Screening For Early Detection Of Cancer

Screening for Early Detection of Cancer
Routine screenings can detect diseases in early, and often more treatable, stages. There are many different screening tests available. A few are recommended for everyone, while others are meant for those at high risk of a disease. The best way to determine which tests are personally most appropriate is to establish a good relationship with your family physician. Your medical history, family history, diet and lifestyle all interact to influence your personal risk for cancer and other diseases.

Here are some guidelines for some types of cancer. Keep in mind these recommendations are for people with average risk of cancer. Patients with a personal or family history and those with other risk factors may need earlier and/or more frequent screening.

Breast cancer. Breast cancer is the most commonly diagnosed cancer among American women and the second leading cause of cancer death (after lung cancer). The American Cancer Society recommends monthly breast self-exams for women 20 to 39 and a clinical breast exam (by a physician) every three years. An annual mammogram and clinical breast examination is recommended in women 40 and older. Not all health experts agree on the timing of mammograms. The U.S. Preventive Services Task Force recommends screening mammography every one to two years starting at 40. Other health experts recommend annual mammography beginning at 50, citing the lower benefit of mammograms for younger women, a possible increased risk for false-positive readings, and unnecessary biopsies.

Cervical cancer. The American Cancer Society estimates 12,200 cases of cervical cancer will be diagnosed in the U.S. this year and about 4,100 women will die of the disease. Annual PAP screening is recommended within three years of the first sexual intercourse, but no later than 21. At or after 30, a woman with three normal results in a row may be screened every two to three years. The U.S. Preventive Services Task Force recommends against routine screening for women 65 and older who have had regular, normal PAP smears due to an increased risk for false-positive tests and unnecessary invasive procedures.

Colorectal cancer. It's the third most commonly diagnosed cancer in the U.S. and the third leading cause of cancer death. It can occur at any age, but is most commonly diagnosed after 50. For asymptomatic patients at average risk, the American Cancer Society recommends colorectal screening beginning at 50. Screening should be performed by a fecal occult blood test every year, flexible sigmoidoscopy every five years, double-contrast barium enema every five years, or colonoscopy every ten years.

Prostate cancer. Prostate cancer is the most commonly diagnosed cancer in American men and the second leading cause of cancer death. The American Cancer Society recommends an annual PSA blood test and digital rectal exam for men starting at 50. Men at high risk for prostate cancer (such as African Americans or those with a strong family history of the disease) should begin screening at 45. On the other hand, the U.S. Preventive Services Task Force currently does not offer any recommendation for or against PSA testing and digital rectal exams. The organization says a PSA test can detect early-stage prostate cancer, but early detection doesn't necessarily improve outcome. In addition, screening is associated with frequent false-positives, increasing anxiety and unnecessary biopsies.

Skin Cancer. More than a million cases of skin cancer are diagnosed every year. In 2003, about 54,200 Americans will be diagnosed with the most serious form of skin cancer – melanoma. Although regular skin self-examinations are encouraged, there are no general guidelines for how frequently the screenings should be performed. The U.S. Preventive Services Task Force states not enough evidence exits to recommend for or against total body skin exams for early detection of skin cancer. However, Americans are urged to be aware of the risk factors and signs for skin cancer, and to report unusual skin lesions to their physician.

Some Other Preventive Services
There are several other screening tests that doctors sometimes perform. Again, the recommended tests and screening frequency are based on personal risk factors.

Chlamydia. Chlamydia is a sexually transmitted disease that can be passed from one person to another during unprotected sexual contact. A pregnant women can also pass the infection on to the newborn as the baby passes through the birth canal. Symptoms are often unnoticeable or mild. In women, untreated chlamydia can lead to pelvic inflammatory disease, inflammation and scarring of the fallopian tubes, increased risk for ectopic pregnancy, and infertility. The U.S. Preventive Services Task Force recommends chlamydia screening for all sexually active and pregnant women 25 and under. There are no recommendations for general screening for older women and those at low risk.

Cholesterol. Cholesterol is a waxy/fatty substance found in the blood and certain foods. When blood cholesterol levels are high, excess amounts can become deposited onto the walls of the arteries. Over time, the cholesterol combines with other substances to form a hardened substance called plaque. As the plaque builds, the inside of the artery narrows and blood flow is impeded. In severe cases, the vessel becomes blocked and disrupts the flow of blood. Tissue on the other side of the blockage is deprived of oxygen and dies. In the heart, it causes a heart attack; in the brain, a stroke. The U.S. Preventive Services Task Force recommends routine cholesterol screening for all men 35 and older and women beginning at 45. Cholesterol screenings typically provide a complete profile of total cholesterol, LDL cholesterol (the bad kind), HDL cholesterol (the good cholesterol), and triglycerides. Patients with a family or personal history of cardiovascular disease or high cholesterol may require earlier or more frequent screening.

Diabetes. Diabetes is a condition in which the body doesn't produce or is unable to effectively use insulin, a hormone needed to make use of glucose (a type of sugar) for energy. Over time, the disease can lead to a number of serious complications, such as heart disease, stroke, vision loss, delayed healing, and a need for amputation. The American Diabetes Association recommends routine diabetes screening every three years for those 45 and older. Younger patients and those with risk factors for diabetes (such as those who are overweight or have a family history of the condition) may require earlier or more frequent screening.

High blood pressure (hypertension). For most patients, a blood pressure reading is typically taken at every visit to the physician's office, along with measures of height and weight. Blood pressure is expressed by two numbers. The higher number, the systolic pressure, is a measure of the pressure when the heart is beating. The lower number is the diastolic pressure and is a measure of the force while the heart is at rest. High blood pressure is defined as a systolic pressure 140 mm HG or higher and/or a diastolic pressure 90 mm Hg or higher. When blood pressure is high, the heart needs to work harder to pump blood through the body. The heart muscle may enlarge or weaken, decreasing the efficiency of the heart. High blood pressure can also damage the walls of the arteries and lead to a stroke.

Osteoporosis. Osteoporosis is a condition in which the bones become thin, fragile, and susceptible to fracture. Nearly 34 million Americans have low bone mass and are at risk for developing osteoporosis. The condition is four times more common in females because women lose up to 20 percent of their bone mass in the years after menopause. The U.S. Preventive Services Task Force recommends osteoporosis screening for all women 65 and older. For women who are at increased risk for osteoporosis-related fractures, screening should begin at 60.

Beside the common screening tests, there are many other types of preventive services recommended. Routine blood tests may be used to measure levels of calcium (to assess bone health, screen for kidney or parathyroid problems), creatine (kidney problems), albumin (liver or kidney problems), protein (multiple myeloma, inflammation, liver damage, digestive disease), sodium (heart or kidney problems), iron (anemia or iron overload), bilirubin (liver or gallbladder problems). Doctors may also screen for vision or hearing problems, alcohol or drug use, smoking, and in women, screening for intake of folic acid and/or calcium.

For general information preventive screenings:
Agency for Healthcare Research and Quality,
American Cancer Society,, or contact your local chapter
American Diabetes Association,, or contact your local chapter
American Heart Association,, or contact your local chapter
Department of Health and Human Services,