ITEMS IN AFP WITH KEYWORD:
Cancer screening is an essential part of family medicine, although changing recommendations have led to confusion among physicians and patients. Learn about the controversies and current recommendations.
Fecal DNA testing is more sensitive but less specific than fecal immunochemical testing (FIT), and as a result, has a higher false-positive rate. It is also more expensive than other noninvasive alternatives such as FIT. We do not know which test will be better at reducing mortality.
Immunochemical FOBTs, such as OC-Micro, OC-Sensor, or OC-Light, are moderately sensitive (73% to 89%) and highly specific (92% to 95%) for identifying colorectal cancer. In comparison, Hemoccult Sensa has a lower sensitivity (64% to 80%) and specificity (87% to 90%). Immunochemical FOBTs also have the advantage of requiring only one sample.
In patients screened for lung cancer using low-dose computed tomography (LDCT), more than 18% of all lung cancers found are slow-growing and will not cause symptoms or harm during an average 6.4 years of follow-up. This risk of overdiagnosis should be part of the discussion regarding whether to screen.
M.B., a woman with diabetes mellitus, presents to your office for an annual well visit. M.B. reports having smoked one and a half packs of cigarettes daily for 20 years. Her neighbor was recently diagnosed with lung cancer, and M.B. requests to be tested for lung cancer, too.
In patients with a significant (greater than 50 pack-year) history of smoking, yearly screening for lung cancer using low-dose computed tomography (CT) will extend their lives. A significant proportion of screened patients will have a false-positive finding or a finding not related to lung cancer.
Case study: A 55-year-old woman presents for a routine well-woman examination. She states that she is worried about ovarian cancer because one of her friends was recently diagnosed. She has no family history of breast, ovarian, or colon cancer.
May 15, 2013 Issue
Screening for Ovarian Cancer: Reaffirmation Recommendation Statement [U.S. Preventive Services Task Force]
The U.S. Preventive Services Task Force (USPSTF) recommends against screening for ovarian cancer in women.
Mar 15, 2013 Issue
Screening for Hepatocellular Carcinoma in Patients with Hepatitis C Virus Infection [FPIN's Clinical Inquiries]
There is no evidence that it is beneficial to screen for hepatocellular carcinoma in symptomatic patients with HCV.
Case Study: A 61-year-old black man presents for a routine checkup. He has hypertension and diabetes mellitus that are well controlled with medication. During the visit, he tells you that a friend advised him to get a prostate-specific antigen (PSA) test to screen for prostate cancer, and he would like to pursue testing.