Health care dana bartlett, bsn, msn, ma, cspi

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Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevire, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students.


Screening is an effective method for detecting and preventing acute and chronic diseases. In the United States healthcare tends to be provided after someone has become unwell and medical attention is sought. Poor health habits play a large part in the pathogenesis and progression of many common, chronic diseases. Conversely, healthy habits are very effective at preventing many diseases. The common causes of chronic disease and prevention are discussed with a primary focus on the role of health professionals to provide preventive healthcare and to educate patients to recognize risk factors and to avoid a chronic disease.

Policy Statement

This activity has been planned and implemented in accordance with the policies of and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities.

Continuing Education Credit Designation

This educational activity is credited for 4 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 0.5 hours (30 minutes).

Statement of Learning Need

Health professionals need to know the recommended screening tests that may lead to early detection or prevention of medical problems that cause morbidity and mortality if left undiagnosed and untreated.

Course Purpose

To provide health clinicians with up-to-date knowledge of the current recommendations for preventive health screening tests and techniques, as well as recommendations in lifestyle changes that will promote preventive healthcare.

Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Dana Bartlett, BSN, MSN, MA, CSPI, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures

Acknowledgement of Commercial Support

There is no commercial support for this course.

Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course.

  1. One of the limitations of screening tests is:

  1. Guidelines are often changed and updated.

  2. They rarely provide a high degree of specificity or sensitivity.

  3. They can only be used for adolescents and adults.

  4. The benefits seldom outweigh the risks.

  1. Screening tests must be used with the understanding that

  1. they are seldom able to detect diseases.

  2. most of them are associated with harmful side effects.

  3. they are not diagnostic.

  4. they cannot be used for children.

  1. Adults should be screened for alcohol misuse if they

  1. are males over age 35.

  2. drink hard liquor.

  3. use illicit drugs.

  4. engage in risky drinking behavior.

  1. Breast cancer is

  1. only found in post-menopausal women.

  2. the second most common cancer in women.

  3. primarily caused by cigarette smoking.

  4. not detectable without a biopsy.

  1. Breast cancer screening may include

  1. an x-ray.

  2. a CT scan.

  3. a biopsy.

  4. mammography and genetic testing.


Screening is an effective method for detecting and preventing acute and chronic diseases. Instead, healthcare in the United States is typically provided after someone has become unwell. People generally seek a physician or medical attention when sick and not before. Additionally, poor health habits play a large part in the pathogenesis and progression of many common, chronic diseases. Often people view illnesses, such as atherosclerosis, diabetes, hypertension, or obesity, as acute and unexpected rather than conditions that can be prevented through screening and follow-up with their health clinician.

Collaboration In Preventative Medicine

In many cases, the signs and symptoms of chronic medical problems that cause morbidity and mortality in most Americans are just confirmation of an illness that has been present for many years. For example, approximately 34% of the adults in the U.S., are obese. Obesity is a major risk factor for the development of type 2 diabetes. The primary cause of obesity is harmful patterns of food intake and energy expenditure; too many calories and not enough exercise. Studies have clearly shown that type 2 diabetes can be prevented by weight loss, dietary changes, and exercise. Healthy habits are very effective at preventing many other diseases, as well.

Preventative medicine involves a collaborative effort by the healthcare community and individual patients. These include the following local healthcare and individual efforts to promote health prevention.

  • The healthcare community identifies the diseases that affect, or are likely to affect a specific population.

  • The healthcare community screens for acute and chronic health problems and identifies people at risk.

  • The healthcare community delivers specific interventions and therapies that will prevent disease, i.e., vaccinations.

  • The healthcare community provides consumers with information about behaviors and interventions that can help prevent chronic illness.

  • The healthcare community supports consumers in a life-long commitment to healthy life style choices

  • The individual makes the changes in diet, exercise, and other life style factors that influence his/her health.

