Many of my patients are often concerned about cancer testing and rightly so. As of this writing, the amount of people diagnosed with cancer continues to rise. In addition, certain types of cancers such as prostate and colon cancer are now being diagnosed in younger individuals. Because of this, understanding your risk as well as which cancers you should be testing for is vital.
In this comprehensive guide, I will delve into the specifics of cancer screenings for different types of cancers. I will highlight the importance of each screening test and share the recommended timelines for getting each test.
Prostate Cancer Screening
Prostate cancer is one of the most common types of cancer affecting men. Early detection is crucial for successful treatment. The two primary tests used for screening are the PSA as well as the digital rectal exam:
Screening tests:
- Prostate-Specific Antigen (PSA) Test: This blood test measures the level of PSA, a substance produced by the prostate gland. Elevated levels may indicate the presence of cancer.
Digital Rectal Exam (DRE): During this exam, a doctor manually examines the prostate gland through the rectal wall to check for abnormalities.
General Screening Guidelines:
- General Recommendations: Men should start discussing prostate cancer screening with their healthcare provider at age 50.
- High-Risk Groups: Those with urinary symptoms, a family history of prostate cancer, or African American men should consider starting discussions about prostate cancer screening around age 40 to 45.
Breast Cancer Screening
Breast cancer is a major health concern for women worldwide. Today breast cancer diagnosis is on the rise but we know that early detection can significantly improve treatment outcomes.
Screening Tests:
- Mammography: This is an x-ray of the breast and is the most common screening test for breast cancer. It can detect tumors that are too small to be felt.
- Breast Ultrasound: An ultrasound or sonogram of the breast may be used in conjunction with a mammogram to help detect breast cancer. A breast ultrasound alone is not a recommended screening tool for breast cancer in women older than 40 or women with less dense breast tissue.
- Breast MRI: For women at high risk, a breast MRI may be recommended in addition to mammography and/or ultrasound.
General Screening Guidelines:
- Women aged 40-44: Have the option to start annual breast cancer screening with mammograms.
- Women aged 45-54: Should get mammograms every year.
- Women 55 and older: Can switch to mammograms every 2 years, or continue yearly screening.
Colon Cancer Screening
Colon cancer screening is critical as it can detect precancerous polyps that can be removed before they turn into cancer.
Screening Tests:
- Colonoscopy: This test involves examining the entire colon and rectum with a flexible, lighted tube.
- Fecal Immunohistochemical Test (FIT): This test checks for microscopic blood in the stool, which can be a sign of cancer.
- Stool DNA Test (Cologuard): This test looks for certain DNA markers that cells from colorectal cancer or polyps shed into the stool.
Note: There are other tests for Colon Cancer such as the fecal occult blood test and the CT colonography. However, the tests mentioned above are the Tier 1 recommended tests for colon cancer.
General Screening Guidelines:
In a recent update by the U.S. Multi-Society Task Force of Colorectal Cancer, which includes experts from the American College of Gastroenterology, the American Gastroenterological Association, and The American Society for Gastrointestinal Endoscopy, new guidelines for colorectal cancer (CRC) screening have been released.
These guidelines categorize screening for colon cancer into three tiers based on their effectiveness, cost, and practicality. The top recommended tier for testing includes a colonoscopy every 10 years and an annual fecal immunochemical test (FIT). Both colonoscopy and FIT are emphasized as the primary methods for Colorectal Cancer screening. This now means these two tests are considered the most reliable and effective ways to check for colorectal cancer regularly. More frequent screening may be recommended for those at higher risk, such as individuals with a personal or family history of colon cancer or individuals with an abnormal colonoscopy.
Screening should begin at age 50 for most individuals and continue until age 75. For those at higher risk of colon cancer, those with a family history of colon cancer, or black men, the recommendations for screening start earlier than age 50. You should discuss the appropriate age which you should start screening with your doctor to ensure that you are appropriately screening for Colorectal Cancer.
Cervical Cancer Screening
Cervical cancer was once one of the most common causes of cancer death for American women. However, the cervical cancer death rate has dropped significantly with the increased use of the Pap Smear test. This screening procedure can find changes in the cervix before cancer develops. It can also find cervical cancer early when it’s small and easier to cure.
Screening Tests:
- Pap Smear: During a Pap smear, cells from the cervix are gently scraped away and examined for abnormal growth.
- HPV Testing: This test looks for the presence of high-risk types of human papillomavirus (HPV). HPV is a type of virus that is most commonly known to cause cervical cancer.
A study published in the Journal of the American Medical Association (JAMA) in 2023 highlighted the importance of regular cervical cancer screening for individuals aged 21 to 65 years with a cervix. The study emphasized that cervical cancer can be effectively prevented by screening for and treating precancerous cells also known as high-grade squamous intraepithelial lesions.
General Screening Guidelines:
- Women aged 21-29: Should have a Pap test every 3 years.
- Women aged 30-65: Should have a Pap test combined with an HPV test every 5 years or a Pap test alone every 3 years.
- Women over 65: May be able to stop screening if they have a history of normal results.
High-Risk Group Screenings
Certain types of cancer, such as lung, liver, uterine, and ovarian cancer, are screened primarily in high-risk groups due to the nature of the disease and the current state of screening technology.
Lung Cancer:
- High-Risk Population: Includes older adults with a history of heavy smoking.
- Screening Test: Yearly Low-Dose Computed Tomography (LDCT) is recommended for those at high risk.
Liver Cancer:
- High-Risk Population: Individuals with chronic hepatitis B or C or cirrhosis.
- Screening: Regular ultrasound examinations and Alpha-fetoprotein (AFP) blood tests.
Uterine and Ovarian Cancer:
- High-risk individuals: Those with a family history or genetic predisposition.
- Screening Tests: There are no standard screening tests for these cancers. However, high-risk individuals may undergo more frequent gynecological examinations and imaging tests. You should discuss your risk for uterine or ovarian cancer and the appropriate screening with your doctor.
Why We Don’t Typically Screen for Certain Cancers (Brain, Pancreas, Kidney)
Screening for cancers such as those of the brain, pancreas, and kidney on a population level is not typically done for several reasons:
- Challenges in Early Detection: These cancers often don’t have specific symptoms or effective early screening tests.
- Low Prevalence: Compared to other cancers, these cancers are relatively rare in the general population.
- Current Research: Ongoing research is focused on finding reliable methods for early detection of these cancers.
- Importance of Symptom Awareness: Being aware of and reporting unusual symptoms to a healthcare provider is crucial for these cancers.
Cancer screening is a vital component of preventive health care. Understanding the when, how, and why of various cancer screenings empowers you to take proactive steps toward reducing your risk. Regular annual exams and staying informed about the latest screening guidelines are essential. Remember, each person’s risk factors and health history are unique, so it’s important to have regular discussions with your doctor to determine the most appropriate screening plan. If you have any questions about cancer screening feel free to call our office and speak with our doctors.
Dr. Sergio Guiteau is a physician who is board-certified in Family Practice and Sports Medicine with added certifications in Aesthetic Medicine. He specializes in Preventive Medicine, Sports Medicine, and Anti-Aging Medicine and blogs on Advancedrejuv.com/blog