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    Which Cancer Screenings You Need, When, and WHY

    Mohammed Allaw, MD Internal Medicine, Deaconess Clinic Gateway Professional Building 09/12/2017

    Cancer screening recommendations can be confusing for many people--in my 20 years of practicing primary care medicine for adults, thousands of patients have had questions about various cancer screenings. 

    In modern medicine, we are incredibly fortunate to have cancer screenings, as even a couple of generations ago, there were no ways to detect cancer in early stages. However, with those medical advancements come questions about which screenings are needed, when to get them, and why they’re important.

    In this article, I’ll focus on breast, prostate, lung, colon and skin cancer screenings.

    Breast Cancer Screening
    Every woman should pay attention to breast cancer screening recommendations.  It’s important to note that there have been significant changes in recommendations in recent years. I follow the US Preventive Services Task Force recommendations: women of average risk should begin annual screening mammograms at age 50.

    However, women who have certain concerns or risk factors should consult with their physician earlier/at any age, including:

    • First degree family history of breast cancer (mother/sister/daughter)
    • Any abnormal finding in the breast by physical exam, or visually noticing something different about the breasts
    Most health insurance companies continue to cover annual screening mammograms beginning at age 40, so any woman with any concerns should talk with her doctor.

    Women should also be familiar with what is “normal for them” in her breasts and even the area on her side under her arm.  Anything different or unusual (such as a thickening, lump, puckering of the skin, nipple changes or discharge, etc.) should cause a woman to see her doctor as soon as possible. 

    Prostate Cancer Screening
    Prostate cancer screening is a controversial topic due to varying opinions and outcomes based upon the two components of screening:  the PSA (blood test) and DRE (digital rectal exam).

    Recommendations for PSA (prostate specific antigen) and other screening tests can be confusing. All men over 40 are encouraged to talk to their doctor about prostate cancer screenings, so they can decide together what options are best for them.
    Here are my recommendations on who should definitely be screened for prostate cancer:
    • Men who have family history of prostate cancer (uncle, father, grandfather, brother)
    • Any man who is concerned about his prostate health and wants to monitor changes
    • Men who have urinary symptoms such as slow stream, delay or interruption in starting stream, urgency and frequency, excessive nighttime urination, etc.
    Screening for prostate cancer with PSA has potential benefits and harm. Due to the lack of definitive data on screening outcomes, it is particularly important that patients make informed decisions about undergoing testing.

    The US Preventive Services Task Force Guidelines, American College of Physicians, American Urologic Association and the American Cancer Society all stress the importance of informed decision making.

    If you’d like an additional perspective on prostate cancer screening, my colleague Dr. Joseph Klink, urologic oncologist at Deaconess Clinic, shares his insights.

    Lung Cancer Screening
    Lung cancer is the number one cancer killer in this country, as more people die of lung cancer than of breast, prostate and colon cancer combined.  As smoking is the most significant risk factor for lung cancer, lung cancer screening recommendations are currently tied to smoking history.

    An annual screening for lung cancer (intended for long-term smokers) is now being recommended by major medical organizations, including the U.S. Preventive Services Task Force.

    To be eligible for the screening, you must have the following risk factors:
    • Be between the ages of 55-80*
    • Have a 30 pack-year history or more**
    • Be currently smoking or have smoked within the last 15 years
    • No current symptoms of lung cancer

    All criteria must be met for this testing. Because the test does involve some radiation, the risk for lung cancer must be higher than the overall lifetime radiation risk.

    *If someone has a higher risk due to extensive smoking history, or a first degree relative (parent, sibling) who had lung cancer, screening may be recommended earlier.

    **The “pack-year history” is determined by calculating how many packs of cigarettes per day have been smoked for what number of years. For example, if an individual started smoking at age 20, and smoked a pack a day until age 50, that would be 30 pack years. If that same person smoked 2 packs per day, 30 pack years would be reached by age 35.

    Screening for lung cancer is conducted by low dose CT, which is test that must be ordered by a physician.  So if you meet the criteria above, I encourage you to talk with your doctor about lung cancer screening.

    Colorectal Cancer Screening
    Colon or colorectal cancer is the most common cancer (besides skin cancer) that is diagnosed in both men and women.  It’s a leading cause of cancer death as well.

