Why screen for cancer? 

Or as stated by some of our patients.. 

"If it ain't broke why fix it?"

Screening for cancer is done to identify people in the early stages of developing cancer before they have symptoms. As you would expect, much more can be done to cure cancer if it is caught in its earliest stages. Unfortunately the body often does not give us clues ( like symptoms) that a cancer is present until it is in a much more advanced stage. For this reason we have developed tests to help us find cancers before symptoms develop. From many studies we have learned what types of people may be more at risk for certain types of cancer and what  activities and things in our environment  may cause cancer. This information sometimes helps doctors recommend who should be screened for certain types of cancer. Not all screening tests are helpful, and some have risks. For this reason, we only recommend screening test in people and situations where the benefits outweigh the risks.

 The following is a summary of the recommended cancer screening procedures based on sex and age. Talk to your doctor about cancer screening and whether it is appropriate for you.

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Cancer Prevention

Breast Cancer Screening

Risk of breast cancer

Breast cancer is second only to skin cancer in the number of new cancer cases among women in the US, and only lung cancer causes more cancer deaths.  The number of cases per 1,000 women has increased slightly every year over the last 50 years. Breast cancer occurs in men also, but the number of new cases is small.

 Some of the risk factors for breast cancer are as follows:

Age - Breast cancer is more likely to develop as you grow older. Beginning menstruation at an early age and late age at first birth may also increase the risk of development of breast cancer.

History of Breast Cancer - If you have already had breast cancer, you are more likely to develop breast cancer again.

Family History - If your mother or sister had breast cancer, you are more likely to develop breast cancer, especially if they had it at an early age.

Diet - A diet high in fat has been associated with a higher risk of breast cancer

Estrogen Use - A history of using estrogen over a prolonged period of time has been associated with a slight increase in breast cancer risk

Studies have found that race, social status, income, education, and access to screening and treatment services may affect a woman's risk of developing breast cancer.

Screening for breast cancer

Breast Self-Examination - Studies have not yet proven a link between breast self examination and a reduction in the number of deaths from breast cancer. Therefore, it should not be used in place of clinical breast examination and mammography. However, since there is no cost or risk to doing self exams they should be performed on a regular basis in addition to having mammograms and seeing your doctor for your regular exams.

Clinical Breast Examination - During your routine physical examination, your doctor or health care professional may do a clinical breast examination (CBE). During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.

Mammogram - A mammogram is a special x-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Your doctor may suggest that you have a mammogram, especially if you have any of the risk factors listed above.

The ability of mammography to detect cancer depends on such factors as the size of the tumor, the age of the woman, breast density, and the skill of the radiologist. We recommend that women have a baseline mammogram at age 35, mammograms every other year from age 40-49, and annual mammograms after age 50. As with all screening tests these guidelines may be altered depending on risk factors and should be discussed with your doctor.

Ultrasonography - Ultrasonography uses sound waves to make a picture of the breast. Ultrasound is used to evaluate lumps that have been identified by BSE, CBE, or mammography. It can be helpful in determining whether a mass is a fluid filled cyst (probably benign) or a solid mass ( possibly malignant). 

Cervical Cancer Screening

Cervical cancer is one of the most common cancers in young women. The primary risk factor is the human papilloma virus which causes genital warts. As such this cancer can be considered in some ways to be a sexually transmitted disease.

Risk factors for cervical cancer:

Age - Rates of cervical carcinoma in-situ (cervical cancer that has not spread to other parts of the body) reach a peak in both black and white women between the ages of 20 and 30 years. After the age of 25 years, the number of cases of invasive cervical cancer increases with age in white women and black women, but it increases more rapidly in black women. The chance of dying of cervical cancer increases as women get older.

Pap Test (Smear) History - Women who have never had a Pap test or who have not had one for several years have a higher-than-average risk of developing cervical cancer.

HPV Infection -  Cervical infection with HPV (human papilloma virus) is the primary risk factor for cervical cancer. HPV is the same virus that causes genital warts. However, HPV infection is very common and only a very small percentage of women infected with untreated HPV will develop cervical cancer. A history of genital warts is a strong indication for regular PAP smears.

