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Recommended cancer screening guidelines across a range of disease sites have been revised by several organizations over the last several months, including M. D. Anderson, leaving many confused about when to get screened, or if they even should. The common denominator driving many of the new recommendations is personal cancer risk.

According to the National Cancer Institute (NCI), a risk factor is anything that raises a person's chance for developing a disease. Although science has yet to explicitly define why one person develops cancer and another does not, specific risk factors are known to increase one's chances of developing certain types of cancers.

According to Therese Bevers, M.D., medical director of the Cancer Prevention Center at M. D. Anderson, knowing your cancer risk is important because that information offers guidance about efforts to prevent and detect cancer at its earliest, most treatable stage.

Bevers encourages individuals to talk about their cancer risk with their doctors to determine an appropriate schedule for cancer screening. But how do you uncover your personal cancer risk? The NCI lists four main types of cancer risk factors - some controllable, some not.

Risk Factor #1: Behavioral
Do you smoke? Drink excessively? Eat poorly and never exercise? Lay out in the sun until you have a dark tan? Your cancer risk just increased. There is a reason these risk factors are called "behavioral." By changing these unhealthy behaviors and habits, you can significantly lower your risk for any number of cancers.

Risk Factor #2: Environmental
Believe it or not, where you live and work can affect whether or not you get cancer at some point in your life. If you work in the sun, are usually around secondhand smoke or are frequently exposed to asbestos, radon, pollution or pesticides, your risk of getting cancer increases.

Risk Factor #3: Biological
Biological risk factors are one set of factors that are truly out of an individual's control - they include gender, age, skin complexion and race. Some cancers are gender-specific: only women can get ovarian and cervical cancer, and only men get prostate cancer. In terms of age, cancer risk increases as an individual gets older. Light-skinned individuals are more susceptible to skin cancer than dark-skinned people, and studies have shown that African-American men are at higher risk for prostate cancer than other men.

Risk Factor #4: Genetic
Approximately 5% to 10% of cancer is inherited, which means that changes (or mutations) in specific genes are passed from one blood relative to another. Individuals whose close relatives were diagnosed with cancer have a much higher chance of developing cancer within their lifetime - and at an earlier age. Over the last 15 to 20 years, scientists have made progress in identifying the genes that predispose individuals to breast, colorectal, gynecologic and endocrine tumors. Individuals who have a hereditary predisposition to cancer are recommended to undergo high-risk cancer surveillance - perhaps even including genetic testing - in order to manage their increased cancer risk.

Questions will be answered live on Mar. 23rd

Do you have more questions about your cancer risk? Bevers will be available live on Twitter on Tuesday, March 23, at 1:00 p.m.CT to answer your questions.

Follow @Cancerwise on Twitter and the hashtag #CancerRisk, or join us on tweetchat.

By Lora Shea, Staff Writer

The debate continues on the value of cancer screening. The latest target: prostate cancer.

The American Cancer Society has issued new prostate cancer screening guidelines that encourage doctors to better communicate the risks and benefits to their patients before testing is pursued. The guidelines question the value of mass prostate screening.

M. D. Anderson urologist John Davis, M.D., says the new guidelines represent "a growing shift from the more simplistic days when doctors told men to go get screened, and we'll deal with the results as needed."

Studies show that more men die with prostate cancer than because of prostate cancer. Screening for prostate cancer may be the right choice for some men, but that decision should be made after careful consideration of a man's personal and family health history, and the risks and benefits of the specific tests. M. D. Anderson's screening guidelines affirm the need for men to discuss testing with their doctor and give specific recommendations based on a man's risk, should he decide to be tested.

The ACS guidelines also call into question the value of community screening events, in which large groups of asymptomatic men are tested. M. D. Anderson has replaced mass screening with education events for the past few years, Davis says. "These events give us the opportunity to talk to men not only about the issues around screening, but also about the variety of treatment and disease management options available to them if they are found to have prostate cancer."

Davis worries that the ACS guidelines "paint a very negative picture of prostate cancer treatment, that harm is inevitable." He says that for those properly evaluated, treatment in the right hands can offer the best outcomes.

"Furthermore, the guidelines are mostly based on two randomized trials. The American trial showed no benefit to screening, but unfortunately has numerous flaws (especially contamination between the treatment arms) and therefore is not conclusive," he says.

"On the other hand, the European study, which did not suffer from as many problems as the American trial, demonstrated a 20% lower risk of dying of prostate cancer as early as nine years from diagnosis. Given the slow natural history of prostate cancer, the percent of men who benefit from screening should go up as these patients are followed to the 15- and 20-year marks."

So who will choose to screen versus not screen? Davis predicts that "for most men who have greater than 10 years of life expectancy and work with their physicians to minimize their cancer AND cardiac disease-related risks, the result will be the well-informed decision to screen."

