Screening is performed earlier and more frequently when there is a strong family history. Randomized, controlled trials have documented that fecal occult blood testing (FOBT) confers a 15 to 30% reduction in colon cancer mortality. Although randomized trials have not been performed for sigmoidoscopy or colonoscopy, well-designed case-control studies suggest similar or greater efficacy relative to FOBT. b In the future, Pap smear frequency may be influenced by HPV testing and the HPV vaccine. Note: Prostate-specific antigen (PSA) testing is capable of enhancing the detection of early-stage prostate cancer, but evidence is inconclusive that it improves health outcomes. PSA testing is recommended by several professional. | Chapter 004. Screening and Prevention of Disease Ky 4 Screening is performed earlier and more frequently when there is a strong family history. Randomized controlled trials have documented that fecal occult blood testing FOBT confers a 15 to 30 reduction in colon cancer mortality. Although randomized trials have not been performed for sigmoidoscopy or colonoscopy well-designed case-control studies suggest similar or greater efficacy relative to FOBT. AIn the future Pap smear frequency may be influenced by HPV testing and the HPV vaccine. Note Prostate-specific antigen PSA testing is capable of enhancing the detection of early-stage prostate cancer but evidence is inconclusive that it improves health outcomes. PSA testing is recommended by several professional organizations and is widely used in clinical practice but it is not currently recommended by the . Preventive Services Task Force Chap. 81 . Source Adapted from the . Preventive Services Task Force 2005. Guide to Clinical Prevention Services 3d ed. http www. ahrq. gov clinic Cost-Effectiveness Screening techniques must be cost-effective if they are to be applied to large populations. Costs include not only the expense of testing but also time away from work and potential risks. When the risk-to-benefit ratio is less favorable it is useful to provide information to patients and factor their perspectives into the decision-making process. For example many expert groups including the USPSTF recommend an individualized discussion about prostate cancer screening as the decision-making process is complex and relies heavily on personal issues. Although the early detection of prostate cancer may intuitively seem desirable risks include false-positive results that can lead to anxiety and unnecessary surgery. Potential complications from surgery and radiation treatment include erectile dysfunction urinary incontinence and bowel dysfunction. Some men may decline screening while others may be more .
