Age-related screening recommendations for early detection of cancers

At a Glance:

What is cancer screening?

The process of identifying cancer before a person develops any symptoms is called cancer screening. Early detection of cancer or any abnormal tissue can help in early treatment as cancer may grow and spread if not detected early, making it more difficult to treat or cure. However, one must remember that merely getting a screening test does not always mean that a person may have cancer.

What are the types of screening tests?

There are different methods to screen cancers, some of which include:

• Person’s family and medical history; physical examination: A person’s personal history including habits like smoking tobacco, alcohol consumption, etc and family history of the presence of any type of cancer is taken. This is followed by a physical examination of the body for general signs of health and presence of any abnormalities like lumps. 
• Laboratory tests: Investigations in which tests are performed on samples of body tissue, blood, urine, or other fluids of the body.
• Imaging tests: Investigations like X-ray, MRI, etc of areas inside the body to identify any abnormalities.
• Genetic tests: Medical tests to identify the presence of any mutations/abnormal genes that may be linked to some types of cancer.

Are there any risks of screening tests?

While screening tests are helpful in many cases, it should be kept in mind that not all screening tests are helpful, and many of them have risks. Thus, it is strongly recommended that a person should consult his/her oncologist before undertaking any screening test. Some of these risks include:

Some screening tests may have side effects:

Some screening procedures may be invasive in nature and may cause bleeding or other problems. For example, screening for colon cancer using procedures like sigmoidoscopy or colonoscopy may cause tears in the colon’s lining. 

It is possible to have false-positive results:

Sometimes, the screening tests may report abnormal positive even if there is no cancer. As a result, the person may become anxious and may have to undergo more tests and procedures, which have their own risks.

It is possible to have False-negative results:

Sometimes, the result of a screening test may appear to be negative in the presence of cancer. As a result, there may be a delay in seeking medical advice even in the presence of symptoms.

Early detection may not guarantee the prevention or help the person live longer

There may not be any symptoms in certain types of cancers or they may not be life-threatening. On the other hand, some cancers may be very aggressive even if identified early. As a result, treating cancer doesn’t always mean that a person would live longer in the situation if no treatment were given.

Do screening tests diagnose cancer?

An important fact to always remember is that screening tests are usually not meant to diagnose cancer. An abnormal screening test may just mean that an individual may be at a higher risk or more tests may be required to check for cancer. For example, a positive mammogram may just be indicative of the presence of a breast lump. Further tests like pathological examination of a sample of tissue or biopsy from the lump may be needed to confirm if the lump is cancer. Sometimes, certain screening tests may be recommended only for people having some risk factors for certain cancers. For example:

• Past history of a cancer
• Family history of certain cancers
• Detection of some gene mutations linked to some cancers. 

Having a risk factor does not mean that a person will get cancer. Similarly, not having a risk factor does not mean that a person will not get cancer. Yet, some screening tests are advised only for people with known risk factors for some cancers. 

At what age should a person get cancer screening done?

A person’s overall health gets affected with diet, personal habits and fitness levels, and the genetic risk for developing cancers and chronic diseases. There are many internationally recognized screening guidelines. These recommendations may vary from country to country, and they may also vary from one organization to another within the countries. Hence, it is important for a person to follow age-based recommendations for cancer screening depending on individual susceptibility and the advice of the oncologist.

What are the screening recommendations for the early detection of cervical cancer

• Cervical cancer testing should start at age 21. Women under age 21 should not be tested.
• Women between the ages of 21 and 29 should have a Pap test done every 3 years. HPV testing should not be used in this age group unless it is needed after an abnormal Pap test result.
• Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called “co-testing”) done every 5 years. This is the preferred approach, but it is OK to have a Pap test alone every 3 years.
• Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing goes past age 65.
• A woman who has had her uterus and cervix removed (a total hysterectomy) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.
• All women who have been vaccinated against HPV should still follow the screening recommendations for their age groups.

Some women – because of their health history (HIV infection, organ transplant, DES exposure, etc.)  may need a different screening schedule for cervical cancer. Talk to a health care provider about your history.