Sexual History - Women who first had sexual intercourse at an early age or who have had many sexual partners have a higher-than-average risk of developing cervical cancer.

Screening test for cervical cancer

Pap Test (Smear) - This test is performed during a regular office visit to a doctor. A doctor uses a wooden scraper and/or a small brush to collect a sample of cells from the cervix and upper vagina. These cells are placed on a slide and sent to a laboratory to check for abnormalities. Studies suggest that the death rate of cervical cancer will decrease if women who are or have been sexually active or who are in their late teens or older have regular Pap tests.

Colorectal Cancer Screening

Cancer of the colon or rectum is often called colon cancer. The colon and the rectum are part of the large intestine, which is part of the digestive system.Colon cancer is the second leading cause of death from cancer in the United States. It is common in both men and women.   

Risk factors:

Age - The risk of developing colon cancer rises after age 50 years.

Family History - You may have inherited a condition from your parents that puts you at a higher risk of developing colon cancer. If your mother, father, brother, or sister has had colon cancer or has had an adenoma diagnosed before 60 years of age, you have a higher of developing colon cancer. Your doctor may ask you medical questions about your relatives and may perform some tests to see if you have any hereditary conditions that might increase your risk of colon cancer.

Personal History of Colorectal Cancer - If you have already had colon cancer, you are more likely to develop colon cancer again.

Personal History of Ovarian, Endometrial( Uterine), or Breast Cancer - If you have had ovarian, endometrial, or breast cancer, you have an increased risk of developing colon cancer.

Personal History of Chronic Ulcerative Colitis or Crohn's Colitis - If you have longstanding chronic ulcerative colitis or Crohn's colitis, you have a higher- than-average risk of developing colon cancer.

Screening tests for colorectal cancer

Stool guaiac test - This test examines a patient's solid waste (stool) for occult (hidden) blood. This test is not as sensitive as a colonoscopy/sigmoidoscopy because small tumors don't always bleed. It is a useful non-invasive test which has been shown to decrease the death rate from colon cancer

Digital Rectal Examination - A digital rectal examination is performed during an office visit or prior to sigmoidoscopy or colonoscopy. For this examination, the doctor inserts a lubricated gloved finger into the rectum and feels for lumps or abnormal areas. He/She will also have the opportunity to examine the prostate in male patients during this examination. 

Colonoscopy- A colonoscope is an examination in which a doctor uses a thin, flexible fiber optic tube with a light to look inside the rectum and colon for polyps or tumors. If a lesion is found it can be removed with this instrument. The test is usually done with conscious sedation which is a type of anesthesia, and is relatively pain free.

Prostate Cancer Screening

The prostate is located between the bladder and the rectum. The normal prostate gland is the size of a walnut and surrounds the urethra, the tube that carries urine from the bladder. Prostate cancer is the second most common cancer in North American men after skin cancer. It is the second leading cause of cancer death in men after lung cancer. Both the number of new cases of prostate cancer and the number of deaths due to prostate cancer have increased in the past decade.

Age - Prostate cancer is rarely seen in men younger than 50 years old. The chance of developing prostate cancer increases as men get older.

Race - Black males are more likely to develop prostate cancer than white males. Black males are also more likely to die of prostate cancer than white males.

Family History  - A man whose father, brother, or son has had prostate cancer has a higher-than-average risk of developing prostate cancer.

Screening tests for prostate cancer

Digital Rectal Examination - A digital rectal examination (DRE) is performed by a doctor during a regular office visit. For this examination, the doctor inserts a gloved finger into the rectum and feels the prostate gland through the rectal wall to check for bumps or abnormal areas.

Transrectal Ultrasonography - During this examination, high-frequency sound waves are sent out by a probe about the size of the index finger, which is inserted into the rectum.  Doctors examine the sonogram for echoes that might represent abnormal areas. This test is only used in men who have an abnormal DRE (see above) or an elevated PSA ( see below)

PSA - For this test, a blood sample is drawn and the amount of prostate- specific antigen (PSA) present is determined in a laboratory. PSA is a marker that, if present in higher than average amounts, may indicate prostate cancer cells. However, PSA levels may also be higher in men who have benign prostate conditions.

