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been widely studied for primary cancer prevention (see 39), but large trials in women taking aspirin, vitamin E, or calcium and vitamin D did not find reductions in cancer incidence or mortality Use of tamoxifen, raloxifene, and aromatase inhibitors for breast cancer prevention is discussed in s 16 and 39 Hepatitis B vaccination can prevent hepatocellular carcinoma, and the development of an HPV vaccine holds promise for prevention of cervical cancer
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Cook NR et al Low-dose aspirin in the primary prevention of cancer: the Women s Health Study: a randomized controlled trial JAMA 2005 Jul 6;294(1):47 55 [PMID: 15998890] Lee IM et al Vitamin E in the primary prevention of cardiovascular disease and cancer: the Women s Health Study: a randomized controlled trial JAMA 2005 Jul 6;294(1):56 65 [PMID: 15998891] Wactawski-Wende J et al; Women s Health Initiative Investigators Calcium plus vitamin D supplementation and the risk of colorectal cancer N Engl J Med 2006 Feb 16;354(7):684 96 [PMID: 16481636]
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Screening has been shown to prevent death from cancers of the breast, colon, and cervix Current cancer screening recommendations from the American Cancer Society, the Canadian Task Force on Preventive Health Care, and the United States Preventive Services Task Force are shown in Table 1 9 The appropriate form and frequency of screening for breast cancer is controversial A large randomized trial of breast self-examination conducted among factory workers in Shanghai found no benefit A systematic review performed for the United States Preventive Services Task Force found that mammography was moderately effective in reducing breast cancer mortality for women 40 74 years of age The absolute benefit was greater for older women, and the risk of false-positive results was high for all women All current recommendations call for cervical and colorectal cancer screening Prostate cancer screening, however, is controversial, as no completed studies have answered the question whether early detection and treatment after screen detection produce sufficient benefits to outweigh harms of treatment Providers and patients are advised to discuss how to proceed in light of this uncertainty Single serum prostate-specific antigen (PSA) measurements appear to offer relatively high sensitivity and specificity to detect prostate cancer The sensitivity is about 65%, the specificity about 80%, and the positive predictive value for prostate cancer is about 45% When both the digital rectal examination and serum PSA are abnormal, PSA specificity increases, but sensitivity falls (to 30%) and predictive value rises only slightly Whether early detection through screening and subsequent treatment alters the natural course of the disease remains to be seen There are still no data on the morbidity and mortality benefits of screening Unlike the American College of Physicians, the American Cancer Society recommends that providers offer annual PSA testing for men over age 50 Screening is not
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CANCER PREVENTION Primary Prevention
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Mortality rates of cancer have begun to decrease in the past 2 years; part of this decrease results from reductions in tobacco use, since cigarette smoking is the most important preventable cause of cancer Primary prevention of skin cancer consists of restricting exposure to ultraviolet light by wearing appropriate clothing and use of sunscreens In the past 2 decades, there has been a threefold increase in the incidence of squamous cell carcinoma and a fourfold increase in melanoma in the United States Persons who engage in regular physical exercise and avoid obesity have lower rates of breast and colon cancer Prevention of occupationally induced cancers involves minimizing exposure to carcinogenic substances such as asbestos, ionizing radiation, and benzene compounds Chemoprevention has
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Table 1 9 Cancer screening recommendations for average-risk adults, 2003
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Test Breast Self-examination (BSE) Clinical breast examination Mammography ACS1 Monthly for women over age 20 CTF2 Fair evidence that BSE should not be used Every 1 2 years in women aged 40 59 USPSTF3 Insufficient evidence to recommend for or against Insufficient evidence to recommend for or against Recommended every 1 2 years for women aged 40 and over (B)
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