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Transcript

 

Lee Tetreault:

Hello and welcome to Frequently Ask Questions from The Session. Cancer Screening update. Breast, lung, colorectal, prostate. We are joined today by Dr. Erin N. Marcus, MD-MPH. Doctor, before we begin, can you provide a few key pointers for our audience from today's session.

Erin N. Marcus: 

Pointer number one is that risk assessment of the individual patient plays an important role in determining whether and when to offer certain cancer screening tests. Those risks could include family history or habits such as smoking. Pointer number two, is that the risks of screening include detection of clinically insignificant abnormalities, and pointer number three is that patient should be informed of risks and benefits so that they can make an informed decision about whether to proceed with screening for different cancers.

Lee Tetreault:

Okay, so let's get into some of these frequently asked questions. First, what does the term breast density mean? 

Erin N. Marcus: 

Breast density is a radiologic finding that describes the proportion of stroma and ductal tissue to fat in the breast. The higher this proportion, the more dense the breast. Note, that dense breast tissue is not abnormal since about half of women have this finding on mammography screening.

Lee Tetreault:

And who needs to be screened for lung cancer? 

Erin N. Marcus: 

The United States Preventive Services Task Force recommends annual lung cancer screening in people ages 55 to 80 who have a 30 pack-year of smoking history and currently smoke or have quit within the past 15 years.

Lee Tetreault:

Should a patient delay getting a PSA, if he just had a digital rectal exam? 

Erin N. Marcus: 

No. Studies have found that men with PSA in the normal range do not have a statistically significant change in their PSA level after a digital rectal exam. Prostate massage which is performed in the evaluation of suspected chronic prostatitis can significantly increase PSA levels however.

Lee Tetreault:

What role does family history play in the decision regarding when people should undergo screening colonoscopy? 

Erin N. Marcus: 

The United States Multi Society Task Force on colorectal cancer screen recommends that colonoscopy screening be begun at age 40 or 10 years before the age of diagnosis if the patient has one first degree relative diagnosed with colorectal cancer or an advanced adenomatous polyps and an age younger than 60 or two first degree relatives at any age.

Lee Tetreault:

Last question, Dr, how should a clinician decide when to stop recommending tests for Cancer Screening? 

Erin N. Marcus: 

The decision to stop screening depends on a person's comorbid conditions and general functioning. Most major screening trials excluded people older than 75. While some cancers are more common with age, it should be noted that interventions may have more risks in this population. Also, the benefits of screening aren't seen immediately. Usually the benefits are seen five to 10 years after the screening test is performed. Since there's a delayed benefit to screening, it can be helpful to use a mortality risk calculators such as University of California, San Francisco's ePrognosis tool. 

Lee Tetreault:

That's really interesting information, doctor. Thank you so much for your time today.

Erin N. Marcus: 

Thank you.