Ovarian Cancer

          Ovarian Cancer is not as common in women as breast, lung or colon cancer.  It is more difficult to treat and also more difficult to screen for.  At this point in time there is no proven method of early detection which has been shown to have any benefit.  

Sonograms: A sonogram uses sound waves to take pictures of the bodies internal structures. Screening sonograms have not been shown to decrease mortality or increase survival.  

CA125: A blood test called CA125 which is used to follow the progress of ovarian cancer after treatment has also shown no benefit as a screening tool since many other conditions besides ovarian cancer can also elevate the CA125. 

New Screening test - There is a new blood test on the horizon which may offer some hope to those who are at high risk for breast cancer. See New Ovarian Cancer Blood Test for more information. 

At this point in time no screening program can be recommended for ovarian cancer detection.

Lung Cancer

     Lung cancer is the most common cause of cancer deaths in men and women.  By far the greatest risk factor is smoking.   Within 10 years of quitting smoking and individuals risk for lung cancer drops nearly to the level of someone who has never smoked.

Chest X-rays:  For years chest x-rays were used as a routine screening method for lung diseases such as lung cancer.  A large study done a number of years ago showed that chest x-rays only detect lung tumors at a point when they are already inoperable.  Consequently chest x-rays are no longer used for screening purposes.

Sputum cytology: This is a test looking for cancer cells in the sputum. There is no evidence that this test has any benefit in screening for lung cancer.

Thin Section Cat Scans: One recent study seems to show a benefit when this test is used to screen for lung cancer. A Cat scan is a special computerized x-ray that allows the lung to be viewed in much greater detail than a standard x-ray. While this method shows promise, further studies need to be done. At this point in time most insurance companies do not cover this test which costs several hundred dollars.

Skin Cancer

  Skin cancer affects over 500,000 people a year in the US.  It is the single most common type of cancer in Americans, and the incidence is increasing as people spend more time exposed to the sun.

Risk factors:

Sun exposure is by far the single most important controllable risk factor. The effects of the sun are cumulative, so the longer you are in the sun and the more often you are exposed the more damage will accumulate.  

Skin type:  While all skin types are susceptible to skin cancer ( even Blacks and Hispanics), those with fair skin have a higher risk and should double their efforts to avoid sun exposure. 

Screening:   Screening relies mostly on examination of the skin the patient and their physician, and attention to certain warning signs. Things you should look for are

• A change in the color of a mole

• Moles with multiple colors ( especially with blue or black areas)

• Moles with irregular borders

• Moles that bleed

Prevention:  To lower the risk of developing skin cancer it is important to avoid sun exposure. All individuals should avoid the sun when possible and use a sun screen with an SPF of at least 30 when they must go in the sun. Sun screen should be applied prior to going out in the sun and should be reapplied after several hours and after coming out of the water.  Any burning or tanning ( yes even tanning) is evidence of sun damage and should be avoided. One note... There is no such thing as a safe tan. Tanning booths use ultraviolet rays and have not been shown to be any safer than getting a tan from the sun.

Testicular Cancer

This type of cancer doesn't get much press but is easily detectable and can often be cured if caught in early.  Testicular cancer occurs most commonly in men from their late teens to mid thirties.  It is rare after age 40.  

Screening requires manual exam. Patients should learn how to do their own exams and should be examined by their physician whenever they have their annual exams. Any abnormalities found on self exam should be brought to the attention of a physician for further evaluation.

• Monthly testicular exam

• Annual rectal exam

• Colonoscopy every three to five years
• Annual rectal exam
• Annual stool test for blood
• Annual PSA ( prostate specific antigen)

• Annual Pap Smear
• Monthly self breast exam
• Annual breast exam by physician

• Annual Pap smear
• One baseline Mammogram
• Monthly Breast self exam
• Annual breast exam by physician

• Annual Pap smear
• Mammogram every 2 years
• Monthly Breast self exam
• Annual breast exam by physician
• Annual rectal exam

• Annual Pap smear
• Mammogram every year
• Monthly Breast self exam
• Annual breast exam by physician
• Annual rectal exam and stool blood test
• Colonoscopy every three to five years