Update on screening for breast and lung cancer
-
Upload
pennmedicine -
Category
Health & Medicine
-
view
88 -
download
3
Transcript of Update on screening for breast and lung cancer
![Page 1: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/1.jpg)
Update On Screening For Breast And Lung Cancer
Antje L Greenfield, MD PhDClinical Associate of Radiology
![Page 2: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/2.jpg)
Breast CancerFacts
Most frequently diagnosed cancer in women
2016: estimated 246,660 new dx in women, 2,600 in men, additional 61,000 new DCIS dx (Rate stable in white women, slight increase in AA women since 2008)
2016: 40,890 death expected
American Cancer Society 2016
![Page 3: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/3.jpg)
Should We Screen For Breast Cancer?YES, because
decreased mortality of 36 % from 1989-2012 due to early detection with mammography and better treatment options
= estimated 250,000 lives saved
American Cancer Society 2016
![Page 4: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/4.jpg)
The Debate
What is the best balance of screening?
What age, how many women, false- positive mammograms, negative biopsies, overtreatment/potential harm
vs # of lives saved
Mammography saves lives
Mammography overdiagnoses breast cancer
![Page 5: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/5.jpg)
USPSTF Recommendations
• Women 50-74 yo : screening mammography every 2 years
• Women before 50 yo: individual decision when to start with screening mammo every 2 years
• Women older than 75 yo: no specific recommendation, based on risk assessment
• No breast self exams
USPSTF update Jan 2016
![Page 6: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/6.jpg)
ACS Recommendations
• Women 40-44 yo: choice of mammography• Women 45-54 yo: annual mammography• Women 55 yo and older: every 1-2 years
(good overall health, life expectancy 10 years or greater)
• Women with high risk profile: annual screening mammo plus MRI, start around 30 yo
American Cancer Society 2016
![Page 7: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/7.jpg)
ACR Recommendations-Average risk (less than 15 %): screening for all women starting at age 40 yo with annual mammography-Intermediate risk (15-20%): annual mammo at any age if biopsy proven lobular neoplasia, ADH or other factors-High risk ( greater than 20%): BRCA gene mutation, family history (8 year rule) , personal h/o DCIS or invasive cancer screen with annual mammo plus other exam such as MRI
![Page 8: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/8.jpg)
Whhhhaaattt?
![Page 9: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/9.jpg)
The Real Question Is:
• How much should society spend on saving one life?
• What is a reasonable balance of cost and benefit?
![Page 10: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/10.jpg)
What do we agree on?• Yes, we need to screen for breast cancer
with mammography, ideally with 3D (shows increased detection rates up to 40% over digital mammo)-
• Women between 50-54 yo screening at least every two years
• Individualized screening for women before age 50 and after 55, risk factors to be considered
![Page 11: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/11.jpg)
Beyond The Differences:• One does NOT fit all.• Education of patients about risks, symptoms and
options for prevention and screening• Recommendations are guidelines, need to be
individualized based on:– Risk factors (BRCA, family history, personal medical
history)– Breast density– Age– Life style (smoking, ETOH, obesity)
![Page 12: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/12.jpg)
Maintain A Perspective:• Risk of breast cancer is relatively high,
approximately 1 in 9 women• Treatable and potentially curable when dx early
with better functional outcomes • Premenopausal breast cancer is often more
aggressive• Risk of radiation induced breast cancer from
mammo is extremely low (86 ca/ 11 death in 100000 in women 40-49 yo = 0.1 %) Radiology. 2011 Jan
![Page 13: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/13.jpg)
Until There Is A Better Solution:
• Patient education and awareness• Talk to your doctor• Assess your risk profile
(http://www.cancer.gov/bcrisktool)• Make an individual decision based on knowledge• Reduce your risk factors and optimize your health
status• Follow through on your personalized screening
schedule
![Page 14: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/14.jpg)
![Page 15: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/15.jpg)
Lung Cancer
Facts2nd most commonly diagnosed cancer (male/female)
2016: estimated 224,390 new (14% of all ca dx)Rate declining by 3% per yr since 2008 due to decrease in smoking and change of environmental factors and life style
2016: 158,000 death expected (1 in 4 cancer death)
American Cancer Society 2016
![Page 16: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/16.jpg)
National Lung Screening Trial
• Screening LDCT of the chest reduces the risk of dying from lung cancer (20% lung-cancer specific mortality benefit)
• Not all cancers will be detected• Relatively high false-positive rate, can result
in additional testing and some invasive procedures
• Smoking cessation has high priority in LC prevention
CA Cancer J Clin 2013
![Page 17: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/17.jpg)
ACS LC Screening Recommendationsbased on results of NLST
• Screening with low-dose spiral CT (LDCT) of the chest in apparently health patients 55 to 77 yo with at least 30 pack-year smoking history (currently smoking or quit within 15 years)
• Shared and informed decision of patient with physician
• Similar recommendations issued by USPSTF
American Cancer Society 2016
![Page 18: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/18.jpg)
Pearls
• LDCT not appropriate for patients with– Diagnosis and /or current treatment for
lung cancer– Lung symptoms such as SOB,
hemoptysis, infection– Had a CT chest within one year
![Page 19: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/19.jpg)
How to determine PPY history?
![Page 20: Update on screening for breast and lung cancer](https://reader033.fdocuments.net/reader033/viewer/2022061617/58ed89d41a28abda598b4621/html5/thumbnails/20.jpg)
Pearls
• LDCT radiation exposure is about equivalent to radiation dose of a screening mammogram
• Cost: if meeting high risk criteria usually covered by insurance, if no coverage at UPENN $125 self-pay rate