An Ounce of Prevention: A Guide to Cancer Screening and Detection
Risk factors:
* Age; more than 75% of cases diagnosed in men 65 and older
* Being African American, a group that has one of the highest prostate cancer rates in the world
* Having a close family member with prostate cancer
Warning signs:
Frequent urination; inability to begin urinating; feeling of not being finished after urinating; back pain.
Self-screening frequency:
None.
Frequency of screening tests by doctor:
Prostate-Specific Antigen (PSA) blood test and digital rectal exam--Annually, beginning at age 50; African Americans and those with a family history of prostate cancer should begin annual screening at 45 or earlier, as directed by doctor. (For those with a family history of prostate cancer, screening may begin 10 years before the age at which the affected relative was diagnosed.)
What the future holds:
More sophisticated techniques to identify other tumor markers in the blood, reduce false-positive test results and improve accuracy of tests.
Notes:
The jury is still out on whether prostate screening saves lives, but it does detect disease at an earlier stage. Transrectal ultrasound, using high-frequency sound waves that help detect possibly malignant prostate abnormalities, can also be used in screening. Cost: $10 to $20 for PSA; $250 for transrectal ultrasound.
More info:
* Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/prostate/prostate.htm.
* CaP CURE, Assn. for the Cure of Cancer of the Prostate: https://www.capcure.org; (800) 757-CURE; 1250 4th St., Suite 360, Santa Monica, CA 90401.
* American Urological Assn.: https://www.auanet.org
Cancer Type: Breast
Risk factors:
* Age (risk increases as you get older)
* Family history of breast cancer in mother or sister
* Early puberty (under 10) or late menopause (55 and older)
* Obesity post-menopause; recent use of oral contraceptives or hormone replacement therapy
* Never had children or first child born after age 30
* Consumption of two or more alcoholic drinks per day
* Breast biopsy showing abnormal cells (hyperplasia)
Warning signs:
Lump detectable by touch; thickening tissue; clear or bloody spontaneous discharge from the nipple.
Self-screening frequency:
Breast self-exam--For ages 20-39 years, conduct monthly a few days after menstrual bleeding stops. For ages 40 and older, conduct monthly or more often.
Frequency of screening tests by doctor:
Clinical breast exam--Ages 20-39, every three years; after 40, annually.
Mammogram--Annually, beginning at age 40. Those with a family history of breast cancer should initiate screening 10 years before the age at which the affected relative’s disease was diagnosed.
What the future holds:
* Magnetic resonance imaging--uses no radiation; could be used to screen all women; of particular value for 35 and younger; requires intravenous dye; being tested in clinical trials of high-risk women.
* High-resolution ultrasound--Noninvasive; uses only sound waves; undergoing testing in high-risk women.
* Infrared testing--Looks for tumor cells; in development.
* Laser testing--Measures blood oxygen; in development.
Notes:
Breast self-exams are recommended by many cancer groups but must be coupled with regular mammograms and clinical breast exams to reduce breast cancer deaths. Mammograms cost about $100 and are usually covered by health insurance. (Medicare covers testing after age 40.) Mammograms have not been proved to reduce deaths in women over 69.
More info:
* National Cancer Institute: https://www.nci.nih.gov; (800) 4-CANCER.
* National Alliance of Breast Cancer Organizations: https://www.nabco.org; (212) 889-0606; 9 E. 37th St., New York, NY 10016.
* American Cancer Society: https://www.cancer.org; (800) ACS-2345.
* Breast Cancer Risk Assessment Tool, sponsored by the National Cancer Institute: https://bcra.nci.nih.gov/brc/q1.htm.
Cancer Type: Colorectal
Risk factors:
* Personal or family history of colorectal polyps
* Family history of colorectal cancer
* Inflammatory bowel disease
* Smoking, alcohol consumption
* Physical inactivity
* High-fat and low-fiber diet
* Low intake of fruits and vegetables
Warning signs:
Blood in the stool; change in bowel habits or stool size; abdominal pain.
Self-screening frequency:
Fecal occult blood testing (FOBT)--Usually done at home; involves smearing small fecal sample on a card and sending to lab for detection of blood; annually beginning at 50.
Frequency of screening tests by doctor:
FOBT should be performed annually beginning at age 50 for those without colorectal cancer in immediate family. Flexible sigmoidoscopy every five years, colonoscopy every 10 years or double contrast barium enema (DCBE) every five years.
FOBT and DCBE annually or at doctor’s discretion beginning as young as 40 for those with a family history; other tests every five to 10 years. People with irritable bowel may need different screening schedule.
What the future holds:
Virtual colonoscopy--Uses electron beam tomography; minimally invasive but requires the same pretest restricted diet and body-flushing regimen as colonoscopy; unlike in standard colonoscopy, doctors can’t remove suspicious lesions for biopsy; recently approved by Food and Drug Administration.
Notes:
Studies suggest that colonoscopy is more effective at screening than the double contrast barium enema or sigmoidoscopy. Cost: $750 to $1,000 for colonoscopy; $250 for sigmoidoscopy; about $325 for barium enema. Health insurance may not cover colonoscopy, unless a polyp or other problem is found.
More info:
Cancer Research Foundation of America: https://www.preventcancer.org/colorectal/; (800) 227-CRFA; 1600 Duke St., Suite 110, Alexandria, VA 22314.
Cancer Type: Cervical
Risk factors:
* Sexual intercourse begun at early age
* Multiple sexual partners
* Infection with certain strains of human papilloma virus (HPV)
* Cigarette smoking
Warning signs:
Abnormal vaginal bleeding or spotting; abnormal discharge.
Self-screening frequency:
None.
Frequency of screening tests by doctor:
Cancer Type: Skin
Risk factors:
* Excessive exposure to sun or other ultraviolet radiation, such as tanning booths
* Fair complexion
* Occupational exposure to coal tar, pitch, creosote, arsenic compounds or radium
* Family history of skin cancer
* Numerous or atypical moles
Warning signs:
Open sore that bleeds, oozes or crusts for two to three weeks; reddish patch that crusts; pink growths; shiny bumps or nodules; recent elevation of existing mole. In moles, look for asymmetry; border irregularities; color (shades of black and brown, possibly with white, red or blue); diameter (melanomas are usually larger than a pencil eraser).
Self-screening frequency:
Check skin and scalp while standing naked in front of a full-length mirror; perform annually.
Frequency of screening tests by doctor:
Skin checkup; done annually.
What the future holds:
Whole-body digital photography, analyzed by computer; now in use at some medical centers.
Notes:
Basal and squamous cell cancers are the most common types of malignancy; an estimated 1 in 4 people will develop them at some point. But they are among the most easily treated cancers. Melanoma, on the other hand, is among the most deadly.
More info:
* Skin Cancer Foundation: https://www.skincancer.org; (800) SKIN-490; P.O. Box 561, New York, NY 10156.
