JustCare

Tag: USPSTF

  • Should you be taking aspirin every day?

    Should you be taking aspirin every day?

    When it comes to health care, everyone needs options tailored to their particular needs. That’s the beauty of traditional Medicare–it is one size fits all, working for everyone, so long as they have supplemental coverage. It’s also why the US Preventive Services Task Force’s recommendation against the use of daily aspirin for most people does not apply to everyone. Should you be taking aspirin every day?

    As reported in Just Care last week, the USPSTF recently recommended against the use of daily low-dose aspirin for most people because it determined that the risk of internal bleeding was greater than the benefits. However, that recommendation is the rule, for which there are likely exceptions. Andrew Chan, the director of cancer epidemiology at the Mass. General Cancer Center and a professor at Harvard Medical School, believes that powerful evidence indicates that low-dose aspirin can be effective in preventing colorectal cancer.

    Chan argues that the USPSTF is wrong to suggest that the evidence of the benefits of low-dose daily aspirin use is inconclusive when it comes to colorectal cancer. Chan’s research team found that people can benefit from taking aspirin if they start before they turn 70 and ward off colorectal cancer. If they start at 70, the data indicates that it might be too late to ward off cancer.

    Chan appreciates that there are serious risks of internal bleeding for some people who take low-dose aspirin daily. The key is to identify those people and make sure that they are not prescribed daily aspirin use. At the same time, Chan believes that low-dose aspirin can have beneficial anticancer effects for some people. It’s important to understand who can benefit.

    Science is evolving so it will likely be possible to understand a lot more about the population who benefits from taking daily aspirin and the population whose health is endangered from daily aspirin intake. Chan would like to see studies that identify biomarkers or another molecular factor that is able to calibrate risks and benefits of aspirin for particular individuals. He says that preventive medicine should be looking into this.

    Here’s more from Just Care:

  • Daily use of baby aspirin can present greater risks than benefits

    Daily use of baby aspirin can present greater risks than benefits

    For quite some time now, older adults with certain health conditions have been told to take a daily dose of baby aspirin in order to ward off heart disease. A panel of independent experts at the US Preventive Services Task Force now recommends against this treatment, finding that daily use of baby aspirin generally presents greater risks than benefits for people over 60.

    People at high risk of a heart attack or stroke are generally better off not starting a daily regimen of baby or low-dose aspirin (81-100 milligrams), according to the recommendations of the US Preventive Services Task Force “USPSTF.” Apparently, the side effects of daily low-dose aspirin intake are more grave than originally understood. Internal bleeding is more likely than heart attack prevention. Moreover, aspirin use has never reduced the risk of death from heart disease.

    The expert panel also does not recommend taking baby aspirin daily for the prevention of colorectal cancer any longer. One recent study found that taking aspirin nearly doubled the number of colorectal cancer deaths after five years. But, aspirin has been found to reduce the risk of polyp growth in the colon as well as the risk that polyps will become cancerous.

    The panel believes that, for people over 60, daily intake of low-dose aspirin can lead to a higher risk of internal bleeding that can be life-threatening. Aspirin reduces the formation of blood clots, which can block arteries.

    Aspirin increases the likelihood of bleeding in the brain and digestive tract, especially for older people. For this reason, the panel discourages older adults from starting a daily aspirin regimen.

    The recommendations do not apply to people already taking daily aspirin or to people who have had a heart attack. The panel recommends that these people should speak to their doctor regarding the best course of action.

    Here’s more from Just Care:

  • Should you be screened for prostate cancer?

    Should you be screened for prostate cancer?

    Prostate cancer is one of the leading causes of cancer death in the US. It is also the most common cause of cancer among men, according to the Centers for Disease Control. That said, most men survive prostate cancer. Virtually all men survive for several years, with 98 percent surviving for 10 years, and 96 percent surviving for at least 15 years. The five-year survival rate falls to 29 percent for men with prostate cancer that has spread to other parts of the body. Should you be screened for prostate cancer?

    Should you get a prostate cancer screening?

    The US Preventive Services Task Force (USPSTF) advises that men between the ages of 55 and 69 should decide for themselves whether to get a prostate-specific antigen (PSA)-based screening for prostate cancer. They should consult with their physicians about the risks and benefits and factor in their preferences in their decision.

    The USPSTF says that screening offers a small possible benefit of lowering the risk of death from prostate cancer for men between 55 and 69. It also says that screening can cause many harms, including extra testing and perhaps prostate biopsy, as well as overtreatment. Overtreatment can lead to incontinence and erectile dysfunction.

