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Redefining Screening Guidelines for Certain Cancers

Author Information (click to view)

Therese B. Bevers, MD, FAAFP

Professor of Clinical Cancer Prevention Medical Director Cancer Prevention Center and Prevention Outreach Program
University of Texas MD Anderson Cancer Center

Therese B. Bevers, MD, FAAFP, has indicated to Physician’s Weekly that she currently has no financial interests to report. In the past, she has received grant support, been part of a speaker’s bureau, and been a consultant for Eli Lilly, and she has been on an advisory board for Merck.  However, none of these companies are current financial interests.

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Therese B. Bevers, MD, FAAFP (click to view)

Therese B. Bevers, MD, FAAFP

Professor of Clinical Cancer Prevention Medical Director Cancer Prevention Center and Prevention Outreach Program
University of Texas MD Anderson Cancer Center

Therese B. Bevers, MD, FAAFP, has indicated to Physician’s Weekly that she currently has no financial interests to report. In the past, she has received grant support, been part of a speaker’s bureau, and been a consultant for Eli Lilly, and she has been on an advisory board for Merck.  However, none of these companies are current financial interests.

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The University of Texas MD Anderson Cancer Center has released comprehensive, risk-based screening guidelines for breast, cervical, and colorectal cancer, highlighting important new evidence to guide practices.
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According to the American Cancer Society, more than 40% of Americans will develop cancer at some point in their lifetime. It is also estimated that cancers that can be prevented or detected earlier by screening account for at least half of all new cancer cases. Estimates from 2009 indicate that about 192,370 women will be newly diagnosed with breast cancer, and another 40,170 will die from it. About 11,270 new cases of cervical cancer will be diagnosed in women, and 4,070 women will die from it. New cases of colorectal cancer will be diagnosed in 106,100 men and women and 49,920 of these people are estimated to die from the disease.

Building on Previous Recommendations

Considering the magnitude of these cancers, researchers at the University of Texas MD Anderson Cancer Center released comprehensive, risk-based screening guidelines for breast, cervical and colorectal cancers. Available at www.mdanderson.org, the recommendations translate best practices in cancer prevention employed at the university into accessible guidelines for the public to follow. It identifies risk categories and provides information about when to begin and discontinue screening exams. “The guidelines reconstruct and expand upon previously published guidelines for screening,” says Therese B. Bevers, MD, FAAFP. “The guidelines were developed by multidisciplinary panels of MD Anderson disease site experts across several areas.” Those areas include medical oncology, surgical oncology, cancer prevention, and imaging as well as others.

Adjusting for Individual Risk

“Cancer screening is not a one-size-fits-all strategy,” says Dr. Bevers. “The new risk-based recommendations from the University of Texas MD Anderson Cancer Center are more personalized, precise, and detailed than what has previously been released by other cancer organizations. The new guidelines build on established cancer screening practices and offer more specific recommendations for individuals at increased risk for these three cancers [Breast Cancer, Cervical Cancer, and Colorectal Cancer].”

Cancer screening recommendations have historically been targeted largely to patients at average risk for developing cancer based on characteristics such as age, family history, or genetic predisposition. However, average risk has not been previously defined, and recommendations for individuals at increased or high risk have not been outlined. Dr. Bevers says, “Providing physicians and patients with more knowledge about how decisions are made about risk levels and screening tests may provide a deeper understanding of disease processes and enable them to put cancer risk into perspective.”

The new screening guidelines define risk categories and offer recommendations for those at increased and high risk of developing cancer. “For example,” says Dr. Bevers, “there are now five different sets of screening recommendations for those at increased risk for breast cancer. There are also four categories of age-based risk recommendations for cervical cancer. For colorectal cancer, patients need to be proactive about obtaining results from their screening tests. For example, if a colonoscopy reveals polyps, it’s critical to know the type of polyps, how many were found, and the size of the polyps. This information factors heavily into what colorectal cancer risk category patients should fall under and the intervals at which screenings are needed.”

Dr. Bevers also notes that the guidelines state that it is critical for women who do not require annual cancer screenings to continue with annual appointments to obtain other appropriate healthcare. “Clinicians need to stop linking specific visits for preventive care with one activity. We must remember to continue treating the whole patient and take every opportunity to provide preventive measures to ensure the well-being of each individual.”

More to Come

The new recommendations represent the first wave of an effort by MD Anderson to improve the effectiveness of cancer prevention and detection efforts at their earliest, most treatable stages. Risk-based screening guidelines for prostate, liver, skin, endometrial, and ovarian cancers are currently in development. Furthermore, an online risk assessment tool integrating the new screening guidelines is expected to be launched on the MD Anderson website in 2010. “Our guidelines are designed for patients who are at increased risk for cancer,” says Dr. Bevers. “The hope is that providing more tools to clinicians and their patients will help us catch cancers at their earliest stages, ultimately improving our chances of treating the disease effectively and reducing the enormous burden of cancer.”

Readings & Resources (click to view)

To access cancer screening guidelines from the University of Texas MD Anderson Cancer Center, go to http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/prevention-and-screening/cancer-screening-guidelines/index.html.

For resources for clinicians from the University of Texas MD Anderson Cancer Center’s website, go to http://www.mdanderson.org/education-and-research/resources-for-professionals/index.html.

Bevers TB, Anderson BO, Bonaccio E, et al; National Comprehensive Cancer Network. Breast cancer screening and diagnosis. J Natl Compr Canc Netw. 2006;4:480-508.

Mahoney MC, Bevers T, Linos E, Willett WC. Opportunities and strategies for breast cancer prevention through risk reduction. CA Cancer J Clin. 2008;58:347-371.

Meijer CJ, Berkhof J, Castle PE, et al. Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older. Int J Cancer. 2009;124:516-520.

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