past which the potential harms from screening tests are likely to outweigh benefits (see Sidebar 20, p. 59). For example, USPSTF guidelines recommend against screening for prostate cancer in men older than 69. However, a recent study found that 55.3 percent of men ages 70 to 74, 52.1 percent of men ages 75 to 79, and 39.4 percent of men age 80 and older were screened for prostate cancer in 2020 (292). Suboptimal adherence to recommended cancer screening guidelines is evident across cancer types, and researchers are continually working to develop evidence-based approaches to increase adherence to cancer screening guidelines (see Progress Toward Increasing Adherence to Cancer Screening Guidelines, p. 64). The COVID-19 pandemic has further adversely impacted cancer screening rates (293). A recent study evaluating the impact of the COVID-19 pandemic on cancer screening found that, in the United States between 2019 and 2021, screening within a prior year decreased from 60 percent to 57 percent for breast cancer, from 45 percent to 39 percent for cervical cancer, and from 39.5 percent to 36 percent for prostate cancer (259). Another area of major concern is the inequities in cancer screening and follow-up testing among certain U.S. population groups (see Sidebar 2, p. 17). For example, compared to the overall U.S. population, cancer screening rates are lower among certain racial and ethnic as well as sexual and gender minorities (see Sidebar 22, p. 63) (293). A multitude of barriers contribute to low screening rates, including social and structural barriers; bias and discrimination against minorities in the health care system; mistrust of health care professionals among minorities; lack of access to quality health insurance and coverage; low health literacy; and miscommunication between patients and providers (13). It is important to fully understand why individuals belonging to certain population groups are at a higher risk of being diagnosed with certain types of cancer, and whether suboptimal uptake of screening contributes to this higher risk. Furthermore, there is an urgent need to collect disaggregated data related to all aspects of cancer burden and clinical care from individuals belonging to racial and ethnic minorities, sexual and gender minorities, and others who are socially and economically disadvantaged, including people who belong to USPSTF Recommendation for Breast Cancer Genetic Testing in Women USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with mutations in breast cancer 1 and 2 (BRCA1/2) genes with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. FIGURE 12 NO YES CLINICAL SUMMARY OF USPSTF RECOMMENDATIONS Does the individual have personal or family history of breast, ovarian, tubal, or peritoneal cancer or have an ancestry associated with BRCA1/2 gene mutations? ? Do not perform routine risk assessment, genetic counseling or genetic testing A trained health care provider should assess the risk with appropriate brief familial risk assessment tool such as 7-Question Family History Tool GENETIC COUNSELING Done by a trained professional to determine whether genetic testing is needed, to interpret results after testing, and discussion of next steps GENETIC TESTING Performed by a clinical laboratory and interpreted by a trained genetic counselor and health care provider AACR Cancer Progress Report 2023 Screening for Early Detection 62
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