August 16 is National Cancer Screening Day for breast, cervical and colorectal cancer. Sponsored by a grant from the Wellpoint Foundation to the American Cancer Society
(ACS), the day is an effort to increase awareness and education for breast, cervical and colorectal cancers, with the goal of offering free cancer screenings to underserved populations.
Breast cancer screening
Cancer screening can help detect cancer at an early stage, often before symptoms present — the stage at which it is most curable. Cancer screening should be routine for everyone. The ACS recommends regular screening for three cancers: breast, cervical and colorectal. We asked City of Hope experts in those three cancers to weigh in on the ACS’s latest screening recommendations for those malignancies.
- Breast cancer (ACS guidelines): The ACS has changed its guidelines for mammograms a few times in the last several years, leading to much confusion. In 2018, they stated that women should start getting the scans annually at age 45, unless they choose to start annual breast cancer screening with mammograms starting at age 40 “if they wish to do so.” They should receive them biennially after age 55, “or they can continue yearly screening.”
Veronica Jones, M.D.
, breast cancer surgeon and assistant clinical professor in the Division of Breast Surgery
of the Department of Surgery
at City of Hope, says: “I would stress that these guidelines are only for the average risk individual, and every woman should meet with her physician to determine what her actual risk is and how the guidelines should be tailored to her to ensure she has the best screening possible (given her family history and personal factors). The vast majority of my patients (I would say greater than 95%) do not qualify for the 'average risk' category and therefore, these guidelines do not apply to them.”
- Cervical cancer (ACS guidelines): Screening should start at age 21. Women between 21 and 29 should have a Pap test done every three years. Women between 30 and 65 should have a Pap test plus an HPV test done every five years. Women over age 65 who have had regular cervical cancer testing in the past 10 years with normal results should not be tested.
City of Hope’s Thanh Dellinger, M.D.
, gynecologic oncology surgeon and assistant professor in the Division of Gynecologic Oncology
in the Department of Surgery, weighs in: “The ACS recommendations were changed in an effort to reduce public health costs associated with cervical dysplasia, and should apply only to women with normal immune systems. At City of Hope, due to its large cancer patient and especially large bone marrow transplant population, these guidelines are often modified to suit the needs of immunosuppressed patients following transplants and chemotherapy (with more frequent screening).
"Additionally, since cervical cancer and dysplasia are primarily caused by HPV, which is a sexually transmitted disease, caution should be used in stopping screening in patients over the age of 65, who may start new sexual relationships, and therefore be exposed to a new HPV subtypes. In my practice, I therefore do not stop screening at age 65 if the patient has new sexual partners.”
- Colon and rectal cancer (ACS guidelines): For people at average risk of colorectal cancer, screening via either a stool-based test or a visual exam (colonoscopy) should start at age 45 and continue through age 75.
Trilokesh Kidambi, M.D.
and assistant clinical professor in the Division of Gastroenterology
of the Department of Medicine, shares his thoughts: “There has been an alarming rise in the incidence of early-onset colon cancer in our patients under the age of 50. This epidemiological phenomenon initially was described in our patients here in the United States, and subsequent studies have shown the same trends in Europe, which suggests that the trend is real and not just a statistical anomaly. Many of these patients are presenting with advanced, metastatic disease with limited treatment options.
"As a result, the American Cancer Society re-ran their mathematical models to account for an increased burden of disease in the younger population (which other groups such as the U.S. Preventive Task Force have not), and the results were that it was effective to commence screening earlier in order to detect and potentially prevent colorectal cancer. I have a discussion with each of my patients to explain the risks and benefits of screening earlier, and individualize the decision based on the patient. From a nationwide health care perspective, it is yet to be determined whether earlier screening is cost effective, but for many of the patients, it is the right decision.”
Men are advised to discuss the pros and cons of prostate cancer screening
with their doctors. Screening for skin, ovarian, pancreatic, testicular and thyroid cancers has not been shown to reduce deaths from those cancers.
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