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Cancer Screening

Many cancers, especially solid tumors, show signs or symptoms at the beginning. During this period, the only way to detect a cancer may be through screening. Since the chances of curing many cancers increases the earlier it is diagnosed, doctors recommend screening tests for certain cancers and for people at higher risk.

Screening tests are almost never definitive in themselves. A second test is generally required to confirm (or exclude) the diagnosis of cancer. This follow-up test should not be a repeat of the screening test, but should be a more specific test, meaning it's less likely to have false results than the screening test. Most confirmatory tests are tissue biopsies: a portion of tissue is taken and examined under the microscope to determine whether or not cancer is present.

Screening tests have been developed for some common cancers that have a long period of development before symptoms develop. The tests need to be accurate and acceptable to people in order for them to be an effective part of medical care. Unfortunately, all of these conditions are not always met. Examples include breast and ovarian cancer.

Breast Cancer Screening

Routine mammograms are recommended for all women starting at 45 years of age since the risk of cancer increases with age. As a screening test, mammograms are useful because they are relatively inexpensive to perform and are reasonably sensitive at finding masses too small to be detected by either you or your doctor.

However, mammograms are not specific. In fact, for a woman whose risk of breast cancer is low (those under age 50 with no family history), a positive mammogram is very unlikely to be cancer. It is for this reason that a mammogram, or any screening test for that matter, should never be relied upon to make the final diagnosis of cancer. A biopsy is always required.

Ovarian Cancer Screening

Unlike breast cancer, there is no effective screening test for ovarian cancer. A technique called a laparoscopy could be used for screening, but it is an invasive procedure. It is also impractical because of the risk and expense involved. Since ovarian cancer is relatively rare, this screening is not considered practical and is not widely used.

It turns out that there are only a handful of cancers for which useful screening tests exist: breast, cervical, prostate, colon, and rectal.

Screening Schedules

There is disagreement among medical groups regarding the appropriate timing and frequency for some of the screening tests.

Below are recommendations from the American Cancer Society (ACS) for routine cancer screening in people of average risk (same as the general population) for cancer. Other organizations may have different recommendations. People at higher risk, such as those with a family history or specific gene markers, should generally be screened earlier and more frequently. Speak with your doctor about the appropriate screening schedule for you.

Procedure

Frequency

Colon and rectal cancers (one of the following)

Fecal occult blood test

Yearly starting at age 50

Sigmoidoscopy with or without barium enema

Every 5 years starting at age 50

Double-contrast barium enema

Every 5 years starting at age 50

Colonoscopy

Every 10 years starting at age 50

Prostate Cancer

Talk with your doctor about the risks and benefits of the prostate-specific antigen (PSA) blood test with or without a digital rectal examination

Yearly starting at age 50—men at high risk should begin screening starting at age 45

Cervical Cancer

Pap test

Every 3 years for ages 21-29

Every 5 years for ages 30-65 if having both Pap test and the human papillomavirus (HPV) test (or continue to have the Pap test every 3 years if desired)

Women over age 65 with a history of normal test results may permanently stop cervical cancer screening

Breast Cancer

Breast self-examination (BSE)

Not recommended

Breast physical examination

Not recommended

Mammography

Yearly for ages 45-54

Every 2 years starting at age 55 and continue as long as overall health is good and life expectancy is at least 10 years

Women can choose to have yearly tests for ages 40-44 and continue yearly exams after age 55—talk to your doctor about the risks and benefits

Other Screening Tests

Other screening tests are available, but they have not been shown to reduce cancer deaths, unlike some recommended screening tests. Testing may be done for those who are in a high risk group, like someone with specific genetic markers or Barrett esophagus. Talk to your doctor about your risk and how often you may need to be tested.

Tests may include:

  • Blood tests—Blood tests help determine levels of specific proteins in the blood that are elevated in the presence of cancer. Examples include prostate-specific antigen (prostate), CA-125 (ovarian) or alpha-fetoprotein (liver).
  • Breast MRI scan and/or transvaginal ultrasound—Women who carry the genetic mutation BRCA1 or BRCA2 have a high risk of breast, ovarian, or uterine cancers. Regular testing may help detect abnormalities earlier.
  • Skin exams—May help detect abnormalities of the skin, such as changes in the color and shape of moles, which increases the chance of skin cancers (especially melanoma). This may be done yearly or at regular checkups. Your doctor may advise you to check your skin at home once a month.

Risks of Screening

As with all things, the potential benefits of cancer screening must be weighed against the potential harms. False-positive results, tests indicating the possibility of cancer when there is none, can create undue psychological stress. They can also lead to unnecessary invasive, expensive, and painful diagnostic tests. Even an accurate test may not always be in a person’s best interest. For example, prostate cancer often grows slowly. It may never harm elderly men before they die of natural causes. A positive test, though accurate, may compel someone to undergo an unnecessary, aggressive course of treatment to remove a tumor that would otherwise not have been a problem.

Screening tests can also produce false-negative results (the test fails to detect cancer that is actually present). A false-negative screening test may mistakenly reassure someone that they are free of cancer and need not pay close attention to early signs or symptoms.

A diagnosis of cancer must always be made with as much certainty as possible. For this reason, positive screening test results alone are not enough for a diagnosis. A biopsy is required to definitively diagnose cancer. To learn more about how cancer is diagnosed, see the cancer diagnosis section of this classroom.

Genetic Testing

Doctors use genetic tests to detect the presence of genetic mutations that may signal the presence or the risk of a disease or disorder. The genetic changes that are associated with specific cancers were determined by testing genes of people who have had that cancer and families who have a high risk of cancers.

A more recent innovation for genetic testing is its use in estimating the lifetime risk of developing certain cancers in adults. For example, women who carry 1 of 2 BRCA gene mutations have an 85% risk of developing breast cancer during their lifetime. This compares to a lifetime risk of approximately 12% in the general population. However, since this mutation only accounts for about 5% of breast cancers, it is not an appropriate screening test for the vast majority of women. It is however, an appropriate test for those who have a strong family history of breast cancer.

Despite the fact that more and more genetic screening tests for cancer risk are being developed and marketed, they are not without controversy. Questions remain about who should have access to genetic information and how this information should be used. If you have a strong family history of cancer, you may wish to speak with your doctor about the risks and benefits of genetic screening. To learn more about genetic mutations, see the cancer genetics section of Cancer 101.

What are the signs and symptoms of cancer?How is cancer diagnosed?What is staging and grading?How is cancer treated?Can cancer be prevented?What are some other cancer resources I can use?

Revision Information

  • American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. American Cancer Society website. Available at: http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs. Updated October 20, 2015. Accessed November 3, 2015.

  • Cancer screening overview. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/screening/overview/HealthProfessional. Updated July 17, 2015. Accessed January 5, 2015.

  • Saslow D, Soloman D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172.

  • Understanding medical tests and test results. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/special-subjects/clinical-decision-making/understanding-medical-tests-and-test-results. Updated July 2015. Accessed January 5, 2016.