Despite lung cancer screening guidelines for smokers being issued in 2013, the rate of lung cancer screening is abysmally low with only about 3% of eligible smokers undergoing low-dose CT lung cancer screening. The USPTFS guidelines are for long term smokers with a 30-pack year history or more of smoking who are between 55 and 80 years of age. Many early lung cancers detected on screening exams can be treated with an 85% cure rate, yet most cancers today are still diagnosed at a late stage with minimal survival. There are approximately 7 million smokers eligible for screening, but only 210,000 are being screened annually as recommended. Under the USPFS guidelines, 12,000 deaths could be avoided each year with screening. With expanded risk-based guidelines, another 5,000 lung cancer deaths could be avoided. Unfortunately, most long-term smokers are not made aware of and do not receive life-saving screening.
More than 12,000 women a year get cervical cancer, yet up to 93% of these cancers are preventable. The Centers for Disease Control reports that up to 8 million American women have not been screened for cervical cancer in the last 5 years, which is approximately 10% of all women who are at risk for the disease. The Papanicoolaou (Pap) test screens for abnormal cells and is a time tested screening method for detecting cervical carcinoma. More recently, testing for HPV infection to identify women at high risk for the disease has also been added to the screening and detection process. HPV vaccination is also another important part of the cervical cancer reduction public health program; however, vaccination does not prevent against all cervical cancers, and screening is critical to early diagnosis.
The controversy about whether breast cancer screening with mammography increases survival or only causes anxiety and healthcare costs for women continues. A recently published Norwegian study on mammography screening and breast cancer mortality looked at all Norwegian women aged 50 to 79 between 1986 and 2005. Norway provides an ideal setting to evaluate the effects of breast cancer screening because of the well-defined population and access to medical records. The study shows that breast cancer screening with mammography reduces deaths from breast cancer by 28%.
Lung cancer screening of all current and former smokers with low-dose CT scanning would result in preventing 12,000 deaths in the United States each year. A study in Cancer reported that, compared with chest x-ray, CT screening would reduce lung cancer mortality by 20%. The total number of potentially avoidable deaths could even be greater. The patients in the study were 55 to 74 years of age and smoked at least one pack a day for 30 years. Even though these patients are at risk for cancer, screening is generally performed by chest x-ray which misses 20% of tumors.
New guidelines for cervical cancer screening have been released by the American Cancer Society in conjunction with the U.S. Preventive Task Force (USPTF) that are based on new understanding of the role that human papillomavirus (HPV) infection plays in the development of this disease. The guidelines recommend less frequent testing across all age groups and are aimed at detecting early cellular abnormalities while at the same time reducing unnecessary biopsy procedures and the anxiety caused by false positive PAP smears. Vaccination against HPV has reduced the incidence of cervical malignancy but the vaccine only protects against for 70% of cervical malignancies. The decreased recommendations for screening may cause women to reduce the frequency of their gynecologic visits and consequently cause missed opportunities for the detection of other women's health issues that are detected during routine visits.
Cancer screening rates in the United States declined over the last ten years, and the only testing in conformance with Health People 2010 (HP2010) goal of 50% or more was for colorectal . Adherence rates for screenings have generally declined for all other types and are below HP2010's target. On the other hand, survival met goals for all types except cervical cancer. Increased prevention efforts are needed if the United States is going to continue to meet its survival goals into the future. Despite earlier diagnosis and more effective treatments that increase survival, it is still a leading cause of death and chronic illness, with deaths in the United States exceeding 570,000 in 2011.
Prostate cancer survival for men with metastatic disease significantly improved with routine Prostate Specific Antigen (PSA) testing over the last 20 years, despite a current US Preventive Task Force's (USPTA) recommendation against general screening. A study in the Journal of Urology showed a significant reduction in the stage severity of the cancer in men who followed with testing. Overall survivability increased for men with metastatic disease who underwent screening, especially black American men. The study leaves no doubt that PSA testing plays a role in extending lives for such patients. It also supports the use of PSA testing for general screening in asymptomatic patients.