Prevention & Early Detection
Even the most conscientious efforts to prevent cancer through a healthy lifestyle cannot guarantee that the disease will not occur.
Regular screenings for some of the most common forms of cancer add another level
of personal intervention.
Breast
For the general population, a baseline mammogram is recommended between the age of 35 and 40 years and annually thereafter. If there is a maternal history of breast cancer, screening for daughters should begin 10 years before the age at which the mother was diagnosed. If the mother was diagnosed at age 40, screening should begin at age 30 for daughters. If there is a history of lymphoma with mantle radiation, the risk of breast cancer increases and these patients should start mammographic screening earlier. Annual screening mammography is recommended 8 years following completion of chest irradiation but not before the age of 25.
Cervical
First Pap smear at age 21. Women aged 21 to 29 should have a Pap test every 3 years. Women aged 30 to 64 should have a Pap test every 3 years or, if combined with HPV testing, every 5 years. Regardless of the frequency of the Pap test, physicians still recommend an annual gynecologic examination even if a Pap test is not performed at every visit.
Colon
Routine colorectal cancer screening should begin at age 50 and continue until life expectancy is less than 10 years, or to 75-80 years of age. African Americans appear to be at increased risk of colorectal cancer and should initiate screening at age 45. People with an increased risk of colon cancer based on such variables as listed below will often require screening at an earlier age and have to undergo more frequent screening compared to those at average risk.
You are in this higher-risk category if you have:
A personal history of colorectal cancer or colon polyps
A family history of colorectal cancer or genetic syndrome predisposing to an increased risk of inflammatory bowel disease
Prostate
All men should receive a baseline PSA by the time they're 50. At that age, men should talk to a doctor about the pros and cons of testing to decide if it is the right choice for them. African American men and any man whose father or brother had prostate cancer before age 65 should have this talk with a doctor starting at age 40.
If men decide to be tested, they should have the PSA blood test with or without a rectal exam. How often they are tested will depend on their PSA level.
Patients with significant lower urinary symptoms should also be offered the PSA blood test. Regular annual screening should be left up to a decision between the patient and his doctor. PSA screening should be discontinued for asymptomatic men with a normal PSA when their life expectancy is less than 10 years.
Lung
The target population for screening with Low-Dose CT consists of smokers and former smokers aged 55 to 74 who smoked a pack a day for more than 30 years, who currently smoke, or have ceased within the past 15 years. Screening is not recommended for individuals with multiple severe illnesses that would prevent participating in curative treatment.
The effective duration of screening has not been established. Currently annual screening is recommended in the guidelines. Pre-test counseling should include a description of the potential benefits and harms of screening. Screening should be part of a coordinated program with multiple specialists for screening and image interpretation as well as follow-up evaluation and treatment similar to participants to the National Lung Screening Trial (NLST). This would include the presence of pulmonologists, surgical oncologists, specialized thoracic radiologists and board-certified thoracic surgeons, and is available in BMC’s Lung Nodule Clinic.
