Sandbox:Cancer screening and primary care

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]

Screening

Breast Cancer

United states preventive services task force recommendations for Breast cancer screening
Population	Recommendation	Grade
Women, 40 Years and Older	The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.	I
Women, Age 50-74 Years	The USPSTF recommends biennial screening mammography for women 50-74 years.	B
Women, Before the Age of 50 Years	The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.	C
Women, 75 Years and Older	The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older.	I

Breast cancer screening relevance

Studies have reported that, for women of all age groups with an average risk, breast screening was associated with a reduction in breast cancer mortality of approximately 20%, although there was an uncertainty in the quantitative estimates of outcomes for different breast cancer screening strategies in the United States.

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Colon cancer

United states preventive services task force recommendations for Colon cancer screening
Population	Recommendation	Grade
Adults aged 50 to 75 years	The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.	A
Adults aged 76 to 85 years	The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history. Adults in this age group who have never been screened for colorectal cancer are more likely to benefit. Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy.	C

Colon cancer screening relevance

Studies have reported, 40% to 60% lower risk of incident colorectal cancer and mortality from colorectal cancer after screening colonoscopy.

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Cervical cancer

United states preventive services task force recommendations for Cervical cancer screening
Population	Recommendation	Grade
Women 21 to 65 (Pap Smear) or 30-65 (in combo with HPV testing)	The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years.	A

Cervical cancer screening relevance

Studies have reported, that in patients undergoing regular cervical cancer, approximately 70%-80% of cervical cancer deaths can be prevented.

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Lung cancer

United states preventive services task force recommendations for Lung cancer screening
Population	Recommendation	Grade
Adults Aged 55-80, with a History of Smoking	The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.	B

Lung caner screening relevance

National lung screen trial (nlst) a randomized controlled trial, involving 50,000 participants as demonstrated a 20% relative lung cancer mortality benefit.

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Epidemiology

The most common type of cancer, excluding non-melanoma skin cancers is breast cancer, with more than 249,000 new cases expected in the United States in 2016. The next most common cancers are lung cancer and prostate cancer. In United states, to qualify as a common cancer, the estimated annual incidence for 2016 had to be 40,000 cases or more.

The following table gives the estimated numbers of new cases and deaths in Unites states for each common cancer type:

American Cancer Society. Cancer Facts & Figures 2016
	Cancer Type	Estimated New Cases	Estimated Deaths
1	Breast	249,200	40,890
2	Lung (Including Bronchus)	224,390	158,080
3	Prostate	180,890	26,120
4	Colon and Rectal (Combined)	134,490	49,190
5	Bladder	76,960	16,390
6	Melanoma	76,380	10,130
7	Non-Hodgkin Lymphoma	72,580	20,150
8	Thyroid	64,300	1,980
9	Kidney (Renal Cell and Renal Pelvis) Cancer	62,700	14,240
10	Leukemia (All Types)	60,140	24,400
11	Endometrial	60,050	10,470
12	Pancreatic	53,070	41,780