We would like to review the current recommendations from the American Cancer Society (ASC). We want everyone to know the recommendations so you can take control of your health and be proactive about screening. These screening tools are proven to find cancer at earlier stages. Finding cancer early may mean less treatment is needed and has higher rates of curability.
Breast Cancer:
Current recommendations for screening based on age:
Self breast examinations: it is recommended that women of all ages perform monthly self breast examinations. This is called ‘breast self awareness’. You know your breasts better than anyone else so check them out monthly and report any changes to your provider. Take a look in the mirror for any visual changes, changes in size or shape. Then feel around each breast, taking a systematic approach such as moving up and down like you are mowing the lawn can ensure you don’t miss a spot.
Women less than 40
Self breast examination every month.
Review of family history for hereditary cancer syndromes. If there is a genetic mutation in the family that increases the risk of breast cancer, then genetic testing could be considered. If there is a family history of a close relative (mother, grandmother, or aunt) with breast cancer diagnosed at age 50 or younger, than screening may be indicated prior to age 40.
Women ages 40 - 74 annual mammogram and annual clinical breast examination is recommended
Women 75 and older discuss screening with your provider. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.
Women at high risk for breast cancer based on personal, family history, and possibly genetic information - screening recommendation may include an annual breast MRI in conjunction with your annual mammogram. This is only recommended in high risk individuals as there is an increased rate of false positives. False positives are when a test shows an abnormality (lump, mass, finding) when there is no cancer present.
What is a mammogram?
A mammogram is an xray picture of the breast. This is used as a screening tool to look for breast cancer.
What is a breast MRI?
Breast MRI uses magnets and radio waves to take a 3D picture of your breasts and looks at the breast tissue differently than mammogram.
Colorectal Cancer (cancer including the colon and rectum)
Current recommendations for screening for colon cancer:
Regular screening should begin at age 45. Individuals with personal or family history of cancer prior to the age of 50, genetic predisposition to hereditary cancer syndromes or a multiple polyps found on previous examination may require earlier or more frequent screening.
A stool test or a test that looks directly at the colon can be used for screening. Direct visualization with the colonoscopy is the best study. If you choose to be screened with a test other than colonoscopy (FOBT, FIT, Cologuard, or CT colonography) any abnormal finding will need to be followed up with a colonoscopy.
Screening options for colon cancer:
Fecal occult blood test (FOBT) checks for blood in your stool which may be a symptom of colon cancer. This can miss asymptomatic polyps or cancers that are not bleeding.
Fecal immunochemical test (FIT) checks for blood in your stool which may be a symptom of colon cancer. This is more accurate than FOBT. This can miss asymptomatic polyps or cancers that are not bleeding.
Stool DNA test (Cologuard) looks for abnormal DNA in your stool that may be associated with colon cancer. If positive will need to be followed up with a colonoscopy.
Flexible sigmoidoscopy a flexible, lighted tube that directly visualizes your tissue from your rectum to the lower part of your intestines. This study is not capable of looking at your entire colon.
Colonoscopy examines your entire colon from your rectum to your small intestines. Uses a flexible tube with a lighted camera to directly visualize the tissue. Polyps can be removed if visualized which are often times precancerous.
Computed tomographic (CT) colonography “virtual colonoscopy” xrays are used to create detailed pictures of your colon.
Cervical Cancer
The screening tool for cervical cancer is a PAP smear. This is performed at your annual gynecological examination. A PAP smear looks for precancerous cell changes on your cervix. During your vaginal exam, the provider takes a scrapping of these cells (this is not painful, just feels a little tingly) which are then sent to the lab. It is a very easy test that is proven to save lives!
What is HPV? HPV (human papilloma virus) is a virus that is known to cause the cellular changes on the cervix that leads to cervical cancer. There is now a vaccine available to protect against this virus so we can prevent cervical cancer (and other cancers) for the next generation!
Cervical cancer screening should start at the age of 21
Women between the ages of 21 - 29 PAP smear is recommended every 3 years unless an abnormality is found.
Women between the ages of 30-65 should have PAP smear + HPV test every 5 years. It is also acceptable to have PAP smear only every 3 years.
Women over the age of 65 may stop cervical cancer screening if:
They have had regular cervical cancer screening over the last 10 years with normal results
Women with a history of serious cervical precancerous cells or cervical cancer should be continued to be screened for 20 years after this finding.
Women who have had a total hysterectomy including removal of the cervix (for reasons not related to cervical cancer) do not need to have cervical cancer screening.
All women who have been vaccinated for HPV should still follow the recommendations
Lung Cancer
Yearly lung cancer screening is recommended with a low dose computed tomography (CT) scan of the lungs for high risk individuals. High risk individuals have a smoking history. Individuals with the following criteria should be considered for screening:
Age 55-74
Current smoker or quit smoking within the last 5 years
Have a 30 pack year smoking history (One pack year is one pack of cigarettes daily for one year. One pack per day for 30 years or two packs per day for fifteen years would equal a 30 year pack history and qualify for screening).
Prostate Cancer
Recommendations for prostate cancer screening are not as concrete. The American Cancer Society and the American Urological Association recommend discussing the pros and cons of prostate cancer screening with your provider to make an informed decision about whether screening is right for you. Increased screening does lead to more intervention, such as biopsies, that may not alter the course of the disease or impact mortality.
Screening with PSA blood test can start around the age of 50 after a discussion with your healthcare provider
If you opt for PSA screening, the interval for blood test varies on your level. Annual screening is a good place to start.
Things to consider: family history - first degree relatives with prostate cancer and family history of metastatic prostate cancer may influence your provider’s recommendation for screening.