DON'T FRET OVER CANCER SCREENING

As medical knowledge evolves, new guidelines on cancer screening have created intense debate about the methods used to check for prostate and breast cancer. Despite significant technological improvement, there is still no perfect screening test for most types of cancer. All carry a risk of “false positives” – indicating there is cancer when in fact there is none, leading to costly further tests – and “false negatives”, when cancer exists but is overlooked.

The US Preventive Services Task Force has concluded that the PSA test, the main screening for prostate cancer, causes more trouble than benefit and recommends against it at any age. But as mentioned in a previous column, I believe PSA should still be considered for some men, as long as they’re advised beforehand about the risk and benefit. And, if there is any indication of cancer, they should be referred to specialists.

Another ongoing controversy concerns the age at which women “at moderate risk” should start having mammography exams for breast cancer. The same Preventive Task Force recommends screening every two years from age 50 to 74, discounting younger women because of inconsistent results and relatively little benefit. 

There are several reasons why mammography might be less beneficial for younger women. Those 40 to 49 face far less risk of breast cancer, so there are inevitably going to be more false positives. Younger women tend to have dense breast tissue, which can produce abnormal findings that are difficult to diagnose. And cancers in younger women tend to grow faster, so a mammogram every one to two years is less likely to catch them. 

This last reason, though, also underscores the importance of preventive measures for younger women. 

The American Cancer Society and US National Cancer Institute, on the other hand, advise women to begin undergoing annual mammograms from age 40, as long as they’re healthy. These and other organisations believe the modest benefits outweigh the inconvenience of false positives. Annual health checks also help in the early diagnosis of changes in the upper torso, such as the appearance of lumps, swelling or redness of the breast or rashes and discharges at the nipple.

As with PSA testing, patients should be fully informed about the benefits and risks of screening and, if the need arises, be treated at a good medical centre. 

Even if breast cancer cannot totally be prevented, there are ways to limit the risk. Don’t smoke, limit your use of alcohol and postmenopausal hormones, maintain a healthy body weight, and get regular exercise.

 

Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].