Screening for Early Detection Cancer screening means checking for cancer, or for abnormal cells that may become cancerous, in people who have no signs or symptoms of the disease. Screening for cancer according to evidence-based guidelines can help find aberrations at the earliest possible detectable phase during cancer development and progression. Health care providers use the information gleaned from a cancer screening test to make an informed decision on whether to monitor or treat, or surgically remove, precancerous lesions or early-stage cancer before they progress to a more advanced stage (see Figure 10, p. 55). There are different kinds of cancer screening tests that include laboratory tests to determine the changes in cancer biomarkers in biospecimen samples, and imaging or endoscopic procedures to look for specific abnormalities. In the United States, the U.S. Preventive Services Task Force (USPSTF), an independent Congressionally-mandated panel of experts in preventive care, rigorously reviews the evidence on the benefits and harms of behavioral counseling, preventive medications, and screening strategies related to cancer (see Sidebar 18, p. 56). There are other tests beyond those recommended by the USPSTF that are also used by clinicians for detecting cancer. As one example, magnetic resonance imaging (MRI) is not a USPSTFrecommended test, and is not typically used to screen for breast cancer. However, a breast MRI may be performed to further evaluate abnormal findings on mammograms for persons with dense breast tissue, which makes it hard to see abnormal areas on mammography (272). Researchers also continually evaluate the safety and accuracy of new and improved methods. Importance of Cancer Screening The overarching goal of cancer screening is to reduce the burden of cancer in the general population. Guidelines and IN THIS SECTION, YOU WILL LEARN: ⚫ Screening for cancer means looking for cancer or abnormal cells that may become cancer in people who do not have any signs of the disease. ⚫ In the United States, independent panels of experts, convened by the government or by professional organizations, carefully evaluate the benefits and harms of cancer screening tests before issuing screening recommendations. ⚫ Extensive research has shown that routine cancer screening saves lives. ⚫ Advances in medical research are underscoring the potential for artificial intelligence and minimally invasive screening tests as new frontiers in early detection of cancer. ⚫ Additional research is needed for early detection of certain cancer types, such as cancers of the ovary, pancreas, and liver, that have high mortality rates but no population-level screening tests. ⚫ Evidence-based interventions can increase adherence to recommended screening guidelines but disparities in the uptake of cancer screening persist. In June 2023, FDA approved iopromide-300 and -370 (Ultravist), an iodine-based contrast agent, which can be used as a supplement to mammography and/or ultrasound for enhanced visualization of known or suspected lesions of the breast in adults (270, 271). I O O OH OH H O I I N N OH HO N H O A recent study of more than one million women found that digital breast tomosynthesis had a higher rate of breast cancer detection and a lower rate of false positives compared to standard digital mammography alone (273). AACR Cancer Progress Report 2023 Screening for Early Detection 54
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