Why Cancer Screening Can Be Life-Saving
Cancer is a catastrophic cause of death and morbidity throughout the world. The number of cancer diagnoses has grown over the past few years, but early screening and detection have helped foster effective treatment options and have averted the morbidity and mortality a great deal. In this section we will discuss why cancer screening can be so important to every single person.
Breast Cancer: In the US, Breast cancer is the most common cancer diagnosis among women. It is the second most common cause of death from cancer in women. Cancer screening has caused age-adjusted breast cancer mortality to decline by 40% from 1989 to 2016. This rate is not shared by all ethnic groups and African American mortality rates are higher when compared to other groups. This underlines the need for early detection and treatment, and that is where screening comes in.
Cervical cancer: The incidence and mortality of cervical cancer has declined after the introduction of the Pap smear. From 2006 - 2015 cancer rates for cervical cancer have declined by an average annual rate of 0.7%.
Colorectal cancer: The colorectal cancer incidence and mortality has been declining in adults aged 50 years and older. CRC incidence has declined 32% between 2000 and 2013. CRC mortality has declined 34% between 2000 and 2014. There are still large disparities among different ethnic groups and African American mortality rates are once again higher when compared to other groups.
Screening recommendations - Women:
Breast cancer screening (age 40 onwards) Annual mammography -
It is important to note that recommendations are different for individuals with high risk BRCA mutations, or for individuals with first-degree relatives with Breast cancer or with BRCA mutation.
In these individuals mammography and MRI may start at 30 years of age. This method of dual screening is also recommended for individuals who were treated for cancers and Hodgkin's disease with radiation to the chest, and also for individuals with syndromes like Li-Fraumeni, Cowden, etc.
Cervical cancer screening (Age 21-65) Pap test with HPV DNA testing -
Women who are 65 years or older with 3 normal Pap tests or 2 normal HPV and Pap tests within the last 10 years with the recent testing within the past 5 years can stop cervical cancer screening
Women who have had a total hysterectomy can stop cervical cancer screening.
Endometrial cancer screening - This involves education of women at menopause about the symptoms of endometrial cancer and women should be encouraged to contact their physician with spotting and bleeding.
Screening recommendations - Men:
Prostate cancer screening (age 50 onwards) PSA (Prostate specific antigen testing) with or without a digital rectal exam after counseling about the risks and benefits of screening.
Screening recommendations - Men and Women:
Colorectal cancer screening (age 45 to 75 years) - Annual Fecal occult blood test or fecal immunochemical test, or colonoscopy every 10 years, or flexible sigmoidoscopy every 5 years, or CT colonoscopy every 5 years. Any positive test on a non-colonoscopy procedure must be followed by a colonoscopy and biopsy as needed.
Screening decisions after age 76-85 years must be based on prior screening results, history, medical status, and patients’ preferences.
Screening is discouraged after age 86.
It is important to note that early and more frequent screening is needed for high risk individuals who have genetic mutations that confer higher risk, individuals with lifestyle issues, Inflammatory bowel disease, history of adenomatous polyps, personal history of curative reaction of colorectal cancer, family history of CRC or adenomas in first degree relatives, Cystic fibrosis, known history or suspect presence of syndromes like Familial adenomatous polyposis and Lynch syndrome, or history of abdominal/pelvic radiation for cancers.
Lung cancer screening - This screening should be for current or former smokers.
Low dose helical CT is the screening test of choice.
Patients must be educated on the benefits and harms of low dose CT screening.
In this discussion we have reviewed in detail the importance of cancer screening, as early detection is important for early treatment. It is very important to have follow-ups with your Physician to review latest guidelines. As always, I pray that you keep you health in center focus, and live long and strong!
