Just some general information for folks out there. Very often people have different ideas about what screening is, what is available, and what is recommended.
First, let’s just clarify what screening is all about. There are a lot of different tests and technologies that are out. However, we don’t generally do EVERYTHING. Patients often say “just check for everything”. And so I have to explain what is and isn’t possible. Basically, there are tests that are considered good for screening and have proven themselves to be valuable in terms of possibly reducing mortality or deaths. The tests are also usually evaluated to see if they are cost effective or whether they simply lead to more needlessly invasive procedures or anxiety for patients. Very often your doctor will go over what testing is recommended for you during your annual physical exam or yearly check up.
Much of the decision making is determined by your age and other risk factors including your family history for various cancers.
- Pap smears for sexually active women are the most common tests that we do A LOT! This is a screening for cervical cancer and HPV, the virus that leads to cervical cancer. (see post on pap smear and HPV for more details). Usually, young women do this yearly. There is an argument for doing the pap every 2 or 3 years if you are considered to be low risk. Some elderly women may stop doing paps altogether. Now if you are high risk and have had abnormality on your paps, then you are probably looking at tests every 3-6 months and having a colposcopy, with or without biopsy.
- Mammograms usually start at age 40 for women and are done yearly to screen for breast cancer. If you have a family history of breast cancer early or have the positive BRCA gene, your screenings may start earlier. It isn’t a fun procedure but is a necessary evil. Many cancers can be detected early with screening and chances for survival increases if treatment is initiated early. Some women do self breast exams but many do not. Your doctor can order this for you.
- Colonoscopy is the procedure which many people dread but is what is available now for screening colon cancer. After age 50, you will usually be sent by your primary doctor to see a gastroenterologist to have this testing done. The bowel is usually emptied the day before and the patient is usually sedated while the doctor checks the inside of the colon with a small camera via the rectal opening. If anything worrisome is seen, a biopsy is obtained. The frequency of these exams varies and depends on what is found on the initial test. It could be the next year, in 3-5 years or 10 years. There are also fecal occult blood tests that can be done yearly.
- Prostate cancer screening is controversial because most men do not die of prostate cancer. Regardless, PSA or prostate antigen testing can be obtained with a blood test. But usually, the doctor performs a rectal exam and feels the prostate to see if there is anything concerning. The doctor can then order a PSA and/or the patient is sent to a urologist for further evaluation, ultrasound, and possible biopsy. Rectal exams can be done yearly in the office by your primary doctor and may start at age 45. Of course, the doctor can always examine you at any age depending what risks he is considering.
- No, chest x-rays are not good to screen for lung cancer.
- No, we don’t usually check tumor markers as a routine screening test. These markers are generally used to monitor the disease during treatment or only once the cancer is highly suspect to begin with. Talk to your doctor about specific concerns that you may have.
- You can also check out the American Cancer Society website for their recommendations regarding cancer screening. Then, bring your questions/concerns to your doctor.