The American Cancer Society estimates that nearly 2 million Americans will be diagnosed with cancer in 2023. However, data has shown that the earlier cancer is detected and treated, the better the patient’s odds are of beating the disease and continuing to live healthy, fulfilling lives.
Routine cancer screening is an effective way of detecting certain common cancers earlier and saving lives, but understanding guidelines can be confusing. David Macomber, MD, an internal medicine physician with University of Minnesota Physicians (M Physicians), says that there is no one size fits all equation.
Breast cancer screening consists of mammograms, although other tests may be ordered depending on findings. Dr. Macomber says that breast cancer screening is perhaps the most controversial in terms of when it should start, but the most recent guidelines recommend that women should receive regular mammograms starting at age 40. Especially for patients with a family history of breast cancer, your doctor might recommend screening earlier.
“I find that women come to screening for breast cancer with a little more knowledge. That is, they have family members who have had it, and they have an opinion on when they would like to start screening,” says Dr. Macomber.
Genetic testing helps women to better understand their risk and work with their primary care providers to come up with a plan that fits their unique situation.
Another potentially controversial screening is the prostate-specific antigen (PSA) test, which measures the amount of PSA in the blood to detect prostate cancer in men.
“These guidelines are all over the place,” Dr. Macomber says. “Some say 50, some say 55, some say you have to have a discussion before recommending screening.”
Prostate cancer is the second most dangerous cancer for men, and Dr. Macomber says that an individual discussion with your doctor is important. Annual blood tests are recommended for patients who choose to receive prostate cancer screening.
All adults should receive a colonoscopy when they’re 45, unless they have a strong family history, in which case screening might be beneficial earlier. Unlike other cancer screenings, studies have shown that colonoscopies can actually prevent colorectal cancer. This is because colorectal cancer begins as small, benign clumps of cells that form on the lining of the colon called polyps.
“There’s several different kinds of polyps, but one kind could transform into colon cancer, and it typically takes anywhere from three to ten years,” Dr. Macomber elaborates.
If a polyp is found during a colonoscopy, it is removed, significantly reducing the chance that it could develop into cancer. For this reason, most adults will only need to receive a colonoscopy every ten years.
Screening for cervical cancer begins sooner than other screenings, with females recommended to begin Pap smears at age 21. A Pap smear collects cells from the surface of the cervix to look for irregularities, which may become cervical cancer if not treated properly.
Pap smears are recommended every three years between the ages of 21-29, and every five years after that. Additionally, human papillomavirus (HPV) testing is recommended every five years and can be performed at the same time as a Pap smear. This test screens for high-risk HPV variants that could cause pre-cancers in the cervix.
When Can I Stop Screening?
Most cancer screenings recommend a cutoff of age 75, but Dr. Macomber says that when a patient stops cancer screenings should be an extremely personalized decision.
“The thought is we stop screening when it no longer would make a difference in their outcomes,” he explains. “But that’s very tricky because I have a number of patients that are very healthy, and we go outside the guidelines.”
If a patient is very healthy and active at 75, Dr. Macomber says that continuing cancer screening may still extend their life. On the other hand, a patient with advanced heart disease may not see any benefit to their life expectancy by continuing screening.
“Each patient is unique in their risk factors, their preferences and how we handle it,” Dr. Macomber says. “We like to think one size fits all, but it really doesn’t.”
Putting it All Together
Dr. Macomber emphasizes that nearly everything about cancer screening, from when a patient begins to the age they stop screening, depends on the individual. Guidelines can help patients make decisions, but ongoing conversations with their providers are most important.
Dr. Macomber concludes, “It’s an individual discussion and a clinical judgment.”