Are You Getting the Right Cancer Screening?

Knowing what screening plans you should follow is part of Owning Your Health

Posted Aug 14, 2015

We all fear “The C Word.”  And why shouldn’t we?  After all, cancer is the second leading cause of deaths among American adults, and a whopping 40% of us will be diagnosed with a malignancy during our lifetimes.  While the remarkable success of cancer treatment research over the last several decades cannot be over-emphasized, still roughly one-third of people die from their malignancy within five years of first being diagnosed, and some of the two-thirds who are alive continue to harbor cancer that will ultimately kill them.  And yet so many of us fail to undergo recommended screening to identify a cancer in an early stage (before it grows large enough to cause symptoms or spread), a stage at which the likelihood of cure may be increased.

Why don’t we all protect our futures through cancer screening?  One problem is that not all physicians push all of their patients to follow all of the recommended screening protocols.  I personally believe that this is in large part due to today’s healthcare providers growing overwhelmed as they work harder and longer to keep up with growing patient populations and dwindling reimbursement (a possible explanation, not an excuse).

That said, we as individuals must be primarily responsible for our own health.  Everyone must and can easily gain a basic understanding of the cancer screening tests that we should undergo as we age.  To truly Own Your Health, you must accept responsibility for your body, your health, and your life, empowering you to work with physicians and other healthcare partners.  You know when your taxes are due.  You know when the oil in your car needs to be changed.  You (better) know the date of your wedding anniversary.  You should learn and follow the cancer screening programs that apply to you and that increase the likelihood of a healthy future.

In reality, there is controversy surrounding screening even for of the most common cancers.  For a test or combination of tests to be accepted for “screening,” a number of boxes need to be checked.  First, the targeted malignancy has to be common.  Second, screening must be cost-effective (not always easy to define).  Third, testing must place the screened subjects at very low medical risk.  Fourth, screening should be very sensitive; that is, it should rarely ever miss a cancer.  But it can’t be overly sensitive, frequently mistaking benign lesions for cancer (as such “false positives” need to be further evaluated, leading to wasted money and patient risk).

It is critical that you understand that general screening recommendations apply to the “normal risk population.”  Thus, you may actually be at higher-than-normal risk without knowing it (due to family history or some other factor), and a different screening program may better protect you.  Therefore, it is essential that you discuss with your physician partner the screening plans specifically appropriate for you.  In addition, you should discuss with your physician partner the potential medical risks and financial costs to you of all screening tests.  Understanding these caveats, the following are general recommendations for “normal risk individuals” in screening for the most common cancers killers.

Lung Cancer  When it comes to the #1 Cancer Killer, there is considerable controversy simply as to if we should screen anyone.  Many studies have failed to demonstrate any benefit of screening.  However, the 53,000-subject National Lung Screening Trial did demonstrate a 15% to 20% reduction in the risk of dying from lung cancer in selected patients who underwent low dose CT scan imaging rather than simple chest X-ray screening.  There is also concern about the high false positive rate, leading many patients to undergo additional often-invasive tests that ultimate determine they have no cancer.  Among the several screening guidelines, a common recommendation is for low dose CT scan screening every year in patients age 55 to 74 who still smoke cigarettes or who have quit in the last 15 years and who have at least a 30 pack-year smoking history (average packs per day X years of smoking = pack-years).  If you currently smoke or have quit in the last 15 years, discuss a lung cancer screening plan specifically for you with your physician partner.

Colon & Rectal Cancer  Screening for the #2 Cancer Killer is unique in that such testing can identify pre-cancerous polyps and actually prevent the overwhelming majority of cancers from forming.  Recommendations are for both men and women, and most include an annual fecal occult blood test (which checks for microscopic bleeding from polyps and cancers) and a digital rectal exam (in which the physician’s finger feels the lower rectum for a growth) starting at age 50.  In addition, starting at age 50, men and women should undergo either a flexible sigmoidoscopy (which looks at the rectum and about the last one-third of the colon) every 3 to 5 years or a colonoscopy (which looks at the rectum and entire colon) every 7 to 10 years.  Colonoscopy requires intravenous sedation, is more costly, and carries slightly higher risk.  Sigmoidoscopy, however, does not visualize about two-thirds of the colon, relying on the fecal occult blood test to identify an out-of-sight tumor.  Also, a positive fecal occult blood test or sigmoidoscopy always leads to a full colonoscopy (yep…a second procedure).  For myself and my loved ones?  Colonoscopy.  That said, ladies and gentlemen, please discuss a colorectal cancer screening plan specifically for you with your physician partner.

Breast Cancer  Three tests are commonly recommended for women to screen for the #3 Cancer Killer.  There is minimal disagreement on the importance of mammograms (other than initial age and test interval).  Commonly, annual mammography is recommended for average risk women beginning at age 40, although many physicians recommend mammography every other year and beginning later (age 50) and stopping after age 74.  And ladies, please discuss a mammogram screening plan specifically for you with your physician partner.  While physician-performed Clinical Breast Exams have not definitively been shown to reduce the risk of dying from breast cancer), a common recommendation is to have this performed every three years when in your 20s and 30s and then annually from age 40 on.  Likewise, the benefit of regular Self Breast Exams has not been demonstrated.  However, convinced that my own mother’s survival many, many decades ago was the result of her own discovery of an early stage cancer, I support this safe, fast, and free monthly screening test for women starting in their 20s.

Prostate Cancer  Screening of men to detect the #4 Cancer Killer is controversial, not only because of the paucity of studies clearly demonstrating a benefit, but also because many prostate cancers do not require treatment (and are not the ultimate cause of death).  Still, an annual digital rectal exam (in which the physician’s finger feels for lumps within the prostate gland) is commonly recommended starting at age 50, and in African American men and men with a family history of prostate cancer at age 40 to 45.  The use of the prostate-specific antigen (PSA) blood test for screening (on schedule with the digital rectal exam) is also controversial, as not all cancers release PSA, and many non-cancerous prostate conditions can lead to an elevated PSA and unnecessary further testing.  Don’t forget, gentlemen:  discuss a prostate cancer screening plan specifically for you with your physician partner.

There are many cancers that we just can’t or don’t screen for, diagnosed only when they become large or spread.But for the four major Cancer Killers, screening is available.It’s your body and your life.  So Own Your Health and talk with your physician partner about a screening plan that’s appropriate for you.