Cancer Screenings Could Save Your Life

The numbers publicized by cancer organizations can sound terrifying: One of every eight American women will get breast cancer sometime in her life. One in six American men will develop prostate cancer. One in four people will get skin cancer. One in 18 will be stricken by colorectal cancer.

The combined effect might lead one to believe that cancer is nearly inevitable--that it’s just a matter of where and when, not if. Public service announcements, reasonably enough, urge consumers to be screened for various cancers. But what exactly does a screening get you? How often should screening be performed? And on whom? At what cost?

To answer those questions and others, the Washington Post Health section talked with screening experts at the National Cancer Institute, the American Cancer Society and elsewhere. The accompanying sidebar details screening procedures--as well as information about risk factors, warning signs and other useful information--on five killer cancers that, if detected early, can be treated effectively.

Underpinning this information are some ideas about screening that often get lost in the public service messages--or that never reach the right people, who’d rather not deal with cancer risk at all. Here are the facts you need to know:

* A vast majority of cancers--at least 90%--occur in people with no family history of the disease.

Yes, it’s true that family history plays a role in cancer. If your mother or sister had breast cancer, you’re at increased risk for the disease and need to be more vigilant than others about screening. The same applies if your father had prostate cancer or if either of your parents--or any of your siblings--have been diagnosed with colorectal cancer.

But saying high-risk people should be especially careful is different from saying everyone else can relax. It’s vital to remember that only 5% to 10% of cancer cases are attributable to genetic predisposition, according to the American Cancer Society. The majority of malignant tumors result from damage to genes from a variety of causes, often occurring over decades. The lack of certain genes at birth isn’t a guarantee of a cancer-free life--or a free pass to skip the screening room.

* Practical screenings exist for some of the most killing cancers--but not all of them.

Health officials urge the public to get checked regularly for some of the more common cancers, including breast, cervical, colorectal, prostate, testicular, mouth and skin. Screenings for all these cancers have proved effective in detecting precancerous cells and tumors that have not yet produced obvious symptoms. Screenings for other types of cancer, including lung cancer--the second-leading cancer for men and women--are still undergoing testing and evaluation.

But some tumors have proven especially tough to crack from a screening standpoint. There are, for example, no good tests for brain tumors, leukemia, Hodgkin’s disease and ovarian, liver and pancreatic cancers. These cancers often are not detected until they produce apparent symptoms, a point at which the cancer may have progressed and where treatment can be less effective.

* You can’t depend on your doctor alone to monitor your cancer screening regimen.

One of the leading reasons people cite for not getting screened is that “their doctors didn’t tell them to get tested,” says Barbara Rimer, director of cancer control and population sciences at the NCI. Another is that people sometimes don’t go to their doctors often enough. And some who get annual physical exams don’t get the screenings they need.

Physicals Aren’t Always Enough

Just ask Ernest Carson, 60, a retired Defense Department analyst who lives in the District of Columbia. Two years ago, Carson had just received a clean bill of health from his annual physical when he saw a notice on television for free prostate cancer screening at Georgetown University’s Lombardi Cancer Center.

He hadn’t received prostate-specific antigen (PSA) test results after his physical, as he should have, so he went for the free screening. The results he received a week later showed an elevated PSA level of 10.1. Follow-up testing confirmed that he had early-stage prostate cancer.

“It was like a bombshell,” Carson says. “I thought I was the picture of health. I had no symptoms.”

Carson had surgery and regularly undergoes testing for recurrences. He now has a clean bill of health. But he switched doctors and remains vigilant about keeping track of screenings himself. “I am 60 years old now and living the life,” he says. “But I realized how important it is to have everything checked regularly.”

Some of the screenings that often are not performed include mammograms (which require special X-ray equipment and generally aren’t done in the doctor’s office) and Pap smears for detecting cervical cancer. (Internists and family physicians can do a Papanicolaou smear, but many leave it up to women to arrange these tests with their gynecologists.) Clinical breast exams--a thorough 10-minute check of the breasts--are also usually left to the gynecologist rather than to an internist. Many doctors don’t routinely examine the skin, which involves looking from the scalp to the toes. This should be done to check for abnormal moles--a sign of melanoma, the deadliest skin cancer--and to screen for the less-deadly basal cell or squamous cell skin cancers.

Another big gap in screening: fecal occult blood tests (FOBT) for colorectal cancer. This low-tech, simple and inexpensive test is distributed by the doctor for patients to perform at home. It requires following a special diet for a few days, then sampling tiny amounts of stool from several separate bowel movements, placing them on a card and sending it by mail to a laboratory for analysis. If it’s positive, further testing is recommended to rule out colorectal cancer.

A study recently published in the New England Journal of Medicine found that annual and even biennial testing “significantly reduces the incidence of colorectal cancer.”

* Screening is of considerable value to those under 50.

It’s true that 80% of cancer is diagnosed in people 55 years old and older, according to the American Cancer Society. But the disease often takes years to develop, and most cancers are more successfully treated in their earlier stages. Those who are screened earlier stand to gain the most from early detection. Exactly when that screening should start depends on your family history, race, ethnicity and current health status. (The accompanying stories include this information for each screening procedure.)