Screening For Disease Detection And Prevention

Screening is an effective method for detecting and preventing acute and chronic diseases. However, it is important to remember the following points when broad screening guidelines are used for a heterogeneous population.

  • Not all cases of disease can or will be detected.

  • Screening guidelines are always being changed and updated.

  • Screening should be done on a case-by-case basis and when appropriate, screening should be accompanied by an examination and interview with a healthcare professional.

  • A screening test is not a diagnostic test.

In addition, screening is most effective when a disease or disorder 1) is an important public health problem, 2) has an early, asymptomatic phase, 3) has an effective screening test that can accurately identify people who will benefit from treatment, 4) has an available treatment, and 5) involves screening tests with benefits that outweigh the risks. Screening tests should be simple to perform, cost-effective, and easy to interpret and they must be sensitive and specific.

The primary source of information used in this learning module is the U.S. Preventive Services Task Force’s (USPSTF) Guide to Clinical Preventive Services 2014. The USPSTF Guide discusses many diseases and disorders. This module will for the most part only discuss ones for which the Guide provides screening recommendations but some exceptions have been made. The Guide to Clinical Preventive Services 2014 is available online.1
Alcohol Use Disorder And Addiction

The unhealthy use of alcohol by Americans is endemic. The 2014 National Survey on Drug Use and Health noted that 60.9 million Americans reported binge alcohol use in the past month and 16.3 million reported heavy drinking in the past month.2 Over 17 million American adults have an alcohol use disorder, and the twelve-month and lifetime prevalence of alcohol use disorder has been estimated to be 13.9% and 29.1%, respectively.3

The unhealthy use of alcohol is often unrecognized in the primary care setting and studies support screening of the population for unhealthy alcohol use.4 Who should be screened for alcohol use, when people should be screened, and how often screening should be done depends on factors such as age and an individual’s experience with alcohol and/or drugs; and, different screening guidelines are available. The USPSTF recommendations are shown below.5

USPSTF Recommendations for Screening for Alcohol Misuse

Screen for alcohol misuse and provide brief behavioral counseling interventions to persons engaged in risky or hazardous drinking.
There is a moderate net benefit to alcohol misuse screening and brief behavioral counseling interventions in the primary care setting for adults aged 18 years or older.
Counseling interventions in the primary care setting can improve unhealthy alcohol consumption behaviors in adults engaging in risky or hazardous drinking.
Behavioral counseling interventions for alcohol misuse vary in their specific components, administration, length, and number of interactions. Brief multi-contact behavioral counseling seems to have the best evidence of effectiveness; very brief behavioral counseling has limited effect.
Numerous screening instruments can detect alcohol misuse in adults with acceptable sensitivity and specificity. The USPSTF prefers the following tools for alcohol misuse screening in the primary care setting: AUDIT, the abbreviated AUDIT-C, and single-question screening such as asking, “How many times in the past year have you had 5 (for men) or 4 (for women and all adults older than 65 years) or more drinks in a day?”

The AUDIT and the Audit-C screening tools are accurate and well validated, widely accepted and used in primary care settings for alcohol misuse. These screening tools have been shown to be useful in identifying hazardous drinking and to help initiate behavioral changes in patients who engage in harmful or hazardous drinking.6-8
The Alcohol Use Disorders Identification Test – AUDIT

In the AUDIT, the answers are scored as: 0 for never and 1-4 for ascending frequency of use. Questions 9 and 10 are scored as 0, 2, and 4 for ascending frequency. A score of ≥8 is associated with harmful or hazardous drinking; and, a score of ≥13 in women and ≥ 15 or more in men is likely to indicate alcohol dependence. The healthcare professional will ask the following questions when using the AUDIT screening tool.9

1. How often do you have a drink containing alcohol?

a. Never

b. Monthly or less

c. 2-4 times a month

d. 2-3 times a week

e. 4 or more times a week
2. How many alcoholic drinks do you have on a typical day drinking?

