Review Article
Cancer Screening 2016

https://doi.org/10.1016/j.amjms.2016.06.001Get rights and content

Abstract

The primary goal of cancer screening is to reduce cancer-related mortality without incurring significant harm. Screening efforts for solid tumors, therefore, have targeted the precursors of the most common and the most deadly cancersā€”breast, cervical, colorectal, lung and prostate cancer. Balancing risk and benefit has led to controversy regarding the timing of cancer screeningā€”when to begin, how often to screen and when to stopā€”and the nature of the modality of cancer screeningā€”invasive or noninvasive, laboratory-centered or imaging-centered. Evidence-based guidelines published by general medical societies, subspecialty societies and publicly funded task forces on population-based screening aid healthcare providers in making individualized decisions with their patients.

Introduction

Cancer screening is intended to reduce the number of deaths from cancer and, secondarily, to reduce the incidence of cancer. In accomplishing these goals, the ideal cancer screening test is both sensitive and specific, introduces minimal physical and psychological harm to the patient, detects disease at a preclinical phase and screens for a cancer that has a well-defined treatment. Additionally, the appropriate screening interval for any given testing modality is one where the development of invasive cancer is unlikely before the next screen. At present, the cancers for which screening is performed most often are also the most common and deadlyā€”breast, cervical, colorectal, lung and prostate cancer.

Section snippets

Breast Cancer

Breast cancer is the most common nondermatologic cancer and the second most common cause of death among women in the United States, with 230,000 cases of invasive disease and nearly 41,000 deaths estimated for 2015.1 Screening is typically performed with digital mammography, which has a sensitivity of 77-95% and a specificity of 94-97%, and which has been associated with a 15-20% reduction in breast cancer mortality.2, 3

Screening guidelines have differed regarding the recommended age to begin

Cervical Cancer

Most emblematic of the success of cervical cancer screening is the fact that approximately half of the cervical cancers diagnosed in the United States occur in women who have never received cytologic screening via Papanicolaou (Pap) testing.19 Cervical cancer is, therefore, a disease that affects primarily women living in low resource, medically underserved areas, where access to cervical cancer screening is not readily available.19

Epidemiologic studies have demonstrated that, although not all

Colorectal Cancer

Colorectal cancer is the third most common cancer and the second leading cause of cancer mortality in the United States.26 Multiple screening modalities have been explored during the last several decades. Among these are stool-based tests, including the guaiac-based fecal occult blood test (FOBT), fecal immunochemical test (FIT) and stool DNA test, endoscopic tests, including rigid and flexible sigmoidoscopy and colonoscopy, and imaging tests, including double-contrast barium enema and computed

Lung Cancer

Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide and carries a 5-year survival rate of only 16.8%.54 Until 2011, the evidence for an effective lung cancer screening tool was lacking, with several trials examining the use of chest radiography, sputum cytology and chest computed tomography, but none demonstrated a mortality benefit.55, 56 However, in August 2011, the National Lung Screening Trial (NLST) changed the screening landscape. In the large,

Prostate Cancer

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer mortality among U.S. men.72 However, the vast majority of men who are diagnosed with prostate cancer do not die of the disease.73 This has led to an intense debate for the past 2 decades over the merit of screening for prostate cancer, particularly with the prostate-specific antigen (PSA) test, which is not cancer-specific.74 The digital rectal examination, often appearing alongside the PSA in screening

Conclusions

The increasing complexity of medical practice has not spared cancer screening. With the advent of new procedural, imaging and laboratory tools, the ability to detect cancer has increased. The characteristics of the ideal cancer screening modality, though, remain the same. The ability to reduce cancer-specific mortality and to detect cancer that is amenable to treatment at a preclinical phase with sensitivity and specificity, while introducing only minimal physical and psychological harm to

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    The authors have no financial or other conflicts of interest to disclose.

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