Chapter 078. Prevention and Early Detection of Cancer (Part 10)

Lung Cancer Chest x-ray and sputum cytology have been evaluated in randomized lung cancer screening trials. No reduction in lung cancer mortality has been seen, although all the controlled trials have had low statistical power. Even screening of high-risk subjects (smokers) has not proven beneficial. Spiral CT can diagnose lung cancers at early stages; however, false-positive rates are high. Spiral CT screening increases the number of lesions detected and increases the number of diagnostic and therapeutic procedures. However, its capacity to save lives is unproven. Ovarian Cancer Adnexal palpation, transvaginal ultrasound, and serum CA-125 assay have been considered for ovarian cancer. | Chapter 078. Prevention and Early Detection of Cancer Part 10 Lung Cancer Chest x-ray and sputum cytology have been evaluated in randomized lung cancer screening trials. No reduction in lung cancer mortality has been seen although all the controlled trials have had low statistical power. Even screening of high-risk subjects smokers has not proven beneficial. Spiral CT can diagnose lung cancers at early stages however false-positive rates are high. Spiral CT screening increases the number of lesions detected and increases the number of diagnostic and therapeutic procedures. However its capacity to save lives is unproven. Ovarian Cancer Adnexal palpation transvaginal ultrasound and serum CA-125 assay have been considered for ovarian cancer screening. These tests alone and in combination do not have sufficiently high sensitivity or specificity to be recommended for routine screening of ovarian cancer. The risks and costs associated with the high number of false-positive results is an impediment to routine use of these modalities for screening. Most expert panels have concluded that routine screening for ovarian cancer is not indicated for standard-risk women or those with single affected family members but might be worthwhile in families with genetic ovarian cancer syndromes. Prostate Cancer The most common prostate cancer screening modalities are DRE and serum prostate-specific antigen PSA assay. Newer serum tests such as measurement of bound to free serum PSA have yet to be fully evaluated. An emphasis on PSA screening has caused prostate cancer to become the most common non-skin cancer diagnosed in American males. This disease is prone to lead-time bias length bias and overdiagnosis and substantial debate rages among experts as to whether it is effective. Some experts are concerned that prostate cancer screening more than screening for other cancers may cause net harm. Prostate cancer screening clearly detects many asymptomatic cancers but the ability to .

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