a. 1 or 2

b. 3 or 4

c. 5 or 6

d. 7 to 9

e. 10 or more
3. How often do you have six or more drinks on one occasion?

a. Never

b. Less than monthly

c. Monthly

d. Weekly

e. Daily or almost daily
4. During the past year, how often have you found that you were unable

to stop drinking?
a. Never

b. Less than monthly

c. Monthly

d. Weekly

e. Daily or almost daily

5. During the past year, how often have you failed to do what was

normally expected of you because of drinking?
a. Never

b. Less than monthly

c. Monthly

d. Weekly

e. Daily or almost daily

  1. During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?

a. Never

b. Less than monthly

c. Monthly

d. Weekly

e. Daily or almost daily

  1. During the past year, how often have you had a feeling of guilt or remorse after drinking?

a. Never

b. Less than monthly

c. Monthly

d. Weekly

e. Daily or almost daily

  1. During the past year, have you been unable to remember what happened the night before because you had been drinking?

a. Never

b. Less than monthly

c. Monthly

d. Weekly

e. Daily or almost daily

  1. Have you or someone else been injured as a result of your drinking?

a. No

b. Yes, but not in the past year

c. Yes, during the past year

  1. Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?

a. No

b. Yes, but not in the past year

c. Yes, during the past year

Alcohol Use Disorders Identification Test-Consumption - AUDIT-C
For men a score of ≥ 4 is considered positive. In women, a score of ≥ 3 or more is considered positive. Generally, the higher the AUDIT-C score the more likely drinking is affecting health and safety. The questions are listed in the table below.10

  1. How often did you have a drink containing alcohol in the past year? If the answer is never, score questions 2 and 3 as zero.

a. Never - 0 points

b. Monthly or less - 1 point

c. 2 to 4 times a month - 2 points

d. 3 or 4 times per week - 3 points

e. 4 or more times a week - 4 points


  1. How many drinks did you have on a typical day when you were drinking in the past year?

a. 1 or 2 - 0 points

b. 3 or 4 - 1 point

c. 5 or 6 - 2 points

d. 7 to 9 - 3 points

e. 10 or more - 4 points


  1. How often did you have 6 or more drinks on one occasion in the past year?

a. Never - 0 points

b. Less than monthly - 1 point

c. Monthly - 2 points

d. Weekly - 3 points

e. Daily or almost daily - 4 points

The four question CAGE screening test for alcohol use is familiar to many healthcare professionals. This test asks the following:

  • Have you ever felt you should Cut down on your drinking?

  • Have people Annoyed you by criticizing your drinking?

  • Have you ever felt bad or Guilty about your drinking?

  • Have you ever taken a drink first thing in the morning (Eye-

opener) to steady your nerves or get rid of a hangover?
The CAGE test is not recommended as a screening tool for alcohol use as it is not highly sensitive or specific.4
Tobacco Or Nicotine Use And Addiction

Tobacco use and its correlating problems are enormous public health concerns. Tobacco use is the leading cause of preventable death in the United States. The number of Americans who smoke has decreased by more than one-half in the past 50 years, but tobacco and cigarette smoking are still the primary causes of, or contributors to certain cancers, heart disease, common respiratory diseases, and many other acute and chronic pathology. A 2014 report from the Surgeon General noted that tobacco and smoking have “... killed ten times the num­ber of Americans who died in all of our nation’s wars combined.125

It has also been proven that second-hand smoke is a significant cause of serious acute and chronic heath problems in children and adults. Second-hand smoke (also called side stream smoke) is very dangerous. Second-hand smoke is smoke that is produced from burning tobacco or smoke that has been exhaled by someone using a cigarette and there is no safe level of second-hand smoke.