Specific Groups Have Unique Risks

Certain groups are at increased risk for cancer, which makes earlier screening very important. African American men, for example, face a higher risk of prostate cancer, which is why cancer groups recommend that they begin screening at age 40. At Georgetown University Hospital, urology chief John Lynch sees enough men in their 30s and 40s with prostate cancer that he advises all his patients to get an initial PSA test at about age 40. “If it’s low, then you can repeat it every five years or so until age 50, when you do it every year,” he says. (Though prostate cancer does occur in some men in their 30s, it is rare enough that cancer groups do not recommend widespread screening at that age.)

Some experts also recommend that people with a family history of breast or colorectal cancer begin cancer screening roughly 10 years earlier than the age at which their relative was diagnosed. So, if your mother was diagnosed with breast cancer at age 45, you ought to begin screening at 35.

It was just that kind of early screening that alerted Raye Farr, then 49, to early colorectal cancer. Farr’s father died of colorectal cancer at 67. During a routine physical, her doctor gave her an FOBT card. While she often discarded the tests, this time she completed it and sent it in.

“I still don’t know why,” says Farr, director of film and video at the U.S. Holocaust Memorial Museum.

The results were positive, which led to a colonoscopy. During that procedure, doctors found two malignant polyps. Farr then underwent surgery to remove 18 inches of her colon. She has been cancer-free for the last eight years.

“I sure urge people to go and get screened,” Farr says. “Just do it. I sure feel, ‘Boy, wouldn’t I be in a different place if that [screening] had not happened?’ I think how terrible it could be.”

* Most cancer screenings aren’t unpleasant, and they are only rarely painful.

People often fear the discomfort of cancer screening, but studies point to little pain during or after the procedures. More important, understanding the procedure and the purpose of the tests seems to help minimize discomfort. For example, only a small percentage of women complain about discomfort during a mammogram, when the breasts must be compressed to capture an X-ray image.

“We can’t predict who will have tenderness, but the compression lasts just seconds, and it should never be to the point of pain,” says Rebecca Zuurbier, director of the Betty Lou Ourisman Breast Health Center at Georgetown University Hospital. And studies show that women who are taught why compression of the breast is important for accuracy during a mammogram “tolerated that compression better,” says NCI’s Rimer.

Most cancer screenings require no preparation. Colorectal cancer screening is one exception. Colonoscopy needs the most pretest preparation (a couple days of special diet, plus consumption of a body-flushing liquid named “Golytely”). The test itself may cause some discomfort but is rarely painful, as the “Today” show’s Katie Couric demonstrated by undergoing the procedure on national television last year.

Benefits Aren’t Merely Academic

* Screening can extend your life, not just identify cancers.

An estimated 1.2 million people in the United States were diagnosed with cancer last year, and 552,200 died of the disease. Up to a third of deaths could have been avoided through cancer screening, according to the NCI.

The biggest success story in cancer screening? Cervical cancer, thanks to Pap smears, the screening that enables doctors to sample small amounts of cervical cells and screen for abnormalities.

“Cervical cancer was the No. 1 cancer killer of women in the first part of the 1900s,” says Diane Solomon, project director of a large NCI clinical trial comparing efficacy and cost-effectiveness of early detection of cervical cancer. “Now we have a 70% decrease in mortality that is largely attributable to cervical cancer screening” with Pap smears.

Though it has not matched the success of screening for cervical cancer, FOBT has the potential to cut colorectal cancer deaths by up to 30%, according to the latest findings. Even breast cancer death rates have recently started to decline, a reflection, experts say, of the increased use of mammography. More than 85% of women 40 and older have had a mammogram, according to the federal government’s Behavioral Risk Factor Surveillance System--an increase from the 82% reported in 1995.

The jury is still out on whether other screenings, including those for lung cancer and prostate cancer, reduce deaths. But there’s no question that screenings can find tumors earlier, when treatment may be more successful.

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For more information, go to the Harvard School of Public Health’s Web site at https://www.yourcancerrisk.harvard.edu. The questionnaires can help you find out more about your odds of developing various types of cancer--and what you can do to help reduce your risk. Remember that a low risk does not mean no risk--and that you should still abide by screening protocols.

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The President’s Cancer Panel, which reports to the president of the United States, will meet at USC on Thursday and Friday to discuss disparities in cancer care. The public is invited to the hearings (9 a.m.-4 p.m.) and to a town meeting (Thursday, 7:30-9 p.m.). Call (800) 4-CANCER or go to https://www.pcpmeetings.org.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Yearly Statistics on Key Cancers

Breast Cancer:

New cases per year: 193,700

Deaths per year: 40,600

Cervical Cancer:

New cases per year: 12,900

Deaths per year: 4,400

Colorectal Cancer:

New cases per year: 135,400

Deaths per year: 56,700

Prostate Cancer:

New cases per year: 198,100

Deaths per year: 31,500

Skin Cancer:

Melanoma per year: 47,700

Basal per year: 800,000

Squamous per year: 100,000

Deaths per year: 10,000

More information about these types of cancer and how to screen for them is on S4.