"Those who are not screened may be due to other more threatening health concerns, or the occasional patient who places a high personal value on avoiding any treatment-related side effects -- even if that means accepting a higher risk of dying of prostate cancer," Davis says.
 
If you've been screening already, should you stop? According to Davis, "The guidelines provide concise summaries of the relevant data, and it's probably best to let your screening physician talk to you about what age is best to stop."

 

Although colorectal cancer is often preventable and many are aware of the disease, most people still fail to get screened.

Colorectal cancer remains the fourth most common cancer in the United States. According to the American Cancer Society, more than 148,800 people were diagnosed with the disease in 2008 and 49,960 died because of it.

That's why every March there's a concerted effort to raise awareness of this disease and to encourage people to get screened.

New guidelines for screening
A multidisciplinary panel of M. D. Anderson experts in medical oncology, surgical oncology, radiation oncology, cancer prevention, imaging and other areas have developed new risk categories and related guidelines for colorectal cancer.

For men and women at average risk who are 50 years and older, M. D. Anderson recommends a colonoscopy every 10 years (preferred screening), and either a virtual colonoscopy every five years or a yearly fecal occult blood test (FOBT).

For men and women at increased or high risk, the type and frequency of exams, including colonoscopy and flexible sigmoidoscopy, depend on the following factors:
•    Personal history of precancerous (adenomatous) polyps
•    Personal history of colorectal cancer
•    Family history of colorectal cancer or precancerous (adenomatous) polyps
•    Genetic diagnosis of familial adenomatous polyps
•    Genetic history of hereditary nonpolyposis colorectal cancer, or clinical history suggesting such
•    Inflammatory bowl disease (ulcerative colitis or Crohn's disease)

If you fit these guidelines, celebrate March with a check-up and chat with your primary physician about getting screened for colon cancer.

Related stories:
Metastatic Colon Cancer Survival Jumps Dramatically Almost a Third of Patients May Live Five Years

Colorectal Cancer Survivors' Stories Become More Common


M. D. Anderson resources:
Colonoscopy versus Virtual Colonoscopy (podcast)

Colorectal Cancer Treatment and Screening (podcast)



Additional resources:
Colon and Rectal Cancer (National Cancer Institute)

Colon and Rectum Cancer (American Cancer Society)

National Health Observances Toolkit (U.S. Department of Health & Human Services)

By Laura Prus, Staff Writer

The risk for developing cancer varies from person to person. However, until recently, screening guidelines were targeted only to those at average risk.

To provide comprehensive recommendations, M. D. Anderson released risk-based screening guidelines for breast, cervical and colorectal cancers.

These recommendations, available on M. D. Anderson's Web site, are part of an extensive push to improve the effectiveness of efforts to prevent and detect cancer at its earliest, most treatable stage. M. D. Anderson's screening, risk-reduction and diagnosis guidelines will be reconstructed and expanded across eight different disease sites.

According to the American Cancer Society, more than 40% of Americans will develop cancer during their lifetime, and cancers that can be prevented or detected earlier by screening account for at least half of all cancer cases.

Beyond the average risk

Screening guidelines constructed for those at average risk were based on characteristics such as age, family history or genetic predisposition. However, new guidelines define risk through various categories and offer recommendations for those at increased and high risk of developing cancer. They also provide information about when to begin and discontinue screening exams.

"Cancer screening is not one-size-fits-all," says Therese Bevers, M.D., medical director of M. D. Anderson's Cancer Prevention Center. "Our new risk-based recommendations are markedly more personalized and precise, offering more detailed guidance than what has previously been made available to the public."

The new recommendations expand on earlier guidelines and offer more specific regimens for cancer screening.

Breast cancer

Starting at age 20, all women should practice breast self-awareness by being familiar with how their breasts look and feel. Any changes should be immediately reported to a doctor. Women 40 and older at average risk should get annual mammograms and breast exams.

For women at increased risk, the type and frequency of exams, including clinical breast exams, mammograms and breast magnetic resonance imaging (MRI), depend on the extent of a patient's risk factors. Such factors include:
•    History of radiation treatment to the chest
•    Genetic predisposition
•    Diagnosis of lobular carcinoma in situ (a condition in which abnormal cells are found only in the lobules)
•    Gail risk assessment score of 1.7% or greater in women 35 years or older (an explanation of the Gail risk assessment tool:  http://www.cancer.gov/bcrisktool/about-tool.aspx)
•    Lifetime risk of 20% or greater based on family history

Cervical cancer

It is now recommended that women at average risk under age 21 get a liquid-based Pap test within three years of initiating vaginal intercourse. Testing should continue annually until the results are negative three consecutive times.