Smoking and tobacco use are still common in the United States. Statistics from the Centers of Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Association (SAMHSA) are listed in the tables below.126-128

Smoking and Tobacco Use in the United States

  • In 2014, almost 17 of every 100 U.S., adults aged 18 years or older (16.8%) currently smoked cigarettes. This means an estimated 40 million adults in the United States currently smoke cigarettes. There are also millions of people who use smokeless tobacco and e-cigarettes.

  • Cigarette smoking is the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths.

  • More than 16 million Americans live with a smoking-related disease.

  • Current smoking has declined from nearly 21 of every 100 adults (20.9%) in 2005 to nearly 17 of every 100 adults (16.8%) in 2014.

  • In 2014, an estimated 66.9 million Americans aged 12 or older were current users of a tobacco product (25.2%). Young adults aged 18 to 25 had the highest rate of current use of a tobacco product (35%), followed by adults aged 26 or older (25.8%), and by youths aged 12 to 17 (7%).

  • In 2014, the prevalence of current use of a tobacco product was 37.8% for American Indians or Alaska Natives, 27.6% for whites, 26.6% for blacks, 30.6% for Native Hawaiians or other Pacific Islanders, 18.8% for Hispanics, and 10.2% for Asians.

The CDC as well as several other sources have published the health effects of second-hand smoke, as well as recommendations to recognize the potential and ways to avoid it.129-130

Health Effects of Second-Hand Smoke

Asthma attacks



Ear infections

Heart disease

Lung cancer



Sudden infant death syndrome (SIDS)

Second-hand smoke has been estimated to increase the relative risk of developing chronic obstructive pulmonary disease (COPD), stroke, and ischemic heart disease by 1.66, 1.35, and 1.22, respectively.131 Children are especially vulnerable to the harmful effects of second-hand smoke and prenatal exposure to second-hand smoke has been identified as a risk factor for developing asthma.132 Also, close proximity is not necessary for exposure to second-hand smoke; many studies have shown that living in a multi-residential building can expose non-smokers to second-hand smoke.133

Smoking Cessation Interventions

There are interventions that can prevent people from smoking and there are behavioral counseling techniques and medications that have been shown to be effective at helping smokers quit. But nicotine, the primary active component of cigarette smoke, is strongly addictive and since tobacco is legal the prevention of smoking and smoking cessation are considerable challenges. Behavioral-based interventions that can be helpful as aids to smoking cessation include direct provider to patient interaction, group therapy, specialized clinics, self-help intervention using educational resources like printed material or videos, web-based and text-based resources, and telephone applications and telephone contact counseling have all been successfully used. The specific intervention chosen will depend on availability, cost, and patient preference. Important aspects of medication and behavioral interventions as aids to smoking cessation that can increase the chance of success are discussed below.134-138


Pharmacotherapy (with or without behavioral interventions) can significantly influence smoking cessation rates in adults. There are three drugs that are approved by the Food and Administration (FDA) for assisting patients with smoking cessation: bupropion, nicotine replacement therapy (NRT), and varenicline. Alternative approaches to support patients during their course of care in a smoking cessation program have been reported to provide value and good results of quitting smoking, such as acupuncture, hypnosis and e-cigarettes.

Each year approximately two out of every three smokers will try and quit but the majority will be unsuccessful.139,140 There are many reasons why smokers find it difficult to quit and difficult to maintain abstinence, including but not limited to: side effects of cessation such as cravings and withdrawal, weight gain, mood changes, poor social support, access problems for smoking cessation programs, poor preparation for quitting, and incorrect use of medications. These issues, along with the addictive properties of nicotine, clearly present smokers with a considerable challenge when they try to quit and to cease the smoking habit long-term.
Screening and Prevention Through the Electronic Health Record

Improving tobacco use screening and exposure to second-hand smoke has become an area of focus for many electronic health records (EHRs) with smoking prevention and cessation patient teaching tools built into the admission process. Most clinic and hospital providers will screen for tobacco use, such as asking patients how many years or how much they smoke each day. A patient who reports a smoking history may be offered educational handouts that promote health prevention and resources for smoking cessation; several examples are listed below.

