Thursday, February 4, 2021
UNT System HR is bringing UNT World experts directly to you with this periodic and always timely installation called "Ask An Expert." So, let's ask...
EXPERT: Dr. Damon Schranz, Family Medicine Physician at UNT Health Science Center & Associate Professor at
Texas College of Osteopathic Medicine (TCOM).
EXPERTISE: Academic Physician with 20 years of practice; Health Policy Fellow
Today is World Cancer Day and we've enlisted Dr. Schranz from the Health Science Center to address some important recent changes to colon cancer screening guidelines, cervical cancer screening guidelines and recommendations surrounding lung cancer screening. Dr. Schranz joined the Department of Family Medicine as an assistant professor in 2001 and has been an integral member of the department ever since. For the last 20 years, he has taught medical students and residents through two Family Medicine Residency Programs; one at Osteopathic Medical Center of Texas and currently at Plaza Medical Center of Texas.
"The United States Preventative Services Task Force (USPTF) recognizes many different guidelines for Cancer Prevention and Screening," Schranz says. "These are all evidence-based and are reviewed consistently by the USPSTF, and incorporate recent medical studies as well as suggestions from leading specialty societies in their guidelines. Guidelines are rated on a scale of A-D, with an additional category of I (indeterminate). Currently, there are only three Grade A Guidelines (most evidence) for cancer prevention and detection listed, and those are for colon cancer, cervical cancer and education on smoking cessation.
"Q: When should I start being screened for Colon Cancer?
Dr. Schranz: While the USPTF recognizes the importance of routine colon cancer screening starting at age 50, the American Cancer Society (ACS) has recently changed the age to 45. It is not uncommon that specialty societies,
USPSTF and the American Cancer Society do not necessarily agree all the time. For that reason, it is important to have the discussion with your primary care physician or gastroenterologist as to what is right for you. The ACS developed the age of 45 based on outcomes. It noticed an increase in detection of advanced colon cancer in those being screened at the age of 50. For that reason, the guideline was lowered. It is recommended that you have either a fecal immunoglobulin (non-invasive) test or colonoscopy (invasive procedure) starting at 45, and every 10 years thereafter through the age of 75. Screening from age 76-85 should be based on other comorbid conditions and expected longevity based on comorbid conditions. It is not recommended for screening purposes past the age of 85. These recommendations are based on those of average risk.
For those with the following risk factors, colonoscopy is the preferred route for screening, and screening may occur earlier than 45 based on these risks:
- Personal history of colorectal cancer or certain types of polyps
- Family history of colorectal cancer
- Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
- Confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
- Personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer
Q: What are the current guidelines for cervical cancer screening?
Dr. Schranz: Cervical cancer screening has changed multiple times in my 20 years as a practicing physician. The current recommended guidelines state that cervical cancer screening should begin at the age of 21 regardless of prior sexual activity, protected or not protected. This should continue every three years through the age of 29 if using the simple cytology pap smear we have used for decades. Newer technologies that incorporate testing for Human Papilloma Virus (HPV) alone or in addition to simple cytology, can decrease the frequency of these cervical cancer screens to every five years in women age 30-65. For women over 65 and who have had adequate prior screening, there is no proven benefit to continuing this exam. In addition, women who have had a hysterectomy with removal of the cervix for non-cancerous reasons, it has been shown also to have no benefit. Cancer screening is a personal decision and should be discussed with your primary care physician or gynecologist. Guidelines are just that, guidelines, and can be modified based on a host of reasons including patient preference.
Q: What are the current recommendations surrounding Lung Cancer Screening?
Dr. Schranz: The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults age 55-80 who have a 30 pack-year (one pack of cigarettes per day for 30 years) smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. This is a category B recommendation for detection. Early detection often brings hope for a cure by removal of the diseased lung or lobe of lung prior to metastasis.
For prevention of lung cancer and the comorbidities brought about by long-term smoking, it is recommended that all physicians use the 5As:
- Ask all patients about use
- Advise tobaccos users to quit
- Assess the willingness of the patient to attempt to quit
- Assisting with attempts to quit
- Arranging follow up with patient to assess
The category A-rating of prevention rests with the use of behavioral interventions (counseling), pharmacotherapy (Chantix, Buproprion) and simply the physician inquiring and asking about tobacco use.