The Pap test can find abnormal cells in the cervix which may turn into cancer. The HPV test looks for the virus (human papillomavirus) that can cause these cell changes. Pap tests also can find cervical cancer early, when the chance of being cured is very high.

What are the screening recommendations for the early detection of breast cancer?

Screening for breast cancer is done by checking the breasts for the presence of cancer before the disease shows any signs or symptoms. As mentioned earlier, it may not be possible to prevent cancer with screening, but it can help early detection, making it easier to treat. The screening guidelines below apply to most women:

Breast cancer screening exams help to find breast cancer at an early stage. When found early, the chances for successfully treating the disease are greatest.

Along with regular exams, practice awareness is important. This means you should stay familiar with your breasts. That way you’ll notice changes, like a new lump or mass. Then, report them to your doctor without delay.

The screening recommendations below apply to most women:

• Women between age 40 to 44  can optionally start annual breast cancer screening with mammograms.
• Women between age 45 to 54 are recommended to get a mammogram done every year.
• Women between 55 and older can undergo mammograms every 2 years, or continue with yearly screening
• Screening should continue till the time a woman is healthy and is expected to live for 10 years or more.
• All women should be familiar with the known benefits, limitations, and potential harms linked to breast cancer screening.

Screening for women at higher risk

A woman may be at an increased risk for breast cancer under the following situations:

• Radiation treatment to the chest done any time in the past
• Known presence of any genetic mutation like the BRCA 1 or BRCA 2 genes
• History of cancer like lobular carcinoma in situ
• Women with a positive family history of breast cancer should consider speaking with their Oncologist.

High-risk women should be screened with MRI (Magnetic Resonance Imaging) along with mammograms.

Every woman should get familiarized with the benefits and potential risks of breast cancer screening. Women should also be aware of the normal appearance and feel of their breasts. Any changes in self-examination should be immediately reported.

What are the screening recommendations for the early detection of endometrial cancer?

• Women approaching menopause should be educated about the risks factors and symptoms of endometrial cancer. Any unexpected or unusual vaginal bleeding or spotting, if present, should be brought to the notice of a gynaecologist.
• Women at higher risk because of their past medical history should consider having screening annually. Please consult your gynaecologist if you have any positive history of cancer in the immediate relationship.
• Tests that can be done for screening done include: 
  • Endometrial biopsy
  • Pap test
  • Transvaginal Ultrasound

What are the screening recommendations for the early detection of colon and rectal cancer and polyps?

People at higher or increased risk for colon and rectal cancer and polyps include:

• Past family history of colorectal cancer or certain types of polyps
• Personal history of colorectal cancer or certain types of polyps
• A personal history of inflammatory bowel disease i.e. ulcerative colitis or Crohn’s disease
• A known family history of a hereditary colorectal cancer syndrome 
• A personal history of radiation to the belly or pelvic region for the treatment of cancer in the past

As per the recommendations, those who are at average risk of colorectal cancer should begin regular screening at the age of 45 years.

Individuals in good health and those likely to live for 10 years or more should continue with colorectal cancer screening until the age of 75 years.

Those between 76 to 85 years consider discussing with their Oncologist whether or not to continue with screening.

Screening is generally not recommended for people over 85 years.

Some of the tests for screening include:

Stool-based tests:

• Highly sensitive faecal immunochemical test (FIT)
• Highly sensitive guaiac-based faecal occult blood test (gFOBT)
• Multi-targeted stool DNA test (MT-sDNA) 

Visual exams:

• Colonoscopy
• CT colonography (virtual colonoscopy)
• Flexible sigmoidoscopy (FSIG) 

What are the screening recommendations for the early detection of lung cancer

Lung cancer screening helps to identify the presence of lung cancer in otherwise healthy people who are at risk of lung cancer. Older adults who have been or are long-time smokers with no signs or symptoms of lung cancer are highly recommended to go for lung cancer screening with a low-dose CT scan (LDCT)

Age-wise screening is thus ideally advised for 

• People aged 55 to 74 years and in fairly good health who currently smoke or have quit smoking in the past 15 years
• Have a history of smoking at least 30 packs per year smoking history. 
  • A pack-year is 1 pack of cigarettes per day per year. 
  • One pack per day for 30 years or 2 packs per day for 15 years would both be 30 pack-years.

