Let’s Talk Cancer Screenings

Colon cancer has gained a lot of attention in light of the death of Chadwick Boseman last week. And I think this serves as a great opportunity to start the conversation about cancer screenings. Many people don’t know the age at which they need to have their first mammogram or their first colonoscopy. I mean how are they supposed to know unless their doctor suggests it? And if you aren’t regularly going to a primary care doctor, then you’re in a bit of pickle.

Screenings are important tools used to prevent disease, and we can’t stop cancer unless we screen for it. So let’s talk about risk and what the ACS (American Cancer Society) and USPTF (US Preventative Task Force) suggest for cancer screenings based on age and risk factors.

What are the ACS & USPTF?

There are two different governing bodies that create guidelines for disease prevention: ACS (American Cancer Society) and USPTF (US Preventative Task Force). As you’ll see, their guidelines are differing when it comes to age and frequency of screenings. Because there are some discrepancies between the two, some medical providers may vary in their practice based on what guidelines they follow. Ultimately, their choice is based on the safety of the patient. So if they think based on your risk factors, you need earlier screening, listen to your doctor or medical provider.

Breast Cancer

Signs that warrant further workup:

• New lump in the breast or underarm (armpit)
• Thickening or swelling of breast tissues
• Irritation or dimpling of breast skin
• Redness or flaky skin in the nipple area or the breast
• Pulling in of the nipple or pain in the nipple area
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast
• Pain in any area of the breast

Tumor markers: CA 15-3, CA 27.29, CA 125, Carcinoembryonic antigen (CEA)
Imaging studies: Mammograms, Breast Ultrasound, Breast MRI

ACS: Women between 40 and 44 have the option to start screening with a mammogram every year. Women 45 to 54 should get mammograms every year. Women 55 and older can get a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live at least 10 more years.

USPTF: biennial screening mammography for women 50 to 74. Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s. The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.

Cervical Cancer

Signs that warrant further workup:

• Blood spots or light bleeding between or following periods
• Menstrual bleeding that is longer and heavier than usual
• Bleeding after intercourse, douching, or a pelvic examination
• Increased vaginal discharge
• Pain during sexual intercourse
• Bleeding after menopause.
• Unexplained, persistent pelvic and/or back pain

Screening tests: HPV test, Pap (Papanicolaou) test
Imaging studies: Colposcopy, Endocervical curretage, Cone biopsy

ACS: begin at 25; 25 to 65 HPV test* every 5 years.
If primary HPV testing is not available, screening may be done with either a co-test that combines an HPV test with a Papanicolaou (Pap) test every 5 years or a Pap test alone every 3 years. 

USPTF: begin at 21; screening every 3 years with cervical cytology in women 21 to 29; women 30 to 65, screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (co-testing).

Colorectal Cancer

Signs that warrant further workup:

• Blood in or on your stool (bowel movement)
• Stomach pain, aches, or cramps
• Unexplained weight loss

Stool tests: fecal occult blood test (FOBT), fecal immunochemical test (FIT)
Tumor marker: carcinoembryonic antigen (CEA)
Imaging studies: Colonoscopy, Proctoscopy

ACS: people of average risk start regular screening at age 45. This can be done with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test) or with an exam that looks at the colon and rectum (imaging- colonoscopy, CT colonography, flexible sigmoidoscopy).

USPSTF: screening for starting at age 50 and continuing until age 75.

Lung Cancer

Signs that warrant further workup:

• Persistent cough
• Chest pain
• Shortness of breath
• Wheezing
• Coughing up blood
• Increased fatigue
• Unexplained weight loss

Tumor markers: carcinoembryonic antigen (CEA)
Imaging studies: low-dose computed tomography (LDCT)

ACS: 55-74, yearly low-dose CT if current smoker or smoker who quit in past 15 years

USPSTF: annual screening for lung cancer with low-dose CT 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.

Prostate Cancer

Signs that warrant further workup:

• Difficulty starting urination
• Weak or interrupted flow of urine
• Frequent urination, especially at night
• Difficulty emptying the bladder completely
• Pain or burning during urination
• Blood in the urine or semen
• Pain in the back, hips, or pelvis that doesn’t go away
• Painful ejaculation

Screening tools: PSA (prostate specific antigen) level in blood, DRE (digital rectal exam)

ACS:
AVERAGE risk: men at age 50, expected to live at least 10 more years
HIGH risk: men at age 45, including African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
HIGHEST risk: men at age 40, (those with more than one first-degree relative who had prostate cancer at an early age).

USPTF: men 55 to 69, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one.

If you are more of a visual person, here’s all of the above information in a handy dandy table for easy reference!

Ask your parents and grandparents about cancer diagnoses in your family. If certain cancers run in your family, be aware of when you should start screening and educate your family members too. The first step in prevention is limiting risk factors, but the second step is screening.

In America, more than 1.8 million cancer diagnoses are expected in 2020. Approximately 606,520 Americans are projected to die of cancer this year. Our country has incredible medical resources at our disposal, let’s use them for good. Be an advocate for your health and for your family’s. Know the warning signs and symptoms. Let’s conquer cancer in this generation!