  • Freedom from Smoking® is a program offered by the American Lung Association. Use this link: and scroll down the page to the section title Get Help.

  • The American Lung Association also has a help line, 1- 800 LUNG USA.

  • is a website of the United States Department of Health and Human Services. It includes information on healthy habits, how smoking affects one's health, and tips on preparing to quit. It also includes resources specifically for women, teens, and Spanish-speaking patients.

  • 1-800-QUIT Now (1-800-784-0669) is a toll free number that connects smokers to the Quit For Life® program, sponsored by the American Cancer Society.

Lung Cancer

Lung cancer is the most common cause of death from cancer in American adults.73 The National Cancer Institute estimates that in 2016 there will 224,390 new cases of lung cancer and that lung cancer will account for more than one-fourth of all cancer deaths.74 Cigarette smoking is the primary cause of lung cancer. Most lung cancers are discovered when they are in the late stage. Targeted screening is advised.

The USPSTF and the American Cancer Society recommends that asymptomatic adults aged 55 to 80 years who have a 30 pack-year history of smoking and currently smoke or have quit smoking within the past 15 years should have annual screening with low dose computed tomography.5,75 The 2014 Clinical Guidelines state: “Annual screening for lung cancer with low-dose computed tomography is of moderate net benefit in asymptomatic persons who are at high risk for lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking.”5
Breast Cancer

Breast cancer is the most common cancer in women, excluding skin cancer. In 2013, 230,815 women and 2109 men were diagnosed as having breast cancer. That same year, 40,860 women and 464 men died from breast cancer in the United States.11

Risk factors for breast cancer include age, age at first live childbirth, age at menarche, alcohol use, body mass index, breast density, diet, estrogen and progesterone use, menopause status or age, number of first-degree relatives with breast cancer, personal history of ductal or lobular carcinoma in situ, personal history of breast biopsy, physical activity, and race/ethnicity.5
Screening for breast cancer includes screening for neoplasms and screening for genetic susceptibility to breast cancer.

American Cancer Society Screening Recommendations
The American Cancer Society’s breast cancer screening recommendations are outlined below.12

  • Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (X-rays of the breast) if they wish to do so.

  • Women age 45 to 54 should get mammograms every year.

  • Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.

  • Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.

  • All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening. They also should know how their breasts normally look and feel and report any breast changes to a healthcare provider right away.

USPSTF Screening Recommendations

The USPSTF recommendations for breast cancer screening are reviewed in this section.5 Women aged 40-49 should be considered for a biennial mammogram. The decision to do a mammogram should be made on an individual basis, depending on the woman’s circumstances and values. Women aged 50-74 should have a mammogram every two years. The USPSTF does not include a recommendation for the use of mammograms in women age 75 or older.

The USPSTF recommendations apply to women aged ≥40 years that are not at increased risk by virtue of a known genetic mutation or history of chest radiation. Increasing age is the most important risk factor for most women.
There is convincing evidence that using mammography to screen for breast cancer reduces overall mortality from breast cancer. This reduction in risk becomes increased for women aged 50 to 74 years. Harms of screening include psychological effect, additional medical visits, imaging, and biopsies in women without cancer, inconvenience due to false-positive screening results, harms of unnecessary treatment, and radiation exposure. The level of harm appears to be moderate for each age group.
USPSTF Recommendations for Genetic Testing
The population for screening is asymptomatic women who have not been diagnosed with BRCA-related cancer. Genetic testing for breast cancer is recommended for women whose family history may be associated with an increased risk for potentially harmful breast cancer mutations.5
Genetic risk assessment and breast cancer mutation testing involves identification of women who may be at increased risk for potentially harmful mutations, genetic counseling, and genetic testing of selected high-risk women when indicated. If the screening tests are positive women should receive genetic counseling and, if indicated after counseling, breast cancer mutation testing.
Tests for breast cancer mutations are highly sensitive and specific for known mutations, but interpretation of results is complex and generally requires post-test counseling. In women whose family history is associated with an increased risk for potentially harmful BRCA mutations, the net benefit of genetic testing and early intervention is moderate. Interventions in women who are BRCA mutation carriers include earlier, more frequent, or intensive cancer screening, use of risk-reducing medications such as tamoxifen or raloxifene, and risk-reducing surgery such as mastectomy or salpingo-oophorectomy. Genetic counseling and testing for breast cancer mutations is not recommended for women whose family history is not associated with an increased risk for potentially harmful breast cancer mutations.