In addition, the undermentioned people should also consider screening for lung cancer:

• People with a history of lung cancer 
• People with other risk factors for lung cancer like the presence of chronic obstructive pulmonary disease (COPD)
• People with a family history of lung cancer 
• People exposed to chemicals and agents like asbestos at work

What are the screening recommendations for the early detection of prostate cancer

Prostate cancer can often be detected in early stages by testing the amount of prostate-specific antigen (PSA) in the blood of a person. Digital rectal exam (DRE) done by a doctor is another way to find out the presence of prostate cancer. In DRE, the doctor examines the rectum by inserting a gloved, lubricated finger to feel the prostate gland.

• It is generally recommended that men at or above 50 years of age or those with a family history of prostate cancer should consult a doctor about the advantages and disadvantages of undergoing screening for prostate cancer to make an informed decision. 
• Men at 70 or above 70 years of age are generally not recommended to undergo screening for prostate cancer.

What are the screening recommendations for the early detection of head and neck cancer?

• Those people with personal habits like a history of consumption of tobacco products in the past or currently consume tobacco products and those who routinely drink alcohol should undergo general health screening examination at least once a year. 
• Screening for head and neck cancers is a simple, quick procedure where the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination.
• Regular dental check-ups are also important to screen for head and neck cancer.

How can you help reduce the risk of cancer?

While it may not be possible to prevent cancers altogether, certain precautions can help individuals reduce the risk of cancers. Some of these precautions include lifestyle changes like:

• Avoiding all forms of tobacco.
• Maintain a healthy weight.
• Engage in regular physical activity.
• Eat healthily and have plenty of fruits and vegetables.
• Limit alcohol consumption if you drink.
• Protect your skin from excessive exposure to the sun.
• Know yourself and make yourself aware with your family history and your risks.
• Get regular check-ups and consult your doctor for cancer screening tests.

Conclusion:

Screening for cancer before you develop symptoms is a good way to determine the presence of cancers. It is a good way to prevent or treat them early, thus helping in fewer complications and better quality of life in many cases. Screening tests, if done regularly, may be helpful in finding some categories of cancers like breast, cervical, and colorectal (colon) cancers early in people at risk or those in specific age groups. Lung cancer screening is recommended for categories of people who are at high risk. However, screening tests should be undertaken upon consultation with your doctor who can help you in making an informed decision after taking your medical and personal history, doing a physical examination, and weighing the advantages and disadvantages of the screening test.

We hope we were able to address your queries related to screening test guidelines for different cancers. If you wish to know more about screening tests, you can request a call-back, and our experts will call you and answer all your queries.

References:

• Centres For Disease Control And Prevention. Screening Tests. Available at: https://www.cdc.gov/cancer/dcpc/prevention/screening.htm. Accessed on 6th January 2019.
• Mayo Clinic. Prostate cancer screening: Should you get a PSA test?. Available at: https://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/prostate-cancer/art-20048087. Accessed on 6th January 2019.
• American Cancer Society. Cancer Screening Guidelines. Available at: https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines.html. Accessed on 6th January 2019.
• Cancer Screening Guidelines. Detecting Cancer Early. Available at:  https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html. Accessed on 6th January 2019.
• Cleveland Clinic. Cancer Screening Guidelines. Available at.https://my.clevelandclinic.org/departments/cancer/patient-education/wellness-prevention/screening-guidelines. Accessed on 6th January 2019.

About Author –

Dr. Sachin Marda

MS, DNB (Gen. Surgery) (Mumbai) Gold Medalist
MCh, DNB (Surgical Oncology) MRCS Ed (UK)
Clinical Fellow (NCCS, Singapore)

Clinical Director
Senior Oncologist and Robotic Surgeon

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