To Screen-or Not?
Questions to put to your physician before having a test
6. How and where should I have it done?
If you elect to go ahead with a test, take steps to see that it's done right, says Barnett Kramer, associate director for disease prevention at the National Institutes of Health. Wherever you're sent for a test, "it's useful to know how experienced the center is and what techniques are being used," he says. Then ask the doctor how those techniques stack up and what their track records are for false negatives and positives. A recent cautionary tale is computer-aided detection technology in mammography, which has become a hot tech upgrade at imaging centers because software highlights suspicious areas on the mammogram. A government-sponsored study released this month showed that CAD flagged more women for unnecessary biopsies and didn't catch more cancers. For every woman diagnosed with breast cancer using CAD, the researchers figured, 156 women had tests they didn't need and 14 had unnecessary biopsies. Newer is not necessarily better.
7. What are my options besides this test?
Ask your doctor what you can do to protect yourself besides getting a test now, advises Douglas Owens, an internist at the VA Palo Alto Health Care System and Stanford University. It could be to wait to do the test because the odds of developing breast cancer in your 40s don't outweigh your concerns about the downside of a mammogram, so you'd rather hold off until you're 50.
Or, if you've decided against a specific test for a particular reason-maybe you can't get over your squeamishness about a screening colonoscopy even if Katie Couric says it's not that bad-ask about other options. A fecal occult blood test, a CT or "virtual" colonoscopy, or a sigmoidoscopy (which doesn't reach very far into the colon) may be more personally acceptable. Any test for colon cancer is better than none. But since that maxim doesn't hold for every screening test, your decision to have one should be thoughtful rather than automatic.
Thumbs Up and Down
For which cancers is screening indicated for healthy people with typical risks? Which ones aren't? The following advice is taken from guidelines set by the United States Preventive Services Task Force and the American Cancer Society.
Colon: Several methods. The ACS has schedules for each.
Cervical: Pap smear advised for women who are sexually active; not recommended for women over 65.
Breast: Mammography benefits are strongest for women in their 50s, says the USPTF.
INSUFFICIENT EVIDENCE OR POSSIBLE HARM
Prostate: Not enough evidence for a routine PSA test, says the USPTF. The ACS says it should be offered but doesn't endorse it.
Lung, oral, skin: Neither group takes a position for or against testing.
Bladder, ovarian, pancreatic, testicular.
Note: Details are at www.ahrq.gov/clinic/cps3dix.htm#cancer and www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_Guidelines_36.asp?sitearea=PED