Everyone, at some point, is touched by cancer. We all know someone who has battled cancer – a friend, a family member, a coworker. Maybe you have had cancer yourself. Perhaps, sadly, we knew someone who lost their battle with cancer.
People get cancer – and die from it – all too often. In 2020, the most recent year for which data is available, there were more than 1.6 million new cancer cases reported, while more than 600,000 Americans died of cancer.
These sobering statistics speak to the need for diagnostic cancer screenings whenever possible. Early detection of cancer is one of the best ways to beat it. Too often, cancer is not diagnosed until the disease has progressed, making treatment more difficult and reducing the chance of success.
While screenings are not available for every type of cancer, they are for some of the most common. What’s more, advances in genetic testing have made it possible to detect certain genetic characteristics that may point to a greater likelihood of getting cancer in the future. There are pros and cons to these kinds of tests, but they may help some people make more informed decisions about their health.
Schedule your comprehensive cancer screening today with our experienced oncologists at Texas Health Care. Our screening services cover a range of cancers, including breast, lung, colorectal, and prostate cancer. With multiple convenient locations across Texas, taking care of your health has never been easier. Book an appointment by visiting our provider page.
Part 1: Recommended Cancer Screenings
Cancer screenings are recommended based on age, gender and health history. Note that these are general guidelines that will be appropriate for most people. However, your physician may recommend a modified screening schedule based upon your medical history.
Breast Cancer Screening (Mammography and Clinical Breast Exams)
Breast cancer is the most common cancer to affect women, apart from skin cancers. It is the second-most deadly cancer for women. One out of eight women will be diagnosed with breast cancer at some point in her life. Early detection is the key to beating breast cancer.
Screening Guidelines:
- Women ages 25-39 should have a clinical breast exam every 1-3 years.
- Women ages 40 and older should have a clinical breast exam every year.
- Women ages 40-49 who have a normal risk of breast cancer should have a mammogram every year or every other year.
- All women ages 50 and older should have a mammogram every year or two years.
- Screening should continue until at least age 75.
What Is It?
- A clinical breast exam is conducted by your physician during a check-up. The doctor examines the breasts for changes in size, shape and appearance.
- A mammogram is an x-ray image of the breast. The radiologist uses the image to identify any abnormalities that may be of concern.
Why Is It Important?
“Clinical breast exams and mammograms are the keys to early detection of breast cancer. We have made tremendous strides in helping women beat breast cancer, and early detection leads to more effective treatment. The bottom line: breast cancer screenings save lives.” – Dr. Alice Fa, an obstetrician and gynecologist in Frisco.
Guideline Source: The American Congress of Obstetricians and Gynecologists
Cervical Cancer Screening (Pap Test, Pelvic Exam & HPV screening)
Cervical cancer is most often seen in women over age 30. It is highly treatable when detected early. A lot of progress has been made in the fight against both cervical cancer and its main cause, the human papillomavirus (HPV). Decades ago, cervical cancer was the leading cause of cancer death for American women. Fortunately, thanks to regular screening and other medical advances, that is no longer the case.
Screening Guidelines:
- Women ages 21-29 should have a Pap test every three years.
- Women ages 30-65 have options for regular testing:
- A Pap test and human papillomavirus (HPV) test every five years or
- A Pap test alone every three years and
- An HPV test alone every five years
What Is It?
- Generally provided as part of a well-woman exam, the doctor conducts a visual internal and external examination of the pelvic area. The Pap test is done by taking a sample of cells from the cervix. The entire exam only takes a few minutes.
Why Is It Important?
- The Pap test is used to detect cervical cancer, as well as cellular changes that may eventually lead to cancer. By detecting these changes early, physicians can treat or even prevent cancer from occurring in the first place.
- HPV is often harmless, however it can also lead to cervical and other cancers. Parents should ensure their teenagers – girls and boys – receive the HPV vaccine to reduce the chance of cervical, head and neck cancers later in life.
Guideline Source: The American Congress of Obstetricians and Gynecologists
Colorectal Cancer Screening (Colonoscopy)
Colorectal cancer, cancer of the colon or rectum, is the fourth-most diagnosed non-skin cancer in the country. Among cancers that affect both men and women, it is the second deadliest.
