Awareness Month to direct attention to the most common cancer in men besides skin cancer. Approximately one in six men will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society (ACS). But finding prostate cancer early can help improve prognoses

PSA and DRE
Prostate cancer can often be found early through screening. Physicians can screen for prostate cancer by testing the amount of prostate-specific antigen (PSA), a protein produced by the prostate gland that circulates in a man's blood. Healthy prostates generate low levels of PSA in the blood; high levels may indicate disease. Physicians can also screen for prostate cancer by feeling the prostate gland with a gloved finger through the rectum, otherwise known as the digital rectal exam (DRE). The purpose of this exam is to look for any irregularities in size, shape, and texture of the prostate. Abnormal results from either the PSA test or DRE require further testing, such as biopsies, to determine the presence of cancer.

Screening for prostate cancer has sparked controversy nationwide, with some researchers debating the accuracy and usefulness of the PSA blood test and weighing its benefits against the any side effects of more invasive follow-up testing. Nonetheless, many physicians and organizations advocate for screening because of its advantages.

According to Dr. Gulam Bhimani, board certified urologist on staff at Sturdy, "PSA and DRE are not 100 percent accurate, but help detect cancers before they reach advanced stages and therefore improve treatment outcomes. Screening for prostate cancer is valuable, and saves lives."

Organizations including the ACS and the American Urological Association (AUA) recommend that men who are in good health and who have more than a 10-15 year life expectancy should have the choice to be screened and should make informed decisions about the issue with their physicians.

Recommendations Based on Risk Factors
"Generally, men are advised to begin talking with their doctors about prostate cancer and screening at age 50," says Dr. Bhimani. This will allow patients to determine screening start dates and schedules based on individual need.

Men with a higher risk of developing prostate cancer are African-American men and men who have a first-degree relative such as a father, brother, or son diagnosed with prostate cancer before they turned 65. "This high-risk population should discuss prostate cancer screening with their doctors beginning at age 45," says Dr. Bhimani. "Men who have more than one first-degree relative who had prostate cancer should talk to their doctors at age 40." The time between future screenings depends on the results of the PSA blood test, but ranges between every one to two years.

"While some prostate cancers grow and spread quickly, most grow slowly; so slowly that these patients may never need treatment," says Dr. Bhimani. For patients with slow-growing prostate cancer, active surveillance with testing on a regular basis to see if the cancer is growing, or watching to see if symptoms change, is preferred over treating the disease. Patients with more aggressive prostate cancers can be treated with options including surgery, cryosurgery, radiation therapy, or chemotherapy, all of which are available at Sturdy.

"Nonetheless, taking the proactive step of screening appropriate patients puts doctors and patients 'in the know,' and it's better to know about the presence and status of a cancer, than not," says Dr. Bhimani.

Breast Cancer Screening Recommendations

According to the ACS, breast cancer is the most common cancer among American women, except for skin cancers, and is the second leading cause of cancer death among women. Because of the dangers that come with breast cancer, and because it also—although less commonly—affects men, October has been designated National Breast Cancer Awareness Month to alert the public of this disease.

Mammography
Mammograms, which are x-ray examinations of the breast, help detect breast cancer. "In recent years, however, controversy over breast cancer screening has been related to the age at which women should begin mammograms, and how frequently they should receive these screenings," says Dr. Marcy Bernstein, board certified surgeon at Sturdy who specializes in general surgery and diseases of the breast. "Routine mammograms for women between ages 50 and 69 is universally accepted, but some physicians and researchers have challenged the usefulness and accuracy of mammograms for age groups outside this bracket."

Still, mammography remains a vital tool that has helped save lives and decrease overall breast cancer mortality over the years. "For this reason, here at Sturdy, we follow the American Cancer Society's recommendation for women age 40 and older to have a screening mammogram every year, for as long as they are in good health," says Dr. Bernstein.

Sturdy offers digital mammography, which is a relatively new technology that uses digital images instead of film to offer improved resolution and enhanced visualization, and uses less radiation than film mammography to provide these images.

"With digital mammography, Sturdy is able to provide patients with the best technique available to screen for breast cancer," says Dr. Heather Hardie, board certified radiologist at Sturdy. "A screening mammogram usually consists of two views of each breast. Occasionally, another view may be added to fully visualize the patients’ breasts."

Dr. Hardie adds that "approximately five to 10 percent of patients are asked to return for additional diagnostic images to clarify possible findings on their screening mammogram, and a small percentage of these women may need further evaluation with ultrasound or biopsy."

Recommendations Based on Risk Factors
In addition to the ACS, other major medical organizations with demonstrated expertise in breast cancer care including the American Congress of Obstetricians and Gynecologists (ACOG), the American College of Radiology (ACR), and the National Comprehensive Cancer Network (NCCN), recommend that all women have yearly mammograms beginning at age 40.

"Certain populations should be screened for breast cancer earlier than 40, however," says Dr. Bernstein. "Women with personal or family history or genetic predisposition to breast cancer are at higher risk than the general population for getting breast cancer. These at-risk groups should talk with their health care providers about breast cancer screening." High-risk populations, as well as women who have had breast augmentation, might be candidates for other screening such as ultrasound or magnetic resonance imaging (MRI).

"Women whose mothers had breast cancer are advised to start breast cancer screening at an age 10 years earlier than the age their mothers were diagnosed," says Dr. Hardie. "In other words, if a mother was diagnosed at age 44, her daughter should begin routine screening at age 34."

Other Screening Options
The ACS also advises women in their 20s and 30s to have a clinical breast exam (CBE) as part of a regular health exam by a health professional, at least every three years. Additionally, breast self exam (BSE) is an option for women starting in their 20s, who should report any breast changes to their health professional right away.

"Regular breast cancer screening can find cancers before they cause symptoms, or when they are small and still confined to the breast. This improves prognoses, making regular screening a life-saving tool and an important topic to learn about and discuss with your doctor," says Dr. Bernstein.

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