M. D. Anderson recommends further screening every two years unless a woman is at increased risk of cervical cancer based on one or more risk factors, in which case she should continue with annual screening, including:
•    History of cervical cancer or severe cervical dysplasia
•    Persistently testing positive for human papilloma virus (HPV)
•    Exposure to diethylistilbestrol (DES) before birth
•    Human immunodeficiency virus (HIV) infection
•    A dysfunctional immune system

In addition to the Pap test, HPV testing is the preferred option beginning at age 30. If both are negative, a woman may be retested at three-year intervals unless she is at increased risk or an optional HPV test was not done.

Colorectal cancer

For men and women at average risk who are 50 years and older, M. D. Anderson recommends a colonoscopy every 10 years (preferred screening), and either a virtual colonoscopy every five years or a yearly fecal occult blood test (FOBT).

For men and women at increased or high risk, the type and frequency of exams, including colonoscopy and flexible sigmoidoscopy, depend on the following factors:
•    Personal history of precancerous (adenomatous) polyps
•    Personal history of colorectal cancer
•    Family history of colorectal cancer or precancerous (adenomatous) polyps
•    Genetic diagnosis of familial adenomatous polyps
•    Genetic history of hereditary nonpolyposis colorectal cancer, or clinical history suggesting such
•    Inflammatory bowl disease (ulcerative colitis or Crohn's disease)

The risk categories and related guidelines were developed by multidisciplinary panels of M. D. Anderson disease site experts across several areas. These included medical oncology, surgical oncology, radiation oncology, cancer prevention, imaging and others.

Risk-based screening guidelines for prostate, liver, skin, endometrial and ovarian cancers are currently in development. A new online risk assessment tool that will integrate the new screening guidelines is set to launch on the M. D. Anderson Web site in early 2010.

Adapted by Laura Prus from an M. D. Anderson news release.


Related articles:
M. D. Anderson Updates Screening Guidelines With a Focus on Risk


M. D. Anderson resources:
Cancer screening guidelines

New screening guidelines for cervical cancer

New screening guidelines for breast cancer

New screening guidelines for colorectal cancer

M. D. Anderson Cancer Prevention Center

By DAVID SERVAN-SCHREIBER, LORENZO COHEN and DONALD I. ABRAMS

Op Ed Posted in the Houston Chronicle 12/06/2009

The debate about how often and at what age women should have mammograms or men PSA tests has become a national conversation. However, a major issue is being missed in the back and forth argument about costs and individual medical freedom. The reason the U.S. Preventive Services Task Force issued new guidelines is because of a ground shift in the very understanding of cancer.

Cancer is not the ominous downhill process it has been feared to be for several decades. Yes, cancer starts with genetically abnormal cells that begin to grow wildly. The evidence now shows, however, that many small collections of cancer cells may be perfectly well contained by our body's natural defenses, and often even disappear on their own. Cancer, we now know, is not a one-way street. In some cases, small tumors may appear, grow a bit and then stop, or even go away.

What this means is that lifestyle choices that weaken or strengthen the natural defenses that protect us against cancer may play a major role in whether some early tumors develop, or not, into a dangerous disease.

Yet, over the past 30 years, "early detection" has been the primary and almost exclusive mantra of our medical institutions when it comes to breast and prostate cancer prevention. The recommendation for these rather expensive mammograms and biopsies were based on the assumption that cancer inevitably progresses, and had become a largely unchallenged practice. Even though most experts have known for some time that the benefits of these screenings have limits, and that the downsides of overtreatment are significant, they have been frustrated by lack of an alternative strategy for prevention.

Missing from this debate is the fact that modifiable lifestyle factors are known to prevent and/or reduce the risk of a majority of cancers. Most experts now agree that over 50% of cancer is preventable through appropriate lifestyle choices.

Read the Entire Article

If you're a woman or a spouse or loved one of a woman -- and that likely covers most people we know -- you may be struggling with how to interpret some new guidelines on breast cancer screenings that were issued today by the U.S. Preventive Services Task Force. You're probably very surprised to read their recommendations to push back initial mammograms to age 50 and conduct follow-ups every two years.

Thanks to the efforts of the American Cancer Society, Komen for the Cure, Avon, many other advocacy groups and even M. D. Anderson's own Public Education Office, it's likely that most women and their physicians would answer "40 years old" to the question: At what age should you get your first mammogram? Furthermore, we'd expect to hear "every year" in response to the question of how often to have this test.

Based on practices in our Cancer Prevention Center and the risk-based guidelines for breast cancer screenings, M. D. Anderson is standing by those recommendations.  