Screening Guidelines:
- For healthy adults, colorectal screening should begin at age 45.
- If there are no abnormal results, repeat test once every ten years until age 75
What Is It?
- During a colonoscopy, the patient is sedated. The physician then passes the colonoscope – a thin, flexible tube with a high-definition camera attached – into the colon to examine all surfaces. When precancerous polyps are spotted, they can be removed during the procedure. Suspicious polyps will be tested for cancer. The exam typically lasts about 30 minutes.
- The day prior to the colonoscopy, the patient drinks a clear liquid diet and undergoes a special bowel preparation that has been prescribed by your doctor. The purpose of this prep is to thoroughly empty the colon, allowing the doctor to have a clear view of the surfaces of the colon during the exam.
- A stool test can also be used for screening, but it is less accurate than a colonoscopy and cannot detect or remove polyps.
Why Is It Important?
“Nine out of ten cases of colon cancer that are caught in the early stages are curable. The colonoscopy also allows us to spot precancerous polyps and remove them during the screening, before they ever become cancerous.” – Dr. Eduardo Castillo, a colon/rectal surgeon in Fort Worth.
Guideline Source: The American Cancer Society
Part II: Optional Screenings
Additional screenings may be appropriate for certain people. These include:
Lung Cancer Screening
Lung cancer is the deadliest form of cancer. It is often associated with smoking, yet people who have never smoked sometimes get lung cancer.
Screening Guidelines:
- People ages 50-80 who have a 20-pack year smoking history and
- Currently smoke or
- Have quit smoking within the last 15 years
- A “pack year” refers to smoking an average of one pack of cigarettes a day for one year. In other words, a 20-pack year smoking history could be someone who smoked a pack a day for 20 years or two packs a day for 10 years.
What Is It?
- A low-dose CT scan of your chest
Additional information:
- The United States Preventive Services Taskforce (USPSTF), an independent board of medical professionals and scientists, recommends this screening for current and former smokers with a 20-pack year history.
- People who fit the criteria for lung cancer screening should discuss the pros and cons with their doctor. Downsides of this screening include a false positive – a test that indicates cancer when none is present, as well as detection of a cancer that ultimately will not cause a problem for the patient, a situation known as overdiagnosis. And, while this CT scan is low-dose, the patient is still exposed to additional radiation.
Guideline Source: United States Preventive Services Taskforce
PSA Test (Prostate Cancer Screening)
Cancer of the prostate is the second-most common cancer that affects men, after skin cancer. Many prostate cancers are slow-growing and may never result in serious health concerns. However, some are more aggressive and can lead to significant problems.
Screening for prostate cancer is challenging. The prostate-specific antigen (PSA) blood test may detect prostate cancer, but it also has downsides. A low level of PSA in the blood indicates a healthy prostate, while an elevated level could indicate cancer. However, an elevated level may also be indicative of an unrelated issue.
Screening Guidelines:
The USPSTF provides the following guidance:
- Men ages 55-69 should make individual decisions about whether or not to have a PSA test
- Before making that decision, men should consult with their physician about the pros and cons of PSA testing and other forms of tests and treatment if cancer is suspected
- Men over 70 should not be routinely screened for prostate cancer
What Is It?
- A simple blood test
Additional information:
- The only way to diagnose prostate cancer is to conduct a biopsy of the prostate. An elevated PSA test may indicate cancer – but it may also lead to an unnecessary biopsy that determines there is no cancer present.
“Men 55 and older should discuss the benefits and risks of prostate cancer screening with their health care provider and, taking into account medical history and other factors, make a decision together as to whether or not a PSA test is in order.” – Dr. Daniel Kutzler, an internal medicine physician in Fort Worth.
Guideline Source: United States Preventive Services Taskforce
Part III: Genetic Testing
Sometimes, cancer is caused by a biological trait that we inherited. For example, someone may have a genetic mutation that changes our body’s ability to produce certain beneficial proteins, causing healthy cells to become cancerous. Genetic mutations are thought to cause between 5% and 12% of all cancers.
Advances in science have made it possible to screen people for certain genetic variations that indicate elevated risk of certain cancers. These tests have become increasingly mainstream. Just last year, the Food & Drug Administration (FDA) granted marketing authorization (permission to advertise) for the Invitae Common Hereditary Cancers Panel, a blood test that looks for mutations in 47 genes that have been linked to cancer.