    Colon cancer screenings really do save lives, as catching colon cancer early makes it far more treatable and even curable.  Unfortunately, our colon cancer screening rates aren’t what they should be because of some people’s discomfort with the screening options. As a doctor, I want to encourage everyone to set aside a little discomfort or embarrassment because these important tests can save your life.

    It’s recommended by numerous organizations that anyone who is healthy, with no symptoms of colon cancer, should have an initial screening colonoscopy at the age of 50. However, if you have a family history of colon cancer, you may need to be screened earlier.  Talk with your doctor about recommended screening ages.
    A colonoscopy is a procedure where a physician uses a scoping tool with a video camera to examine the inside of the colon.  Most insurance companies cover this screening in full.  Medications, the procedure, etc. are included in that coverage.  Colonoscopy is considered the “gold standard” of colon cancer screenings because it is so effective.  Also, if there are growths in the colon (called polyps) they can be removed.  These polyps sometimes develop into colon cancer, so colonoscopy is able to help prevent the development of cancer—no other screening method can do this.

    There are people who flat-out avoid getting a colonoscopy, because they’ve heard something they don’t like about the test. For some, they may feel embarrassed; for others, they may’ve heard that the preparation for the test is unpleasant.  

    A first point to make is that the physician who will perform the procedure has done them thousands of times.  He or she will not be focusing on anything about you except how your colon looks, and they’ll be respecting you for taking this step to protect your health.  Aren’t a few minutes of “embarrassment” worth potentially saving your life?

    Secondly, preparation for a colonoscopy involves cleaning out the colon.  That means taking laxatives and limiting fluid/food so that the colon is empty for the test.  It’s important that this is done completely so that the physician can get a clear view and complete the exam easily.  The prep is, admittedly, not the most fun way to spend an evening at home.  But for most people it’s done just once a decade or so. 

    Someone who recently had a colonoscopy said, “It’s way better than having a stomach bug, because it just involves going to the bathroom a lot, and you don’t feel bad—you’re not sick.” Colon prep is very manageable and just something you have to do.

    For those who still choose to not have a colonoscopy, there are take-home screening tests available that involve collecting a stool sample for examination in a lab.  These tests help detect signs of cancer in the stool.  This test is also (usually) fully covered by insurance.   An important note:  If there are any signs of cancer in the stool test, a colonoscopy will be needed, and it will no longer be a screening colonoscopy, but diagnostic, which will often have an out of pocket cost.

    I encourage all my patients at age 50 to have their first screening colonoscopy.  If it’s “all clear,” the patient is at average risk, and no concerning symptoms develop, another colonoscopy won’t be needed for 10 years.

    To learn more about colon cancer, read the helpful blog shared by my colleague Dr. Rubin Bahuva, gastroenterologist at Deaconess Clinic, and one of his patients.

    Skin Cancer Screening
    Skin cancer is the most commonly diagnosed cancer in the U.S.  One in five people will be diagnosed with skin cancer at some point in their lives.

    Most skin cancers are slow growing and don’t lead to death. However, melanoma is a very serious, aggressively-spreading skin cancer that is becoming more common in young people, especially young women who have used tanning beds. 

    Every patient at any age should have a full skin exam by their primary care physician during their annual well visit (checkup). 

    Both men and women should have their heads, necks, shoulders, legs, etc. examined.  Men are more likely to develop skin cancer on their backs, and women are more likely to develop cancers on their back of their legs—but note:  skin cancers can appear anywhere, even in skin fold areas or parts of the body that you don’t think get much sunshine.

    Not every patient wants this done (although they should), so if you’d like this exam, make sure you mention it to your doctor. You should become familiar with your own skin and note any changes.  A self-exam once a month is recommended.

    There are no recommended imaging tests, blood tests, etc. for skin cancer.  Screening is simply a visual inspection.

    To learn more about skin cancer types, symptoms of cancer, etc. read this blog from my colleagues at Deaconess Clinic Dermatology.

    In summary
    Please talk with your doctor about screening recommendations that are right for you. Take advantage of insurance coverage for cancer screenings, and be screened as recommended. 

    Cancer is much more treatable when caught at early stages.  Catching cancer early is the goal of every screening recommendation.


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