Many of the lives lost to cancer each year could’ve been saved through earlier detection. Here are four screenings that should be at the top of your list in the New Year.
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Breast cancer
Women ages 40 to 44 years old who are not at increased risk for breast cancer should be offered the choice to start an annual mammogram.
“Between 45 and 54 years old, women should definitely get a mammogram every year. After 55 they can switch to every other year or continue yearly mammograms,” said Guerra.
While there is no age maximum for a mammogram, women should discuss with their doctor what screening is best for them after age 54.
“If their physician believes they will live for another 10 years or longer, he or she may recommend screening,” Guerra said.
She also points out that even if you don’t have a history of breast cancer in your family, you should still follow these guidelines.
“The truth is over 90 percent of the cases occur in people without a family history. Also, many patients tell me that they don’t feel a breast lump [during self-exams] so they don’t need screening,” Guerra said. “Mammograms detect tumors that are not able to be captured with a self-exam or even a clinician exam. Some breast cancers are the size of an eyelash. That’s what a mammography detects, something you could never feel with an exam.”
Women who are at increased risk of breast cancer due to personal history, genetic history or because they carry a gene mutation, such as BRCA1 or BRCA2, should talk with their doctor about screening options, such as an MRI scan.
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Cervical cancer
All women should begin cervical cancer screening at the age of 21.
Between 21 and 29, screens should be conducted with a Pap smear every three years.
Starting at age 30 and continuing all the way up to 65 years old, in addition to a Pap smear every 5 years, women should also have an HPV test.
“We know there’s a strong link between HPV and cervical cancer,” said Guerra. “After 65, women can discontinue cervical cancer screening if their last two Pap smears over the last 10 years were normal.”
For women who have had the HPV vaccine, Guerra says, the ACS is currently looking into whether or not screening is still needed.
“I’m on the panel that’s looking at that question now. We don’t know yet if women will have to continue cervical cancer screening in the same way I just stated. New guidelines may come out in the next year or so and may affect the recommendations,” she said.
Guerra also notes that the FDA has approved the HPV vaccination to be offered to people 27 to 45 years, which is an update from the approval of up to 26 years old.
“It’s new, but hasn’t been implemented widely yet. Talk with your doctor,” she said.
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Lung cancer
Lung cancer kills more people than colon, breast, and prostate cancers combined.
Screening for lung cancer involves a low-dose CAT scan of the chest for people who are known to be at higher risk of developing the disease.
Recommendations are to screen people (men and women) who are 55 to 74 years old, and who currently smoke or have smoked in the past, but quit in the last 15 years.
“They have had to have smoked approximately 30 pack years or more. What that means is smoking one pack a day times 30 years or half a pack a day times 60 years,” Guerra explained.
In addition to screening, she suggests smoking cessation counseling.
“Smoking rates have been declining since the publication of the reports of the Surgeon General in 1964. That began to raise awareness of the harms of smoking and a lot of public health research and investment has been put into smoking cessation,” Guerra said. “We suspect that all, along with improvement in treatment, has something to do with declining rates of lung cancer.”
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Colon cancer
Screening for colon cancer not only detects cancer early, but by removing polyps, which can turn into cancer, the screening can actually prevent cancer.
“This is the only cancer screening that can do this,” Guerra said. Recommendations for colon cancer screening changed earlier this year. Previously, the ACS stated that anyone over 50 years old should start screening with colonoscopy or a stool-based test. The new guidelines lowered the age to 45 years old.
“There is a concerning increased rate of colon cancer that we are seeing in younger individuals, even millennials, and we don’t know why. To better address this new trend, the recommendations were lowered and should continue through age 75,” said Guerra.
Between the ages of 76 and 85, you should talk with your doctor about whether screening makes sense, and once you reach 85, screening should stop. Your healthcare provider will also determine how often to screen, but generally, screening is performed once every 10 years with a colonoscopy. If no polyps are found, then screening may continue in intervals of 3 or 5 years.
For those who are concerned that colonoscopy is embarrassing or painful, Guerra says, “The truth is people who have had a colonoscopy almost universally say that the worst part is the prep, which may vary, but generally consists of a liquid you take in two portions and a clear liquid diet.”
She adds that most people don’t remember the procedure because they receive a sedative that helps them sleep.“Sometimes the sedative is combined with a medicine that makes you forget things, so most people wake up and don’t think they had the colonoscopy, yet it’s over,” Guerra said.
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Is it possible to screen too much?
Concern about over-testing and over-screening is a legit one, says Guerra. Doing so can lead to negative consequences such as time spent, cost, and in some cases harmful health effects, such as exposure to radiation (from mammograms).
However, she says this is more reason to adhere to the guidelines.
“For instance, the reason breast cancer screening focuses on age 45 to 54 is because if you were to plot all the cases of breast cancer that occur, it looks like a bell curve that has a peak at those years. Then it falls down,” she said. “As it falls, it’s okay to cut back on screening because the risks are also falling.”
She adds that work needs to be done to get more doctors and patients to realize this.
“Patients want to receive good care, and to them the yearly screening means good care, but it’s actually complex,” Guerra said. “Good care means cutting back for some people. The guidelines are based on a lot of scientific data.”
