Cancer Prevention

Prevention — Perhaps nothing scares a patient than the word ‘cancer’. However, a number of measures can be taken to prevent cancer, including:

●Avoidance of tobacco

●Being physically active

●Maintaining a healthy weight

●Eating a diet rich in fruits, vegetables, and whole grains, and low in saturated/trans fat

●Limiting alcohol consumption

●Protecting against sexually transmitted infections

●Avoiding excess sun

●Getting regular screening for breast, cervical, and colorectal cancer

Prevention is most effective for cancers that are strongly and causally associated with tobacco use: cancers of the oropharynx, bladder, esophagus, and lung.

Breast cancer — Major risk factors for breast cancer in women are age, genetic predisposition, and estrogen exposure. Evaluation for hereditary breast and ovarian cancer syndromes should be considered in men and women with a personal or family history that is concerning.

●Family history – Men and women at risk for hereditary breast and ovarian cancer syndromes should be identified by taking a thorough personal and family history, with a focus on both the maternal and paternal sides of the family. Patients with concerning family history should be referred to a genetic counselor for a formal genetic assessment.

●Screening for average-risk women – Clinicians should discuss breast cancer screening with all women starting at age 40. The decision to perform mammography should be determined by individual patient risk and values through shared decision-making. It should be emphasized that the relative benefits and harms of screening change as a woman gets older. The absolute benefits, in terms of numbers of lives saved, are lower for younger women than for older women because of both decreased incidence of breast cancer and sensitivity of mammography in younger women.

Screen with mammography every two years. 

●Age to stop screening – We suggest that breast cancer screening with mammography be continued as long as a woman has a life expectancy of at least 10 years.

We suggest that breast self-examination (BSE) not be performed except by women who express a desire to do so and who have received careful instruction to differentiate normal tissue from suspicious lumps. BSE should only be performed as an adjunct to mammography and clinical breast examination, not as a substitute for these screening methods.

Cervical cancer — We recommend cervical cancer screening for immunocompetent women ages 21 to 65 years who have an intact cervix.

●For average-risk women (without human immunodeficiency virus [HIV] or immunocompromise) aged 21 to 29, we suggest Pap smear screening every three years.

●For average-risk women (without HIV or immunocompromise) aged 30 to 64, we suggest either Pap smear screening every three years or co-testing (Pap smear and human papillomavirus [HPV] testing) every five years if both initial tests are negative.

●Women ≥65 years who have had adequate negative prior screening and are not at increased risk do not need to be screened.

However, even in older women who have been adequately screened, it may be reasonable to continue to screen those with good life expectancy who have risk factors for cervical cancer. Risk factors include a history of an abnormal Pap test, current smoker or history of smoking, previous HPV-related disease, or new partners. We continue to offer screening to women with good life expectancy who have risk factors for cervical cancer until about age 80, but the upper age limit may vary with the risk factor (eg, women with good life expectancy and a history of CIN 2 or greater should be screened for at least 20 years following diagnosis).

●Older women who have not been adequately screened should be screened until age 70 to 75 years.

●Women who have had a total hysterectomy for reasons other than cervical cancer or high-grade cervical cancer precursors need not be screened.

Ovarian cancer — Screening for ovarian cancer is not recommended for average-risk women.

Colorectal cancer — The age of initiation and frequency of colorectal cancer screening varies with the risk:

●No risk factors – We recommend that average-risk patients aged 50 and older be screened for colorectal cancer. We suggest that screening be continued until the life expectancy for an individual patient is estimated as less than 10 years. For most patients, it is reasonable to stop screening at age 75 years or 85 years at the latest. One-time screening with colonoscopy (to age 83) or sigmoidoscopy (to age 84) is advised for adults who have never been screened for colorectal cancer.

Lung cancer — Smoking tobacco products (primarily cigarettes) is the most important risk factor for the development of lung cancer. All patients who smoke should be counselled to quit smoking as the most effective intervention to reduce the risk of lung cancer.

We suggest annual screening with low-dose helical computed tomography (CT) for patients in whom the cost of screening is not an issue if they are in good health, at risk for lung cancer (age 55 to 74 years; history of smoking at least 30 pack-years and, if a former smoker, and had quit within the previous 15 years). 

Prostate cancer — Individual patient preferences for specific health outcomes are a deciding factor in determining whether to screen for prostate cancer.

Health care providers should periodically discuss prostate cancer screening with men who are expected to live at least 10 years and are old enough to be at significant risk for prostate cancer. We suggest that discussions begin at age 50 in average-risk men. We suggest discussions begin at age 40 to 45 in men at high risk for prostate cancer (including black men, men with a family history of prostate cancer, particularly in relatives younger than age 65, and men who are known or likely to have the BRCA1 or BRCA2 mutations).

When a decision is made to screen, we suggest that screening be performed with prostate-specific antigen (PSA) tests at intervals ranging from every two to four years. We suggest not performing digital rectal examination as part of screening.

Melanoma

●We recommend that individuals at highest risk (history suggesting a familial melanoma syndrome or with multiple atypical nevi) have a regular full-body skin examination by a clinician with skin expertise.

●We suggest that persons at higher risk for melanoma (white men over 50 years, individuals with a history of significant sunburn, or multiple moles) have a periodic full body skin examination performed by a clinician who has had appropriate training in the identification of melanoma.

●We also suggest that individuals at high risk for skin cancer be counseled about self-skin examination and advised to examine their skin regularly and notify their clinicians if moles change.

While we may not be able to prevent all cancers, by taking above precautions we can at least detect them in early stages and start appropriate treatment. 

If you need any testing for cancer, please visit Dr.Paul’s Clinic at your convenience. Call us at 814 424 2095. 

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