(Reuters Health) - Many patients could be screened less often for certain cancers to minimize their risk of receiving unnecessary follow-up tests or treatment for tumors that are unlikely to become harmful, U.S. doctors recommend.
Less frequent screening for some malignancies, as well as starting tests later in life and ending them earlier in old age, may make sense for some adults without a family history or other risk factors for cancer, according to American College of Physicians (ACP) guidelines published May 18 in the Annals of Internal Medicine.
“There are certain cancers that, even if you detect them, are not going to progress in that person’s lifetime to the point where they will die of this cancer, particularly if they have other medical problems or are already at an advanced age,” said Dr. Amir Qaseem, senior author of the recommendations and director of clinical policy at the ACP.
The new recommendations draw on guidelines previously issued by several medical societies for tumors of the breast, prostate, colon and rectum, cervix and ovaries. The recommendations offer framework to assess the value of screening and concentrate testing efforts on situations when treatment is more likely to be necessary and effective.
In breast cancer, for example, healthy women are generally urged to get mammograms every one to two years starting in their 40s or 50s and continue into their 70s.
But, based on research suggesting mammograms don’t reduce the risk of death for women in their 40s, it may make sense to start this test later in life, the new guidelines propose. In addition, women may be able to stop these exams sooner, by the end of their 50s or 60s, based on some research pointing to a limited benefit from detecting this tumor in women who are only expected to live another 15 to 20 years.
“For average-risk women, we want them to understand that starting screening earlier does not change the outcome,” said Dr. Tanveer Mir, a member of ACP’s high value care task force, which developed the new recommendations.
Instead, screening too early can set women up for a series of invasive tests, Dr. Mir said. “Any abnormalities lead to an MRI (magnetic resonance imaging) and more mammograms, and biopsies depending on the nature of the lesion, and you start on a treadmill of over-testing.”
For prostate cancer, ACP also proposes halting tests when men aren’t expected to live more than another 20 years because late in life men have a less than 1 in 1,000 chance of avoiding death by getting screened. Because common tests for prostate tumors can ultimately lead to side effects such as incontinence and impotence, it can be done less often and stop by age 60.
Even for colorectal cancer, it may be possible to screen every 15 years instead of once a decade without increasing the risk of death, the ACP suggests.
“Most colonoscopies are unnecessary, not going to find a polyp, or find a polyp that is not going to progress,” said Dr. Ian Thompson, director of the Cancer Therapy and Research Center at the University of Texas Health Science Center in San Antonio.
The notion of high-value screening is a sensible way for doctors and patients to decide whether a particular test for cancer makes sense, said Dr. Richard Schilsky, chief medical officer for the American Society of Clinical Oncology. He wasn’t involved in crafting the ACP recommendations.
“No screening test is perfect, and most people who get screened don’t have the disease,” said Dr. Schilsky. “Most people who do have the disease won’t benefit from screening because the disease is so aggressive that they would have died anyway, or because it is so slow-growing they would never have symptoms.”
Ann Intern Med 2015.