Screening can be a powerful weapon against cancer, helping catch some tumors months, or even years, before a person would feel sick enough to see a doctor.
There are many different types of cancer, but the U.S. Preventive Services Task Force, a group of independent medical experts, only recommends regular screening for four types: lung, breast, colorectal and cervical. For this quartet, the task force has found that regular screening can save lives without exposing too many people to false alarms, additional testing or unnecessary treatments.
“Screening is on the front lines of reducing deaths from cancer,” said Robert Smith, an epidemiologist at the American Cancer Society.
Why should you be screened for these cancers?
Every so often, the task force systematically reviews the evidence behind cancer screening and issues recommendations by age and potential risk factors, said Dr. John Wong, vice-chair of the task force. These recommendations are for healthy people, so if you have symptoms, your doctor may want to look for cancer regardless of age or when you were last screened.
All four screenings are recommended because they reduce cancer deaths, with the task force’s modeling showing 13 percent fewer deaths from lung cancer and 28 to 30 percent fewer from breast cancer. Clinical trials have reported similar results.
Beyond finding cancer early, colorectal and cervical cancer screening can also help prevent disease, Dr. Smith said.
For example, doctors can remove polyps, or suspicious, potentially precancerous tissue growths, in the colon and cervix. The task force’s modeling shows screening leads to 79 to 85 percent fewer deaths from colorectal cancer and 80 to 87 percent fewer deaths from cervical cancer.
But to fully realize these benefits, patients need to get screened regularly, Dr. Reid said. She recommends talking to your doctor about how often you should be scanned depending on your baseline risk, the screening test being used and your history of suspicious findings.
“You are not a stagnant person,” Dr. Reid said, “so it’s really important that the cadence of the screening matches your increased risk over time.”
Are there age limits?
The task force only recommends screening certain groups, and health insurers are required to cover screening for them without cost sharing.
“The risks are immediate; the benefits are delayed,” said Dr. Mara Schonberg, a primary care physician at Beth Israel Deaconess Medical Center. So, the idea is to screen people who are old enough to face real risk of cancer but young enough to realize the full benefits of early detection and treatment.
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Lung cancer: Anyone between the ages of 50 and 80 years old with a significant history of smoking should get a low-dose CT scan.
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Breast cancer: Women between 40 to 74 years old should get regular mammograms.
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Colorectal cancer: Anyone between 45 to 75 years old should be screened with colonoscopy or at-home stool tests.
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Cervical cancer: Women between the ages of 21 and 65 should receive routine cervical cancer screening with a Pap smear or potentially a human papillomavirus test.
These guidelines aren’t perfect. They miss some people who get cancer and can still lead to unnecessary anxiety and follow-up tests as doctors chase harmless tumors, Dr. Schonberg said. And not everyone receives the screenings as scheduled. One recent study found that, among tens of thousands people eligible for multiple cancer screenings, 65 percent got screened for breast and colorectal cancer and only 17 percent get screened for lung cancer.
If you think you’re eligible for screening, talk to your doctor, said Dr. Therese Bevers, a family medicine physician at The University of Texas MD Anderson Cancer Center. You can also ask about screening outside these guidelines if you feel at high risk because of family history, certain gene mutations like BRCA or other factors. Just know that, outside the guidelines, research suggests that the harms usually outweigh the benefits.
What about other types of cancer screenings?
For some cancer types like skin, oral and bladder, there’s not enough evidence to recommend one way or another. In other cases — like ovarian, pancreatic, testicular, and thyroid cancers — the task force has found that screening people without symptoms can lead to too many false positives and complications without reducing people’s risk of death.
For that reason, the task force recommends against screening older men for prostate cancer but says that men ages 55 to 69 should talk with their doctor to discuss the harms and benefits. Most prostate cancers grow so slowly that they would never be an issue, Dr. Reid said. While screening can find these tumors, it risks a cascade of unnecessary treatments and complications, such as rectal bleeding and impotence.
“Sometimes, the treatment is worse than having the cancer,” Dr. Reid said.
Simar Bajaj covers health and wellness.
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