Cervical Cancer

In 2103, 11,955 women in the United States were diagnosed with cervical cancer and 4,217 women died from the disease.13 Risk factors for cervical cancer include cigarette smoking, early onset of sexual activity, infection with high-risk strains of human papilloma virus (HPV), immunosuppression, multiple sex partners, oral contraceptive use, and persistent HPV infections.14

Cervical cancer screening decreases the incidence and mortality of cervical cancer. In the U.S., it has been estimated that screening has decreased mortality from this disease by 70%,15 and “… reviews and meta-analyses of observational studies provide consistent and compelling evidence that screening leads to a decrease in incidence and mortality from cervical cancer.”14
The harmful effects of cervical cancer screening include cost, psychosocial consequences, and discomfort. In addition, screening may lead to unneeded diagnostic and/or treatment procedures (which have risks), particularly in women <21 years in whom HPV testing may detect abnormalities that are transient.14
The USPSTF recommendations for cervical cancer screening are listed below. These recommendations are identical to the recommendations of the American Congress of Obstetricians and Gynecologists.16

USPSTF Screening Recommendations

The USPSTF recommendations for cervical cancer screening are highlighted below.5

  • Women aged 21-65: screen three years with a Pap smear.

  • Women aged 30-65: screen every three years with a Pap smear or a Pap smear and HPV testing.

  • Women < 21 years: Do not screen.

  • Women older than age 65 who have had adequate prior screening and are not high risk: Do not screen.

  • Women after hysterectomy with removal of the cervix and with no history of high-grade pre-cancer or cervical cancer: Do not screen.

  • Screening women ages 21 to 65 years every 3 years with cytology provides a reasonable balance between benefits and harms. Screening with cytology more often than every 3 years confers little additional benefit, with large increases in harm.

  • HPV testing combined with cytology (co-testing) every 5 years in women ages 30 to 65 years offers a comparable balance of benefits and harms, and is therefore a reasonable alternative for women in this age group who would prefer to extend the screening interval.

  • Screening earlier than age 21 years, regardless of sexual history, leads to more harm than benefits. Clinicians and patients should decide to end screening based on whether the patient meets the criteria for adequate prior testing and appropriate follow-up, per established guidelines.

Prostate Cancer

Prostate cancer is the most commonly diagnosed cancer in men.81 Each year more than 200,000 men in the United States are diagnosed with prostate cancer and it is the second leading cause of death from cancer in men in the United States.81,82 Risks for prostate cancer include age, African American ethnicity, and a family history of the disease.

The need for and the usefulness of screening for prostate cancer is a complex and controversial topic and a full discussion of the issue is beyond the scope of this module. Prostate cancer is very common but death from this disease is relatively uncommon. The death rate of men who have prostate cancer has been estimated to be 2.9% and the

disease progresses so slowly that most men with prostate cancer die from other causes.83 Screening for prostate cancer by measuring prostate-specific antigen (PSA) and digital rectal examination can reduce the mortality rate prostate cancer but this reduction is very small and does not outweigh the risks.83

