Cancer screenings and prevention: How primary care physicians are saving lives

© ST.art - stock.adobe.com

Scientific advances in cancer treatments have saved the lives of patients in the United States and around the world.

So have family medicine and internal medicine physicians who encourage their patients to get appropriate screenings to detect the disease as early as possible.

The study “Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020,” was 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.

Prevention and screening accounted for eight of every 10 averted deaths, the study said. It’s proof that cancer prevention and screenings are working, 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, she discussed the intersection of family medicine, cancer screenings and treatments, and the results of that study.

This transcript has been edited for length and clarity.

Medical Economics: Why is this study important?

Kathleen N. Mueller, MD, FAAFP
_{© American Academy of Family Physicians}

Kathleen N. Mueller, MD, FAAFP: This study really shows that the work that we've done since 1975 to 2020, is actually working. Our screening, our prevention, our interception of potentials for cancer before they become cancer, are quantified in this article, which is so incredibly exciting. We know how important we are, we know the guidelines, we know we're supposed to do this. But to have it put in such a concrete way, and then to have it subdivided into what works for breast cancer, what works for colon cancer, what works for cervical cancer, et cetera, is also just really interesting guidelines, but also impetus for us to make sure that we're applying these guidelines even a little more diligently than we have in the past.

Medical Economics: Can you discuss the current state of medicine about the intersection of primary care physicians and family physicians and their role in cancer detection?

Kathleen N. Mueller, MD, FAAFP: I think it's really changed, particularly over the past decade. Most oncologists now are subspecialized, so you don't usually have an oncologist that treats all cancers, you have someone who does breast cancer, you have if someone who does colon cancer, you have someone who does other GI cancers, and so that's really been a change for us. When I started my career, I would just refer to the local oncologist, and she or he would treat everything. So, the relationships are a little bit different.

The other thing that we've learned is that the survivorship piece, so, the piece where you finish your treatment, or you get your diagnosis, you have your surgery, you don't need any further treatment. What we do to help reduce the risk of recurrence or reduce the risk of progression into a more aggressive cancer is really critical. Oncology departments are working on those programs, and that's one of the things that I'm doing with my work, but also family physicians need to be a really, really integral part of that. Sometimes people are going to feel more comfortable following up with their family doc than their oncologist. Sometimes it will be the opposite. And so these programs to make sure that we are implementing the information from this massive study and the guidelines on, you need a mammogram now every six months because you're at increased risk, or, you're back to every year, we need to make sure that we have programs that are working in coordination with the patient.

Medical Economics: How do you address patient concerns or fears about cancer screening procedures?

Kathleen N. Mueller, MD, FAAFP: As a family physician, I have a different relationship with my patients over the long term. I know a little bit more about them. I know whether they're needle phobic or what they enjoy doing, and so being able to address that with an individual and ask them, why? Why haven't you gotten your colonoscopy? Many people have heard stories that are not true, or reports that they read or heard stories of. that just aren't based in fact. So sometimes my job is making sure that they have the scientific information that they need. Sometimes it's the data — listen, I know you don't have a family history of this cancer, but here are the numbers. You don't have to have a family history to get lung cancer, it's really important that you're working on smoking cessation, or we're getting screening for whichever cancer you could be at risk. So, a lot of it is level setting. A lot of it is giving the correct information, and some of it is just sitting next to the patient and going along for the ride and helping them understand where their barriers are and taking those down the best that we can.