These DNA tests may be a good idea for some people, but it’s important to understand all the implications of testing. That’s why the first step in the genetic screening process is to work with a trained genetic counselor. These professionals can review your family history of cancer, help you decide if testing is warranted, discuss the pros and cons of testing, explain the expenses involved, as well as review the medical decisions that might eventually result from your test.
Advantages of Genetic Testing
There are several advantages to genetic screening for cancer. If the screening does not reveal any hereditary mutations, this may create additional peace of mind and eliminate some degree of worry and stress.
If the test does reveal a genetic mutation linked to cancer, the patient, in coordination with medical care teams, can modify health care screenings. For example, if there are mutations in the BCRA1 or BCRA2 genes, this may be a reason to begin mammography screening sooner and do it more frequently. Similarly, an indication of Lynch syndrome, which is linked to colorectal cancer, would suggest colonoscopies should begin before age 45. These scenarios would be especially true if the patient has a family history of these cancers.
In addition, health care providers may recommend considering medications or even risk-reducing surgery, such as a mastectomy, to further reduce risk of a future cancer diagnosis.
Drawbacks of Genetic Testing
There are downsides to genetic testing, as well. A screening that does not reveal a hereditary predisposition to cancer may create a false sense of security, especially when so many other factors can cause cancer.
Conversely, a screening that reveals a genetic mutation may lead to over-treatment. The presence of a mutation does not automatically mean that a cancer diagnosis is inevitable. A positive result on screening may lead to unnecessary treatments and added stress and worry.
Cancers Sometimes Caused by Genetic Mutations
Several cancers may be caused by genetic mutations. These include:
Breast and Ovarian Cancers
Mutations of the BCRA1 and BCRA1 genes are known to substantially increase risk for both breast and ovarian cancers. When working as intended, both of these genes produce proteins that repair damaged DNA – this is why they are known as “tumor suppressor” genes. Mutations to either the BCRA1 or BCRA2 genes may limit your body’s self-defense against damaged cells that could lead to cancer.
We have two of each of these genes: one from each parent. A genetic mutation can be passed down from the father or mother. If a parent has a mutation, each of their children has a 50% chance of inheriting it.
While there is no guarantee that someone with a BCRA 1 or BCRA2 mutation will develop cancer, there is no question that the odds are significantly increased, according to data from the National Cancer Institute. Among all women, about 13% will get breast cancer at some point. For women who have a mutation in a BCRA1 gene, 55% – 72% will develop breast cancer by ages 70 – 80. Among women with a variant in a BCRA2 gene, 45% – 69% will develop cancer.
Similarly, ovarian cancer impacts 1.2% of all women. But for women with a variant in the BCRA1 gene, risk goes up substantially: 39% – 44% will develop ovarian cancer. BCRA2 variations also elevate risk, with 11% – 17% eventually getting ovarian cancer.
Other Cancers
Lynch Syndrome, an inherited condition that occurs when one of the genes responsible for repairing our DNA mutates, has been shown to increase risk of colorectal cancer.
Genetic mutations can increase likelihood of several additional cancers, including uterine, pancreatic, stomach, thyroid, prostate and kidney.
Of course, usually these cancers are caused by something other than genetics. In addition, it is possible to have a genetic mutation yet never actually get cancer.
“Genetic screening is a useful tool in some instances, depending on your family history and personal health history. Visit with your primary care provider to discuss if genetic screening makes sense for you.” – Dr. Dorris Morrissette, an internal medicine physician in Fort Worth.
Cancer Screenings Save Lives
For many cancers, screening and early detection provides the best defense against cancer. The earlier it is detected, the better your chances of defeating it with treatment. Make sure you are current on your recommended cancer screenings, such as breast, cervical and colon cancers. And if you think you could benefit from additional cancer screenings, including genetic screenings, visit with your primary care provider.
At Texas Health Care, we understand the importance of early detection in fighting cancer. Our experienced oncologists and cancer specialists offer comprehensive cancer screening services at multiple locations throughout Texas. Visit our provider page to schedule a cancer screening with one of our dedicated physicians and take a proactive step towards your health.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
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