October is Breast Cancer Awareness Month. It’s hard to miss that fact if you’re one of the millions of Americans who watches the NFL (pink socks, pink shoes, pink hair, pink, pink, pink!). Aside from being a brilliant marketing strategy, putting mammograms and self breast exams into the common vernacular has stabilized breast cancer rates and potentially produced a slow decline in the number of women who succumb to breast cancer. But mammograms and self-breast exams aren’t the only way to prevent cancer; screening and prevention programs are available for other cancers as well.
The United States Preventive Services Task Force convenienes panels of experts to periodically review the scientific literature in order to publish a list of all the recommended health maintenance activities — these are the things that we, as primary care providers, should offer you to keep you healthy by finding little problems before they become big problems. We don’t have a screening program for every type of cancer, but that doesn’t mean you can’t still be proactive about your health in general. So many aspects of your life can be adjusted to reduce your overall risk for cancer:
- Don’t smoke.
- If you drink alcohol, do so in moderation.
- Avoid exposures to environmental toxins (like asbestos and certain chemicals).
- Exercise regularly.
- Maintain a healthy weight.
- Reduce stress.
- Eat a diet based on fruits, vegetables, and whole grains. (Note: multivitamins haven’t been shown to help in prevention of cancer.)
- Use sun protection.
- Get vaccines — both the Hep B and HPV vaccines can prevent cancer.
Beyond these “just be healthy!” recommendations, I’ve gone ahead and listed the specific USPSTF screening recommendations by sex and age here.
EVERYBODY
- Age 50 +: For a good number of people, it’s recommended that you take a daily 81mg aspirin to reduce your risk of colorectal cancer.
- Age 50 – 75: screening for colorectal cancer is recommended. There are several different ways to do this, and it doesn’t’ always mean getting a colonoscopy. We offer the annual FIT testing at KCDPC for $10 per kit.
- Age 75+: there isn’t good evidence to recommend colon cancer screening past the age of 75 at this point. Stay tuned!
- Age 55-80 who also have a 30 pack-year history of smoking and have smoked regularly in the last 15 years: This one is a little wordy, but boils down to this: If you’re 55 to 80 years old and have smoked at least a pack a day for 30 years and have quit within the last 15 years (or are still smoking), the USPSTF recommends low-dose CT scan of the lungs every year. We can arrange for this study to be done at a number of independent radiology facilities for around $100, and if that’s too pricey, let us help you quit smoking (if you haven’t) so you can save up for the scan :).
Pancreatic cancer – The CDC recommends against screening for pancreatic cancer with studies like ultrasound, labs, radiology, or deep physical exam — we end up causing more harm than good.
Skin Cancer – it is so, so, so important for people — especially those under the age of 25 — to adequately protect their skin from the sun’s harmful rays. Everyone should be aware of their “normal” moles and freckles and the ABCDE warning signs for scary ones. For those at higher risk, an annual skin exam may be beneficial, but there’s no body of evidence suggesting the annual skin exam is helpful.
WOMEN
Breast Cancer – This process has changed some over the years, and those changes have inspired robust conversation about the subject. I’ve included the entirety of the USPSTF recommendation below, but the basics are: before age 50, it’s a gray area; from age 50 – 74, we recommend screening every 2 years and stopping at age 75 (but this all gets tossed out if you have a strong family history of the disease or are BRCA+). Additionally, though many radiological offices offer 3D mammography, the evidence hasn’t (yet) borne out their superiority.
- Age 40-49: This one is the “gray zone” and is based on a discussion with your doctor weighing the risks and benefits of starting screening at an earlier age. From the USPSTF: “While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger. The balance of benefits and harms is likely to improve as women move from their early to late 40s. In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as “overdiagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment…Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.” Essentially, “Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.”
- Age 50-74: The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
- Age 75+: There’s not enough good evidence to support for or against mammograms in women over the age of 75.
- Any age with a family history of breast cancer: “Screen women who have family members with breast, ovarian, tubal, or peritoneal cancer…Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.”
- Younger than 21: no screening.
- Age 21 – 29: Pap smear every 3 years
- Age 30 – 65: Pap smear every 3 years or screening with a Pap smear along with HPV testing every 5 years.
- Age 65+: no need for Pap smears for those who are not high risk.
- Women who have had a hysterectomy: no Pap smear unless the cervix remains and/or a personal history of cervical cancer (i.e CIN grade 2-3)
Ovarian Cancer – The USPSTF recommends against screening asymptomatic women at low risk for ovarian cancer. Talk to your doctor if you feel like you’re at increased risk (i.e. immediate family members with ovarian cancer or a personal or family history of being BRCA+ )
MEN
Prostate Cancer – The current recommendation is against routine prostate cancer screening. There’s no evidence that getting a PSA blood test leads to prevention of lethal cases of prostate cancer, and there really aren’t any good studies that a prostate exam during physical exam is helpful either (meaning, there’s no evidence to point (haha!) one way or the other). That said, like any screening recommendation, talk to you doctor if you have questions.
Testicular Cancer – This one also falls into the category where the USPSTF recommends against routinely screening asymptomatic men, but here’s why: greater than 90% of all testicular cancers are curable, no matter if they’re found early or late. Us doing routine screening doesn’t change that, so why create undue anxiety and unnecessary testing?
Cancers not explicitly listed don’t have enough evidence to support or recommend against screening asymptomatic patients (i.e. bladder cancer, oral cancer, leukemia, thyroid cancer, etc. fall into this category). Updated 1 October 2017.