This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Inappropriate Cancer Screenings Continue, Study Finds
Active Monitoring of Low-risk Prostate Cancer Gets Closer Look
By News Staff
"Despite USPSTF guidelines recommending against routine screening for breast, cervical, colorectal and prostate cancer at the age of 75 years (65 years for cervical cancer), over 50 percent of physicians are continuing to recommend these screening tests in older men and women," the researchers noted. "Interestingly, these high recommendation rates continue in the group 80 years or older for colorectal (54 percent), breast (50 percent) and prostate (53 percent)."
- A recent study found that older patients, including men ages 75 and older, continue to receive prostate-specific antigen-based and other cancer screenings at a high rate, regardless of evidence-based clinical guideline recommendations to the contrary.
- Meanwhile, a panel convened by the Agency for Healthcare Research and Quality examined the role of active surveillance in men with low-risk prostate cancer.
- The panel concluded that no clear standard exists regarding which monitoring strategies are most likely to optimize patient outcomes and recommended further research to determine the best protocols for managing low-risk disease.
"This finding reinforces the critical role for health care providers to make informed screening decision(s) for older adults," said the authors.
Meanwhile, a new evidence report (341-page PDF; About PDFs) from the Agency for Healthcare Research and Quality (AHRQ) examines the role of active surveillance in men with low-risk prostate cancer.
According to Patricia Ganz, M.D., who chaired the panel that produced the report, prostate cancer affects some 30 percent to 40 percent of men older than 50.
"Some of these men will benefit from immediate treatment, others will benefit from observation," Ganz said in an NIH news release. The problem panel members identified, however, is that no clear standard exists regarding which monitoring strategies are most likely to optimize patient outcomes.
The two alternatives to immediate treatment -- active surveillance and watchful waiting -- differ in that the former observes with an intent to cure, a process that involves proactive patient follow-up in which blood samples, digital rectal exams and repeat prostate biopsies are conducted on a regular schedule, and curative treatment is initiated if the cancer progresses. Watchful waiting, on the other hand, is more passive and seeks to alleviate symptoms only if they develop.
"It's clear that many men would benefit from delaying treatment, but there is no consensus on what constitutes observational strategies and what criteria should be used to determine when treatment might ultimately be needed among closely monitored men," said Ganz. "We need to standardize definitions, group patients by their risks, and conduct additional research to determine the best protocols for managing low-risk disease."
In addition, the panel recommended, strong consideration should be given to removing "the anxiety-provoking term 'cancer'" for this condition because of the favorable prognosis that often accompanies low-risk prostate cancer.