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Definition of Cancer Screening The presumptive identification of unrecognized cancer by the application of tests, examinations, or other procedures which can be applied rapidly to an asymptomatic population to sort out those who probably have cancer from those who probably do not. Analytic Framework for Screening (Adapted from USPSTF, Am J Prev Med 20(3S):25, 2001) 1 5 Screening Test Persons At Risk Treatment Early Detection of Targeted Condition 3 4 Association Intermediate Outcome 2 7 Adverse Effects of Screening 8 Adverse Effects of Treatment 6 Reduced Morbidity and/or Mortality Zapka, J. et al. J Natl Cancer Inst Monogr 2010 2010:58-71. Breast Cancer Screening Tests for Asymptomatic Patients (Females) Test or Procedure ACS++ Mammography preceded by CBE 40+ q yr MRI Clinical breast exam (CBE) Breast self exam NR 20-39 q3 yr* 40+ q yr* Optional USPSTF+ 50-74 q 2 yr with or without CBE** IE*** IE*** Against + USPSTF at www.ahrq.gov/clinic/uspstf/uspsbrca.htm ++ Smith RA et al. CA Cancer J Clin 60:99-119, 2010 NR = not recommended * As part of a health examination ** Before age 50, make an informed decision with your doctor *** Insufficient evidence Average Annual In Situ Female Breast Cancer Rates, Iowa, 1973-2006 (rates expressed per 100,000 persons using 2000 U.S. population as standard) 6-fold increase Female Breast Cancer Mortality Rates, Iowa, 1973-2006 (Rates are per 100,000 women and age-adjusted to the U.S. 2000 population.) Rate 34 32 30 28 26 24 22 20 Study (NEJM Oct 27, 2005) reported 46% of breast cancer mortality reduction attributed to screening; remainder due primarily to Improved treatment. 32% decline between 1992 and 2006 737475767778798081828384858687888990919293949596979899 0 1 2 3 4 5 6 Year of Death Prostate Cancer (Smith RA et al. CA Cancer J Clin 60:99-119; 2010 & www.ahrq.gov/clinic/uspstf/uspsprca.htm) Screening Tests for Asymptomatic Patients (Males) Test or Procedure ACS Prostate specific antigen (PSA) test and digital rectal exam (DRE) Age 50+ q yr thereafter* USPSTF Insufficient evidence for men < 75; against for men 75+ years * Require informed decision with health care provider for men who have a life expectancy of at least 10 years. PSA Acceptance: Widely used as cancer marker for initial diagnosis and monitoring response to therapy Aids in prediction of prostate cancer risk and of treatment outcome Controversy: Leads to diagnosis and treatment of prostate cancers that pose no real threat Disagreement over the threshold level of PSA that should indicate biopsy Levels differ by racial, ethnic, age groups Clinical trials not showing benefit Malignant Prostate Cancer Rates, Iowa, 1973-2006 (Rates are per 100,000 men and age-adjusted to the U.S. 2000 population.) Rate 220 200 180 160 140 120 100 80 60 40 20 0 Mortality Incidence 15% decrease in incidence between 1994 and 2006 37% decrease in mortality between 1994 and 2006 73 75 77 79 81 83 85 87 89 91 93 95 97 99 Year of Diagnosis 1 3 5 Avenues for Cancer Prevention and Control Primary Prevention Secondary Screening Early Detection Tertiary Palliative Treatment Rehabilitation Care Quality of Life/Care Genes Environment Birth Incidence Rates Cancer Diagnosis Stage Distribution Mortality Rates Quantity of Life Death Survival Rates