    As a result, the USPSTF gives the prostate cancer screening a “C” grade, meaning that there is “at least moderate certainty that the net benefit is small.” And, for men who are 70 or older, it gives the screening a “D” grade, recommending against it because “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits..”

    Why shouldn’t I get a prostate cancer screening?

    The Prostate-Specific Antigen (PSA) blood test cannot differentiate between cancers that will be aggressive and benign cancers that are slow-growing and will never produce symptoms. Even so, most people with prostate cancer (aggressive or otherwise), never have symptoms. Invasive treatments for prostate cancer, like chemotherapy and radiation, in people with a benign slow-growing form are likely to cause significant harm.

    The Prostate Cancer Foundation reports that as many as two in five men treated for prostate cancer had tumors that would never have presented a risk to their health or lives. But, the radiation treatment many men opt for can cause incontinence and erectile dysfunction. And, hormone therapy treatment can lead to depression and osteoporosis.

    On the other hand, screening could reduce the chance of death from prostate cancer. The medical community recommends shared decision-making around screening. Individuals should weigh the risks and benefits of screening and make an informed decision on whether to proceed.

    What does Medicare cover?

    If you decide to proceed with a prostate cancer screening, Medicare covers a prostate screening each year, including a Prostate-Specific Antigen (PSA) blood test and a digital rectal exam (DRE). If you have traditional Medicare and your doctor takes assignment, the PSA test is covered in full. If you are enrolled in a Medicare Advantage plan, it is also covered in full if you see an in-network doctor. You will be responsible for coinsurance or a copay with the digital rectal exam.

    Medicare covers these tests more frequently for people whose doctors say they are medically necessary for diagnostic purposes.

    Here’s more from Just Care:

  • Risks of lung cancer screening may outweigh benefits

    Risks of lung cancer screening may outweigh benefits

    Health News Review explains why you may want to avoid a lung cancer screening. The risk of harm appears to be greater than generally understood and the benefits limited, particularly for low-risk patients.

    The US Preventive Services Task Force advises “annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year 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.”

    But, data from a VA demonstration project show that there is a high likelihood of false positives. There were false positives more than half the time that people who had been big smokers were screened for lung cancer using low-dose computed tomography (CT) scans. As a result, they received additional testing, including radiation exposure, and biopsies that can cause cancer, anxiety, infections and other complications. The study included more than 2,000 patients. Of those screened, 1.5  out of 100 had lung cancer.

    A January 2018 analysis in the JAMA Network questions whether people who meet the US Preventive Services Task Force criteria for screening really should be screened. For people at the lowest risk, the likelihood of harm from the screening might outweigh the benefits. The screening prevented one death from lung cancer for every 7,000 people screened, along with 2,749 false positives.

    Here’s more from Just Care:

  • No proof annual pelvic exam offers benefits

    No proof annual pelvic exam offers benefits

    Most women get annual pelvic exams–60 million in 2010–but it might be time to stop. There is no proof that an annual pelvic exam offers benefits. The U.S. Preventive Services Task Force (USPSTF) has just issued a draft opinion that evidence is lacking to show that an annual pelvic exam has a significant benefit to the health or lifespan of healthy women over 18, except pregnant women.

    The USPSTF found insufficient proof that pelvic exams help with early detection and treatment of a variety of conditions. There is little evidence of the accuracy of the tests. And, there is also little evidence that early detection and treatment either reduced the likelihood of disease or dying prematurely, or improved quality of health.

    The task force also found no evidence of risks from pelvic exams. However, it did find some likelihood of false positives from the exam that lead to unnecessary surgeries. It gave pelvic exams a grade of “I” for indeterminate because of the lack of evidence.

    Pelvic exams are given because it has been thought that they can detect uterine, cervical, vaginal and ovarian cancers as well as infectious diseases such as genital warts and genital herpes, and uterine fibroids.

    Current guidelines from the U.S. Preventive Services Task Force and ACOG recommend screening for cervical cancer beginning at age 21 and every 3 years thereafter until age 30; after age 30, 5-year intervals are recommended for most women not at high risk of this disease. Medicare pays for cervical exams, including Pap tests, pelvic exams, and clinical breast exams, once every 24 months for all women and once every year for people at high risk for cervical or vaginal cancer, or if you’re of childbearing age and have had an abnormal Pap test in the past three years.

    Here’s more from Just Care: