An ounce of prevention: How primary care physicians can help patients avoid cancer

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Early detection gives patients better odds at recovering from a cancer diagnosis.

Even better: patients and doctors working together to prevent cancer in the first place. That’s a task that primary care physicians are suited for, said Kathleen N. Mueller, MD, FAAFP. She works as system director for integrative medicine and cancer survivorship for Nuvance, a seven-hospital health system in Connecticut and New York.

A member of the board of directors for the American Academy of Family Physicians, Mueller spoke with Medical Economics about the study “Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020,” published in JAMA Oncology in late 2024. It estimated there were 5.94 million deaths averted from 1975 to 2020, counted across breast, cervical, colorectal, lung and prostate cancer. Family medicine specialists and other primary care physicians can guide patients in the prevention efforts and screenings that accounted for eight of every 10 averted deaths.

This transcript has been edited for length and clarity.

Medical Economics: Can you talk about the primary care physician's role in cancer prevention?

Kathleen N. Mueller, MD, FAAFP
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Kathleen N. Mueller, MD, FAAFP: We are so uniquely positioned to help people detect and prevent and intercept cancers earlier than they might have been. Family physicians in particular have a longitudinal view of health. We know our patients from birth throughout their lifespan. So, for example, if I have a patient who comes in, we did a screening mammogram, she's a 58-year-old, it's abnormal, she needs follow up. I get to help her work through that process to find the surgeon that's right for her to know, to feel comfortable with the test that she needs to do. But I also get to work with her after her treatment to make sure she reduces her risk with food and movement and mind-body medicine and lifestyle changes that we know are so important, in addition to screening tests. And as a family physician, if she has three daughters, I get to work with those young women, who now have a family history of breast cancer, to make sure that they are starting their prevention much, much, much earlier than they would have otherwise. Family medicine is so uniquely positioned, not only to implement these screening tests, they're important, but to start much earlier with the pieces that we know help reduce your risk for cancer, which is a good diet — doesn't have to be perfect, but maintaining a healthy weight can make a difference. Movement — the data on movement is mind-blowing, as far as prevention of cancer and during treatment of cancer, how well people do. And then environmental exposure or family history, and taking all that into account, we're just uniquely positioned to help patients all through that journey.

Medical Economics: Do you use specific tools or guidelines, such as the U.S. Preventive Services Task Force recommendations, to determine a patient's risk for certain cancers? Or is it more important to consider a patient's age, gender, family history?

Kathleen N. Mueller, MD, FAAFP: It's all the above. We have guidelines that show that someone who's this age, this gender, in this situation, has this risk. But I deal with individuals, I deal with human beings. And so that person who fits that category might have increased risk because her mother and her grandmother had cancer. That person might be at increased risk because they work in a factory and have exposure to environmental toxins. So, although we need those guidelines and we need the experts like those at the U.S. Preventive Services Task Force, that's their work, that's their specialty, we also deal with human beings, and so we have to individualize the approach to the human beings that we have in front of us.

Medical Economics: What has been your experience with insurance company prior authorizations for cancer screenings?

Kathleen N. Mueller, MD, FAAFP: Every family physician that I know, every primary care specialist I know, and every oncologist has a story about having a test that we've ordered either denied or delayed. And that delay or that denial not only results in poor outcomes for our patients, but it is absolutely soul-sucking for family physicians and for other physicians. It is such a burden for us to have to fight to get what we know is important for our patients, and so there should be absolutely no barriers to getting these screening tests, zero, no financial, no insurance. And hopefully we can expand the time of day and weekends and all that to these appointments for those people who just can't take off from work. We need to do a better job by removing all of the barriers that are possible to prevent people from getting these screening tests. Some of it’s insurance and some of it is just logistical, but every single time someone is delayed, we have the risk of losing them to follow up. So, if you had your colonoscopy and it gets canceled, you have to figure out another day that you can rearrange your life to do that. That's a chance that someone won't follow up. We just need to be better on the front lines and reduce all barriers to these screening tests. And this study helps us have huge amounts of data, 45 years of showing how important this is.