Cancer is a leading cause of death and morbidity in the United States, and recent figures show that 1 in 2 males and 1 in 3 females will be diagnosed with cancer in their lifetime. In essentially all cases of cancer, early detection profoundly impacts the outcome. Part of your annual physical with your primary care doctor includes a review of patient specific cancer screenings. Compared to all the possible types of cancers out there, we only have appropriate (accurate, safe, cost effective) screening methods for a few, but they are particularly important because they are the most common. While we cannot screen for all cancers, this makes staying up to date on your personal cancer screenings especially important. Your primary care doctor will help you navigate this, but I think it is always important to also be your own health advocate.
What specific guidelines to follow is sometimes a controversial topic. There are often small discrepancies from the recommendations from different groups such as the American Cancer Society, the US Preventative Services Task Force, American College of Obstetrics & Gynecology, and the American College of Gastroenterology. Your primary care physician should take these guidelines into account as well as your age, risk, and family history to help you make an informed decision on screening. An important note here is that the following screening information is for average-risk individuals. If you have a strong family history of certain cancers or certain genetic traits, your screening will often be different from someone with average risk.
Breast Cancer Screening
Mammograms in females beginning at age 40 or 50 (depending on which guideline is being followed) and repeat every 1 or 2 years. I recommend starting at age 40 because breast cancer is the most common cancer seen in women (1 in 8 women). There are no concrete recommendations for stopping mammograms, but a generally accepted guideline is to stop when life expectance is <5 years.
Prostate Cancer Screening
Prostate cancer is the most common cancer found in men, but routine screening (with a PSA blood test) remains quite contentious as no major medical organization currently endorses routine screening for men at average risk. This is due to concerns about detecting disease that would never have caused symptoms or harm (most prostate cancer is very slow growing), and potential for serious adverse effects of unnecessary biopsies and/or prostate cancer treatment. To remedy the controversy, the generally accepted advice is to engage in informed decision making with men starting at age 50 regarding PSA testing.
Lung and Bronchus Cancer Screening
Lung and bronchus (airway) cancers are the second most common cancer in both men and women. It is well known that cigarette smoking is a significant risk factor for lung cancer; about 80% of lung cancer deaths in the US are caused by smoking. Current or former (quit within the past 15 years) heavy smokers (have smoked on average 1 pack per day for at least 30 years) should be screened yearly with a low dose CT scan (LDCT) starting at age 50 or 55 until age 74 or 80 (varies based on specific guideline).
Colon and Rectal Cancer Screening
Colon and rectal cancers (CRC) are the third most common cancer in both males and females. We used to start screening at age 50 but given the increased incidence of CRC in a younger population, it is now recommended to start screening with colonoscopy or stool DNA testing at age 45. Screening should continue through age 75 and followed by individualized decision-making for those aged 76-85.
Cervical Cancer Screening
This seems to be an ever-changing topic. The most recent guidelines by the American Cancer Society recommend initiating cervical cancer screening at age 25 with HPV (human papilloma virus which causes cervical cancer) testing. Other groups still recommend pap testing starting at age 21. Screening should continue every 5 years with HPV or co-testing with HPV and a pap smear OR every 3 years with a pap smear alone through age 65.
From a patient’s perspective, it is important to have an idea about what screening tests you might need. There are many other cancers that might get “screened” for based on your symptoms or family history, so it is always important to discuss these things with your physician. Things like a clinical breast exam or annual skin check might not be current “guidelines,” but pose little harm, so make sure to take the time to address what concerns you with your doctor.
Something that I have grown to appreciate as I have practiced family medicine over the last few years is that these standard guidelines are just that – guidelines. Not every patient fits exactly into these categories. Now that I have transitioned to a direct primary care practice, I have far more time to spend with my patients to help identify when someone might need additional screening or earlier screening. Your primary care should be largely evidence-based but with a personalized approach to help you optimize your health and longevity.