If you're of average risk, M. D. Anderson recommends you get your first mammogram at age 40 and return every year after that for regular screenings. If you aren't sure how to assess your risk, we recommend setting up time with your physician.

"We believe the benefits of an annual mammogram outweigh the risks for women, starting at age 40," says Therese Bevers, M.D., professor and director of M. D. Anderson's Cancer Prevention Center.

M. D. Anderson has studied the effectiveness of breast cancer screening and M. D. Anderson faculty contributed to the modeling analyses used by the Preventive Services Task Force to make its recommendation.   

Ongoing dialog and research on this topic are very important in the lives of many women. We'll assess these findings and others in the annual evaluation of our guidelines in March 2010.

The task force, and M. D. Anderson, are united in our emphasis on developing risk-based,  specific breast cancer screening guidelines. We'll continue to seek evidence that benefits women by catching this disease in its earliest stages.

"Doctors need to have more discussion about the risks and limitations of breast cancer screening with patients so they can participate in decision-making," Bevers says. "There have been huge successes in teaching American women about the benefits of screening mammography, but women have not been educated about the limitations of screening -- which is why many women believe that there is no harm in screening and if one test is good, two tests are better and more frequent testing with both is the best."

Read more about this discussion on twitter hashtag - #mammogram40

http://tweetchat.com/room/mammogram40

Transcript from Houston Chronicle MedBlog Live Chat Event
 

By Deborah Thomas, Staff Writer

The M. D. Anderson Circle of Sisters program and the Center for Research on Minority Health helped sponsor a visit to M. D. Anderson for Native American women from the Alabama-Coushatta Reservation. During the visit the women received instruction on breast cancer prevention and free mammography screening. They also spent time learning about the role nutrition plays in cancer prevention, the importance of breast cancer screening, and easy ways to relieve stress and stay healthy.




Deborah Scott, of the Native American Health Care Coalition, says, "In the native community breast cancer is a big problem, because many women are diagnosed late." According to The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved, American Indian/Alaska Native women have the lowest incidence of breast cancer yet have the poorest five-year survival rates.

Event Sponsors:
National Center for Minority Health and Health Disparities (NCMHD)
Native American Health Coalition
M. D Anderson Health Disparities Research, Center for Research on Minority Health
M. D Anderson Mobile Mammography Program
M. D. Anderson Place of... Wellness

M. D. Anderson recently updated its cancer screening recommendations. While the new guidelines focus on a person's chances of developing cancer, they also reveal when screening may no longer necessary. 

What's great about screening exams are that they have the potential to find cancer at its earliest stage, when the disease is most likely to be cured. For most of us, the benefits of getting a cancer screening exam outweigh the risks. However, there are some who may not benefit from having these tests. Therese Bevers, M.D., professor in the Department of Clinical Cancer Prevention, explains more.



Visit our website to review our cancer screening guidelines. To make an appointment in the Cancer Prevention Center at M. D. Anderson for these and other preventative cancer screenings simply fill out our patient self referral form. 

Do you get tests to check for cancer, such as a mammogram or colonoscopy? What do you think about cancer screening?

Cancer screening examinations are medical tests performed when you're healthy and you don't have any symptoms. They help ensure that any existing cancers are identified at their earliest, most treatable stages.

Michael R. Migden, M.D., assistant professor in the Department of Dermatology, talks about the importance of getting regular skin cancer screening exams and checking out that "weird spot" on your body.




Visit Focused on Health for more information on skin cancer prevention.

How often do you do a skin check?

They may be retired National Football League players and coaches but clearly, they still enjoy the camaraderie of a team atmosphere. Even at M. D. Anderson's Genitourinary Center.

Recently, M. D. Anderson and the American Urological Association (AUA) teamed up to screen 37 NFL retirees from the Houston area as part of a 10-city series that the NFL Player Care Foundation initiated to address the medical needs of retired players. The M. D. Anderson screening, led by urologists John Davis, M.D., and Joseph Corriere, M.D., was the seventh site in the year-long tour that has held screening events in Kansas City, Atlanta, Dallas, Tampa Bay, Washington, D.C., and Canton, Ohio, the home of the NFL Hall of Fame.  

This is the first year that M. D. Anderson and the AUA have teamed up to provide the screening for the alumni.

"We screened 37 men between the ages of 31 and 77 at this event and, as former NFL players and coaches, they have tremendous potential to carry the message of the importance of screenings," David says.  

Six other urologists volunteered to work with Davis and Corriere, and they were supported by many others on the M. D. Anderson GU team.

M. D. Anderson recommends that men, beginning at age 50, have an annual digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test. For men with a family history of prostate cancer or African-American men, screening should begin at age 45 because of the increased risk.

For more information on vital screenings for prostate cancer and other cancers, please visit the cancer prevention center online