Berkeley Family Practice

Cancer

Cancer Screening

Detecting cancer early can affect the outcome of the disease for some cancers. 

When cancer is found, a doctor will determine what type it is and how fast it is growing. He or she will also determine whether cancer cells have invaded nearby healthy tissue or spread (metastasized) to other parts of the body. In some cases, finding cancer early may decrease a person's risk of dying from the cancer. For this reason, improving our methods for early detection is currently a high priority for cancer researchers.

Screening

Checking for cancer (or for conditions that may lead to cancer) in people who have no symptoms is called screening.

Screening can help doctors find and treat some types of cancer early. Screening tests are used widely to check for cancers of the breast, cervix, colon, and rectum:

breast cancer screening
See larger image

Breast

Breast cancer can sometimes be detected in its early stages using a mammogram, an X-ray of the breast. Mammography is most beneficial for women as they age and undergo menopause. Mammography is a screening tool that can detect the possible presence of an abnormal tissue mass. By itself, it is not accurate enough to provide definitive proof of either the presence or the absence of breast cancer. If a mammogram indicates the presence of an abnormality, further tests must be done to determine whether breast cancer actually is present.

Cervix

A screening technique called the Pap test (or Pap smear) allows early detection of cancer of the cervix, the narrow portion of the uterus that extends down into the upper part of the vagina. In this procedure, a doctor uses a small brush or wooden scraper to remove a sample of cells from the cervix and upper vagina. The cells are placed on a slide and sent to a laboratory, where a microscope is used to check for abnormalities. Since the 1930s, early detection using the Pap test has helped lower the death rate from cervical cancer more than 75 percent.

cervical cancer screening
See larger image

Should abnormalities be found, an additional test may be necessary. There are now 13 high-risk types of human papillomaviruses (HPV) recognized as the major causes of cervical cancer. The U.S. Food and Drug Administration has approved an HPV test that can identify their presence in a tissue sample. This test can detect the viruses even before there are any conclusive visible changes to the cervical cells.

Women should begin having Pap tests 3 years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first). Most women should have a Pap test at least once every 3 years.

Prostate and Ovaries

The U.S. FDA has approved the PSA test along with a digital rectal exam to help detect prostate cancer in men age 50 and older. Doctors often use the PSA test and DRE as prostate cancer screening tests; together, these tests can help doctors detect prostate cancer in men who have no symptoms of the disease. Most men with an elevated PSA test, though, turn out not to have cancer; only 25 to 30 percent of men who have a biopsy due to elevated PSA levels actually have prostate cancer, so researchers are working hard to find new clues. Experts are trying to develop better blood tests that might alert people to malignancies while the cancers are still in their early stages. For example, several new blood tests for ovarian or prostate cancer are under development.

Colon and rectum

A number of screening tests are used to detect polyps (growths), cancer, or other problems in the colon and rectum. People aged 50 and older should be screened. People who have a higher-than-average risk of cancer of the colon or rectum should talk with their doctor about whether to have screening tests before age 50 and how often to have them.

colon cancer screening
See larger image
  • Fecal occult blood test: Sometimes cancer or polyps bleed. This test can detect tiny amounts of blood in the stool.
  • Sigmoidoscopy: The doctor checks inside the rectum and lower part of the colon with a lighted tube called a sigmoidoscope. The doctor can usually remove polyps through the tube.
  • Colonoscopy: The doctor examines inside the rectum and entire colon using a long, lighted tube called a colonoscope. The doctor can usually remove polyps through the tube.
  • Double-contrast barium enema: This procedure involves several x-rays of the colon and rectum. The patient is given an enema with a barium solution, and air is pumped into the rectum. The barium and air improve the x-ray images of the colon and rectum.
  • Digital rectal exam: A rectal exam is often part of a routine physical exam. The health care provider inserts a lubricated, gloved finger into the rectum to feel for abnormal areas. A digital rectal exam allows for examination of only the lowest part of the rectum.

Other Screening Tests

You may have heard about other tests to check for cancer in other parts of the body. At this time, we do not know whether routine screening with these other tests saves lives.

Which Screening Tests Should I Get?

Doctors consider many factors before they suggest a screening test. They weigh factors related to the test and to the cancer that the test can detect. They also pay special attention to a person's risk for developing certain types of cancer. For example, doctors think about the person's age, medical history, general health, family history, and lifestyle. They consider how accurate the test is. In addition, doctors keep in mind the possible harms of the screening test itself. They also look at the risk of follow-up tests or surgery that the person might need to see if an abnormal test result means cancer. Doctors also think about the risks and benefits of treatment if testing finds cancer. They consider how well the treatment works and what side effects it causes.

You may want to talk with your doctor about the possible benefits and harms of being checked for cancer. The decision to be screened, like many other medical decisions, is a personal one. Each person should decide after learning about the pros and cons of screening.

You may want to ask the doctor the following questions about screening:

  • Which tests do you recommend for me? Why?
  • How much do the tests cost? Will my health insurance help pay for screening tests?
  • Do the tests hurt? Are there any risks?
  • How soon after the tests will I learn the results?
  • If the results show a problem, how will you learn if I have cancer?

Reference: National Cancer Institute (NCI)