The USPSTF does not recommend routine screening for prostate cancer and the 2014 Guidelines state: “There is convincing evidence that PSA-based screening programs result in the detection of many cases of asymptomatic prostate cancer, and that a substantial percentage of men who have asymptomatic cancer detected by PSA screening have a tumor that either will not progress or will progress so slowly that it would have remained asymptomatic for the man’s lifetime (i.e., PSA-based screening results in considerable over-diagnosis).”5
The 2014 Guidelines further state that, “The reduction in prostate cancer mortality 10 to 14 years after PSA-based screening is, at most, very small, even for men in the optimal age range of 55 to 69 years [and the] benefits of PSA-based screening for prostate cancer do not outweigh the harms.”5
The American Urological Association (AUA) and the American Cancer Society (ACS) advise that the decision to screen or not screen should be made by the patient and his primary care physician after a discussion of the risks and benefits.82,83
Skin Cancer

Skin cancer is divided into two categories, non-melanoma and melanoma. Basal cell carcinoma and squamous cell carcinoma are the two non-melanoma skin cancers. These cancers are not usually reported to cancer registries so their true incidence and prevalence are not known:84,85 They account for approximately 97% of all skin cancers but the incidences of morbidity and mortality from these neoplasms are very small.86,87

Malignant melanoma is much less common than the non-melanoma skin cancers but it is much more serious. Malignant melanoma can metastasize to any organ (most often the skin and lymph nodes) and the incidence of malignant melanoma and deaths from this cancer have been increasing for years.88 Risk factors for non-melanoma and melanoma skin cancer include (but are not limited to: 1) Caucasian ethnicity, 2) exposure to sunlight, 3) indoor tanning, 4) immunosuppression, 5) fair skin, 6) family history of melanoma, 7) atypical nevi, 8) advanced age, 9) psoralen, and 10) UVA light therapy.
Unfortunately, there does not seem to be any benefit from universal screening for skin cancer.5,87,89 The USPSTF does not recommend routine screening for skin cancer, noting that there is “… insufficient evidence to assess the balance of benefits and harms of whole body skin examination by a clinician or patient….“5 Clinicians and patients should remember that skin lesions should be considered potentially malignant if they are rapidly changing or if A, B, C, D is present, as shown below:


Border irregularity

Color variability

Diameter > 6 mm

Colorectal Cancer

In 2103, 136,119 people in the U.S., were diagnosed with colorectal cancer and 51,813 people in the U.S., died from colorectal cancer.17 Colorectal cancer is the second leading cause of death from cancer in the U.S., and approximately one of three people diagnosed with the disease will die five years after it is discovered.18

Risk factors for colorectal cancer include a family history for colorectal cancer, African American ethnic status, alcohol use, cigarette smoking, Crohn’s disease, diabetes mellitus and insulin resistance, diet, inflammatory bowel disease, obesity, and radiation therapy for abdominal cancer.
There is unequivocal evidence that colorectal cancer screening and removal of pre-malignant adenomas can decrease the incidence and mortality of colorectal cancer.5,18,19 The specific risks of the invasive screening procedures, of colonoscopy and sigmoidoscopy, include infection, adverse effects from sedating drugs used during the

procedures, perforation and bleeding. Major adverse effects after flexible sigmoidoscopy and colonoscopy examinations are very unusual, occurring is less than 1% of all patients.20-22 The risk of contrast enemas and CT colonography is exposure to radiation.

Several methods are used to detect colorectal cancer. An individual’s risk profile will determine which one is appropriate.
USPSTF Screening Recommendations

The USPSTF recommendations for colorectal cancer screening are highlighted below.

  • Age 50-75: Screen with high sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy.

  • Age 76-85: Do not automatically screen.

  • Age > 85: Do not screen.

  • Screening intervals: Annual screening with high-sensitivity fecal occult blood testing; sigmoidoscopy every 5 years, with high-sensitivity fecal occult blood testing every 3 years; or screening colonoscopy every 10 years.

  • For all populations, evidence is insufficient to assess the benefits and harms of screening with computerized tomography colonography (CTC) and fecal DNA testing.

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