Screening Guidelines: Then and Now
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Cancer Screening Conundrum

Controversy surrounds new cancer screening guidelines.

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By Regina Nuzzo

Screening Guidelines: Then and Now

By Regina Nuzzo



Cervical Cancer

Old guidelines: The American College of Obstetricians and Gynecologists (ACOG) stated that women should start cervical cancer screening about three years after first sexual intercourse, but no later than 21, and then be screened with a Pap test annually. Screening could stop at age 65 or 70 if a woman had had three or more normal test results in the previous decade.

New guidelines: In 2009, ACOG began recommending that women start cervical cancer screening at 21, regardless of age at first sexual intercourse. Women between 21 and 30 should undergo screening once every two years. Women at average risk who are 30 and older should be screened once every three years if they have had three consecutive normal results. Screening can stop at age 65 or 70 if a woman has had three or more normal test results in the previous decade. American Cancer Society (ACS) guidelines are similar, though the ACS recommends that women be tested three years after first sexual intercourse, but not later than 21.

 

Prostate Cancer

Old guidelines: The U.S. Preventive Services Task Force (USPSTF) said there was not enough evidence to recommend or discourage prostate cancer screening with either PSA tests or digital rectal examination (DRE) for men of any age. The ACS recommended that the PSA test and the DRE be offered annually, starting at age 50, for men who had a life expectancy of at least 10 years.

New guidelines: In 2008, the USPSTF began recommending against screening men 75 or older; among men under 75 who are at average risk, there’s not enough evidence to weigh the benefits and harms. In March 2010, the ACS updated its guidelines to recommend that asymptomatic men with a life expectancy of at least 10 years should make an informed decision with their doctor about the potential harms and benefits of screening. Men of average risk should begin this conversation at age 50, while men of increased risk should begin at age 45 or earlier, depending on their situation. Any screening should include a PSA test with or without a DRE.

 

Breast Cancer

Old guidelines: The ACS and the USPSTF recommended routine screening mammography, with or without a clinical breast exam, every one to two years for women age 40 and older.

New guidelines: According to the USPSTF’s 2009 guidelines, average-risk women age 40 to 49 should not receive routine mammography and women 50 to 74 should have mammography every other year; regular screening before the age of 50 is an individual choice and should take a woman’s specific situation, especially her risk factors, into account. There is not enough evidence to determine whether mammography’s benefits outweigh its harms for women 75 and older. It’s also not clear whether clinical breast exams in addition to mammography provide women with any additional benefits. The ACS continues to recommend screening with mammography and a clinical breast exam for all women beginning at age 40.