Should I Be Screened for Cancer?
By Kevin Suttmoeller, MD
Very few words in the English language strike more fear than the word "cancer”. Cancer can occur anywhere in the body and affects large numbers of men and women. However, there’s a good chance that you can improve your odds with early detection and treatment. Keep in mind that with cancer, just like many other diseases, prevention is the key.
Patients often ask me what tests they need to have to screen for cancer. There are several exams I recommend for cancer screening. The U.S. Preventative Services Task Force was convened by the Department of Health and Human Services to help establish these guidelines. They recommend that average risk women should begin mammograms at age 54 and have them every 2 years until the age 74. Breast self-exams should not be substituted for mammography. The American Cancer Society recommends annual mammograms for all healthy women starting at age 40. Many women’s health experts recommend a baseline mammogram at age 35, and then if normal, start annually at age 40. Breast ultrasounds are often added. Women with high risk histories are recommended to have annual mammograms with MRI starting at age 30.
Cervical cancer screening starts at age 21 until the age 65 for women with an intact cervix. Average risk women ages 21-29 should have a Pap smear every 3 years. Average risk women ages 30-64 should have a Pap smear every 3 years or Pap smear with human papilloma virus testing every 5 years after initial test is negative. Screening after the age of 65 is not necessary if the patient has a history of negative screening and no new risk factors. Women who have had a complete hysterectomy do not need to be screened. If a patient has risk factors (abnormal Pap, current smoker, history of HPV–related disease or new partner) and a good life expectancy, screening may continue until age 80.
Colonoscopy to screen for colorectal cancer on a patient with average risk starts at age 50 and continues until life expectancy is estimated to be less than 10 years. Repeat colonoscopies are dependent on the findings on the colonoscopy. Yearly digital rectal exams are recommended.
Prostate cancer screening is controversial. The USPSTF recommends against it. The American Cancer Society and American Urological Association do have guidelines for testing. I often discuss with the patient the ramifications of screening. For average risk men I recommend yearly digital rectal examinations starting at age 50 and a baseline PSA at age 50 or 55.
When it comes to skin cancer, the recommendation is to have a yearly full body examination. This is to catch any changes early. Once noticed, the skin can be biopsied to determine if it is cancer and then if it is, the best treatment options. Like all cancer, early detection is the key.
Lung cancer screening is recommended for patients between the ages 55-74 with a history of smoking 1-pack per day for 30 years, or 2 packs per day for 15 years. The recommended screening is an annual low dose helical computerized tomography. Tobacco use is strongly associated with lung cancer, esophageal cancer, bladder cancer and cancers of the oropharynx. I strongly recommend patients stop smoking or chewing tobacco.
So what can you do to decrease your risk of developing cancer? Avoid tobacco, be physically active, maintain a healthy weight, eat a healthy diet, limit alcohol, protect yourself against sexual transmitted diseases and avoid excessive sun exposure. Most testing should be completed in partnership with your primary care physician. Guidelines for screening will likely change as technology improves so staying in regular contact with your primary care physician should keep you on the track to continued wellness.