From Our 2013 Archives
Which Cancer Tests Do You Really Need?
By Kathleen Doheny
Reviewed by Michael W. Smith, MD
Feb. 1, 2013 -- Not all cancer screening tests are helpful, and some are potentially harmful, according to a new Consumer Reports rating.
In the new report, Consumer Reports recommends only three of 11 common cancer screening tests, and then only for certain age groups.
Screenings for cervical, colon, and breast cancer are recommended.
Screenings for cancers affecting the bladder, lungs, skin, mouth, prostate, ovaries, pancreas, and testicles are not.
"The science of prevention and screening has changed," says John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center. He oversaw the project.
"Consumers need to know that some screening tests are terrific, some are not good, and some can harm you," Santa says.
"We are not talking about people at high risk," he says. "And of course they are not symptomatic. We're not talking about what you should do if you have a mole that is changing or if you feel a breast lump."
The full report is in the March issue of Consumer Reports.
Cancer Screening: CR Ratings
To develop the ratings, Santa and his team looked at medical research, consulted medical experts, surveyed more than 10,000 readers, and talked with patients about screening tests.
They looked closely at recommendations of the U.S. Preventive Services Task Force. This independent panel provides guidelines on health care based on evidence. Much of Consumer Reports' recommendations follow the task force guidelines to the letter. But, their recommendations sometimes differ from those of organizations such as the American Cancer Society (ACS). Here, details on the three recommended tests:
The other eight tests were not recommended for those not at high risk because the cancers are uncommon, the test's effectiveness is not proven, or the test can't detect the disease at a curable stage. And even though some of the tests aren't really recommended by anyone, this list is a valuable reminder for people who may feel they need to seek them out.
On the "avoid" list, screenings for:
Cancer Tests: Perspectives
The new ratings drew mixed reactions.
Otis Brawley, MD, chief medical officer of the American Cancer Society, says the report helps to put screening into its proper perspective. "There has been a significant amount of over-promising and over-promoting," he says.
He frowns on aggressive campaigns that have included mammogram parties or group colonoscopies.
"A lot of screening is being done by organizations that can profit from it," he says.
"The truth is, certain tests do have some significant benefit, and every test has some limitations," he says. "In the spirit of informed decision-making, people need to understand both the potential for benefit and the potential for harm."
As mentioned, the recommendations on breast cancer screening from Consumer Reports and the American Cancer Society are different, but Brawley calls these differences ''minimal."
"We recommend women in their 40s get a mammogram on an annual basis, but we also recommend those women get information on the limitations," he says.
These include missing some cancers and ordering additional tests when no cancer turns out to be there.
Some doctors took issue with the decision to use the task force recommendations as the basic source.
"I'm disappointed they followed the task force guidelines, because we feel they are inadequate to protect women," says Debra Monticciolo, MD, chair of the American College of Radiology's Quality and Safety Commission and vice chair of radiology at Scott & White Healthcare in Temple, Texas.
"Right now, we can't cure breast cancer, so we really need to find cancers early," she says. Research has found the best way to do that is by yearly mammograms beginning at age 40, she says.
The recommendation to avoid PSA tests refutes evidence that they work, say Dipen Parekh, MD, a professor and chair of urology at the University of Miami Miller School of Medicine's Sylvester Comprehensive Cancer Center.
"There is no question the decline in the incidence of advanced prostate cancer is due in large part to PSA screening," he says.
However, the recommendation for women at low risk for ovarian cancer not to seek screening is a good one, says J. Matt Pearson, MD, assistant professor and a gynecologic oncologist at the University of Miami Miller School of Medicine's Sylvester Comprehensive Cancer Center.
The lifetime risk of ovarian cancer in the general population is low. When you screen for a cancer that is not common, he tells women, "you are more likely to find a benign abnormality that pushes you toward [unneeded] surgery."
Cancer Tests: Making the Decision
Santa recommends educating yourself about cancer screening tests, then talking to your doctor about whether the benefits outweigh the risks for you.
"Don't go to a mobile van, don't go to a mammogram party," he says.
"Don't believe a billboard on the highway that tells you to get a PSA test when it comes from a hospital that has a robotic prostate cancer surgery program."
Cancer Prevention: Lifestyle, Lifestyle, Lifestyle
"If you are serious about preventing cancer, you don't smoke, you exercise, and you try to get to a normal weight," Santa says. Obesity has been linked with about 4% of men's new cancers and 7% of women's, he says.
Getting to a normal weight may especially lower the risk for uterine and esophageal cancers.
Regular exercise can reduce colon and breast cancer risk.
Smoking is linked with lung cancer as well as cancers of the larynx, oral cavity, esophagus, bladder, kidney, and pancreas.
SOURCES: John Santa, MD, MPH, director, Consumer Reports Health Ratings Center. J. Matt Pearson, MD, assistant professor and gynecologic oncologist, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine. Consumer Reports March, 2013: "Save your Life." Dipen Parekh, MD, urologic oncologist; professor and chair, urology, University of Miami Miller School of Medicine's Sylvester Comprehensive Cancer Center. Otis Brawley, MD, chief medical officer, American Cancer Society. Debra Monticciolo, MD, chair of the American College of Radiology Quality and Safety Commission; professor of radiology, Texas A & M University; vice chair of radiology, Scott & White Healthcare, Temple, Texas.