Cancer Screening & Prevention. Dr. Jamey Burton, MD, FAAFP

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1 Cancer Screening & Prevention Dr. Jamey Burton, MD, FAAFP

2 Cervical Cancer Breast Cancer Colon Cancer Prostate Cancer Lung Cancer

3 How common is cervical cancer? What causes it? What screening is needed? What are the risk factors? Can cervical cancer be prevented? Cervical Cancer: Talking Points

4 Cervical Cancer: Screening Women under age 21 should not be screened Women age 21 to 29: o Pap test every 3 years o HPV testing should NOT be used unless needed as follow-up after an abnormal Pap test result Starting at age 30: o Preferred screening is Pap test WITH an HPV test every 5 years (co-testing) until age 65 o Another option is just a Pap test every 3 years until age 65

5 Cervical Cancer: Screening Women over age 65: o Stop screening o If routine screening x 10 yrs o They haven t had any cancers or serious precancers in the last 20 years A woman who has had a total hysterectomy: o Stop screening o Unless the hysterectomy was done for cervical precancer or cancer. o Woman still with cervix continue routine screening

6 Cervical Cancer: Risk & Prevention HPV infection Not getting screened Smoking Weakened immune system Avoid exposure Get screened Don t smoke Get vaccinated

7 How common is breast cancer? What causes it? What screening is needed? What are the risk factors? Can breast cancer be prevented? Breast Cancer: Talking Points

8 Breast Cancer: Screening ACS For women at average risk for breast cancer o Women ages 40 to 44: start annual breast cancer screening if they wish to do so. o Women ages 45 to 54: mammograms every year. o Women age 55 and older: mammograms every 2 years, or can continue yearly screening. o Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

9 Breast Cancer: Screening USPSTF/AAFP Women 40 to 49: individualized Women 50 to 74: screening every 2 years Women 75 and old: insufficient evidence ACOG > 75: Weight the benefits and risks of screening Other medical problems and life expectancy should be considered (< 10 years)

10 Breast Cancer: Risk Factors & Prevention Gender Age Race Prior breast cancer Genetic/family history Childbirth in later life, or none Taking birth control Hormone replacement therapy Alcohol use Overweight Dense breast tissue Not breasfeeding Physical activity Get to and stay at healthy weight Limit alcohol use Try non-hormonal birth control Not using hormone therapy for menopause Get screened

11 How common is colon cancer? What causes it? What screening is needed? What are the risk factors? Can colon cancer be prevented? Colon Cancer: Talking Points

12 Colon Cancer: Screening ACS At age 50, both men and women should begin regular screening: o Flexible sigmoidoscopy (FSIG) every 5 years* o Colonoscopy every 10 years o Double contrast barium enema (DCBE) every 5 years* o CT colonography (virtual colonoscopy) every 5 years* o Guaiac-based fecal occult blood test (gfobt) every year* o Fecal immunochemical test (FIT) every year* o Stool DNA test (sdna) every 3 years*

13 Colon Cancer: Screening USPSTF/AAFP Patient 50 to 75 years: screening with fecal occult blood, sigmoidoscopy, or colonoscopy Patients 76 to 85 years: not recommended, but may be considered in certain individuals Patients > 85: should not be screened AGS Screening should not be performed in patients with life expectancy < 10 years

14 Colon Cancer Risk Factors & Prevention Age Diet (high in red meat) Sedentary lifestyle Smoking Diabetes Heavy alcohol use Overweight Inflammatory Bowel Disease Personal/Prior history adenomatous polyps or cancer Stay a healthy weight Be active Eat more fruits/vegetables Limit red meat Limit alcohol intake GET SCREENED! Don t smoke

15 How common is prostate cancer? What causes it? What screening is needed? What are the risk factors? Can prostate cancer be prevented? Prostate Cancer: Talking Points

16 Prostate Cancer: Screening USPSTF/AAFP Does not support routine testing for prostate cancer ACS Starting age 50: Patient should discuss the potential benefits and limitations of prostate cancer screening AUA No screening > 70 and < yr life expectancy Age 55 to 59: Shared decision making

17 Prostate Cancer: Screening Prostate cancer not always life threatening Slowly growing Current data says no proof finding prostate cancer early will have a positive impact on most men Testing helps some, but leads to diagnosis and treatment in others that would have caused no harm Side effects of cancer treatment, i.e. impotence, incontinence, can have major impact on quality of life At autopsy for other causes of death, they re found to have prostate cancer that caused them no problems

18 Prostate Cancer Risk Factors & Prevention Age Race Family history Diet (high in red meats) Eat more fruits/vegetables Limit red meat Speak to your health care provider about screening No vitamins or supplements proven to be of benefit

19 How common is lung cancer? What causes it? What screening is needed? What are the risk factors? Can lung cancer be prevented? Lung Cancer: Talking Points

20 Lung Cancer: Screening ACS Patients who meet ALL of these criteria may be candidates for lung cancer screening: 55 to 74 (USPSTF up to 80) years old In fairly good health Have at least a 30 pack-year smoking history Are either still smoking or have quit smoking within the last 15 years

21 Lung Cancer: Screening Patients who meet the criteria should discuss the benefits, limitations, and potential harms of lung cancer screening with their provider. Insurance may or may not pay for screening. Screening should only be done at facilities that have: The right type of CT scan Experience in using low-dose CT scans for lung cancer screening A team of specialists that can provide the appropriate care and follow-up of patients with abnormal scans.

22 Lung Cancer Risk Factors & Prevention Smoking Radon Asbestos Radioactive materials Inhaled occupational chemicals History of radiation therapy Family/personal history of cancer Air Pollution Don t smoke Heat healthy Avoid radon exposure Avoid exposure to known cancer-causing chemicals

23 Questions?

24 References Cancer screening in Older Patients. American Family Physician: Vol. 93, No.8, pgs April 15, 2016 AMERICAN CANCER SOCIETY website entations/index

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