It’s easy to feel like everything in medicine should be straightforward, but unfortunately that’s far from true. New research is constantly changing and deepening our understanding of how to keep people healthy. But I also recognize that getting conflicting advice can be tough to navigate, especially when it comes to getting screened for cancer. To help us out, the American College of Physicians, the nation’s leading organization for internal medicine doctors, has reviewed the evidence and recommendations for cancer screening to clarify what we know. I wanted to walk through their findings with you so that you can get a better sense of how to stay on top of your cancer risk.
We screen for breast cancer using the mammogram, which is an X-ray image of the breast that can reveal masses that might be cancer in the breast. The problem is, sometimes those masses aren’t cancer at all, and the tests done to figure out which is which can be costly, time consuming, and physically damaging to women. That’s led to controversy over when a woman’s risk is high enough to overcome the risks of having something go wrong as a result of the screening. Here’s what the study found:
- If you don’t have extra risk factors like a family history or genetic risk, you shouldn’t be getting mammograms under 40 or over 75 because the risks outweigh any benefits you might get.
- If you don’t have extra risk factors and you’re between 40 and 49, you should have a conversation with your doctor about the risks and benefits of getting mammograms and decide together when to start.
- If you’re at average risk and between 50 and 75, you should be getting a mammogram every two years.
- If you’re at average risk, other forms of screening aren’t worth the money.
The key news here is that you should talk to your doctor about your risk. If you’re 40 or older and haven’t had a conversation with your doctor about mammograms, you should do so at your next appointment.
Cervical cancer is one of the most common forms of cancer in women. Fortunately, the HPV vaccine is rapidly dropping rates of this cancer in younger women, but screening is still important. Here’s what the researchers found:
- If you’re under 21, you don’t need to be screened since your body clears most infections at that point. If you’re over 21, you should be getting a Pap test every three years. More often than that doesn’t provide any benefit.
- If you’re over 30, you can opt to combine the regular screening with an HPV test. If both are negative, you don’t need another screen for five years.
- If you’re 65 and you haven’t had a positive test in the last 10 years, you can stop being screened.
The takeaway here is that cervical cancer screening is all about age. You start at 21, have the option to space out screenings at 30, and should stop at 65 if you’ve been negative for 10 years.
The colonoscopy is a fantastic screening tool, but unfortunately not enough people are getting them. Fortunately, you have options. Here’s what you need to know:
- You should be getting screened regularly between 50 and 75. If you have a family history or think you might have some risk factors, you should talk to your doctor to see if you should start earlier.
How often you get screened depends on the type of screening:
- If you just get a test looking for blood in your stool, you should get screened every year.
- If you have a procedure called a sigmoidoscopy that looks just at the lower part of your large intestine, you should be screened every five years.
- If you combine the stool blood test and the sigmoidoscopy, you get better coverage for detecting cancer. The stool test can be done every three years and the sigmoidoscopy every five.
- If you go for a colonoscopy, which can look through almost all of the large intestine and also remove small cancers, you only need screening every 10 years.
The key thing to remember with colon cancer is you only need to pick one of these options. Talk to your doctor about which is the best option for you and make sure you’re getting screened as often as you need to be.
This cancer is a scary one both because it’s often deadly and because it’s hard to detect. I’ve talked to a lot of women who are scared to death of this one. The thing is, all the research we’ve done has shown that women with no genetic risk and no family history don’t benefit from screening. In fact, getting screened when you’re not at high risk is more likely to harm you without any benefit. The takeaway? Average risk women shouldn’t be screened. If you’re concerned about your ovarian cancer risk, talk to your doctor and figure out if you need closer attention. Knowing the early symptoms can also help.
Screening for prostate cancer has generated a debate that has raged for most of the past decade. We look for prostate cancer using a protein called PSA, which is made in higher amounts by some prostate cancers. The problem is, a high PSA doesn’t always means cancer. Even if it does, many prostate cancers are very slow growing and most aren’t deadly. But because the prostate is so hard to access, figuring out whether a person has cancer or not can lead to all sorts of erectile and urinary complications. Here’s what you should know:
- If you’re between 50 and 69, you should have a conversation about the risks and benefits of screening for prostate cancer with your doctor. If you’re at average risk, getting a PSA screen is up to you. Because the benefits aren’t clear, you have to weigh what you’re comfortable with.
- If you’re under 50 or over 69, you shouldn’t be getting tested. The likelihood that screening will find a deadly cancer is lower than the likelihood of being harmed by tests if your PSA is high.
The core idea in screening for prostate cancer is that we don’t have a good test. The PSA can help detect early prostate cancer, but it also causes many men to get a variety of tests and procedures they never needed. Before you make any decisions about whether to get screened, you have to have an in-depth conversation with your doctor about what you might gain and what you might risk if you get a PSA test.