May, 2009 Issue

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Cancer Screening

By Asante Dickson, M.D.

Consider yourself no different than the car you drive. You start it up and drive about often without consideration. Most of us know that our cars need regular maintenance to stay roadworthy and functional. We schedule routine maintenance to change the oil, check engine belts , transmission and brake fluid levels. These are necessary actions to prevent inconvenient, costly and often disastrous events that manifest in the form of breakdowns or accidents.

Our bodies are no different in that we all necessitate routine physical examinations to maintain our bodies. Regular visits to the doctor are essential for assessing common ailments and conditions such as high blood pressure or diabetes. One should consistently make appointments for yearly checkups and age appropriate cancer screenings. Screening is a means by which doctors test patients for the signs of cancer even though they have no symptoms. Screening parameters exist as follows:

Breast Cancer

  1. Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
  2. Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
  3. Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
  4. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Colon

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below. The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests. Talk to your doctor about which test is best for you.

Tests that find colon abnormalities

  1. flexible sigmoidoscopy every 5 years*
  2. colonoscopy every 10 years
  3. double contrast barium enema every 5 years*
  4. CT colonography (virtual colonoscopy) every 5 years*
    Tests that mainly find cancer
  5. fecal occult blood test (FOBT) every year*,**
  6. fecal immunochemical test (FIT) every year*,**
  7. stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are positive.

**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.

People should talk to their doctor about starting colorectal cancer screening earlier and/or being screened more often if they have any of the following colorectal cancer risk factors:

  1. a personal history of colorectal cancer or adenomatous polyps
  2. a personal history of chronic inflammatory bowel disease (Crohns disease or ulcerative colitis)
  3. a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in 2 or more first-degree relatives of any age)
  4. a known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

Cervical Cancer

  1. All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
  2. Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years. Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.
  3. Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
  4. Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

Endometrial (uterine cancer)

The American Cancer Society recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary non-polyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.

Prostate Cancer

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

In addition, this discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

The above mentioned health suggestions/screenings are taken from the American Cancer Society. My suggestion is to take a moment to review the above information, review the website and call to schedule screenings for yourself or your loved ones.

(Asante Dickson, M.D. is a contributor to Island Vibes Magazine and writes about wellness. For comments, please feel free to contact him at drdickson@islandvibesmag.com.)
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