Keeping Up With Cancer Screening Guidelines
The guidelines for when and how often to get common cancer screening tests such as colonoscopies, PAP smears, PSA tests and mammograms have changed over the last few years. It’s important to talk to your doctor about when to start and stop these tests, because the major guideline organizations sometimes disagree on the details.
“There has been a 25 percent drop in cancer mortality rates since they peaked in 1990. Most of that progress is due to early detection and better prevention,” says Dr. Richard Wender, Chief Cancer Control Officer of the American Cancer Society.
However, tests are not without risks, namely false positives. They can lead to more invasive, riskier and costly testing. So it’s just as critical to know when you can forgo or stop a screening test. Always ask your doctor for an explanation of why you are being referred for a specific test.
Your health and family history has a lot to do with when and how often you should be screened. “Be sure to find that one relative who knows everyone’s medical history in your family, so you know who had which type of cancer, and at what age they were diagnosed,” Wender says.
If you are expected to live less than 10 years, it’s appropriate to stop the screening tests mentioned here because of the slow growth rate of these cancers, Wender says.
Did you know there are now seven types of tests that can help detect colorectal cancer, according to 2016 guidelines released by the United States Preventive Services Task Force? They range from the fecal immunochemical test (FIT), which is collected from a sample at home and measures minute amounts of blood in the stool, to CT scanning. “Many people don’t know that they might be able to do an annual FIT and avoid a colonoscopy altogether if they have negative results,” Wender says. The key here is annual, and you have to keep up with it for it to be effective.
Though most people start colon cancer screening at age 50, the conversation should start closer to 40 so your doctor can consider other factors, such as inflammatory bowel disease, or a family history of colon cancer. In those cases, you may need to start earlier, Wender says. The good thing about a colonoscopy is that you only need it every 10 years if it’s normal, and every five if it finds polyps.
Simply “aging out” of your screening tests doesn’t cut it. Let’s say you first had a colonoscopy at age 50, and nothing since then. Now you’re 75, which is when the USPSTF recommends you stop.
“You’re not done,” Wender says. “The issue is whether you are up to date.” So you need to get another to confirm you are in the clear.
A mammogram is a special X-ray of the breast. It used to be that every woman started annual mammograms at age 40. Now guidelines vary between ages 40 and 50, and aren’t necessarily annual.“Every guideline group agrees that the conversation begins at 40,” Wender says. You may not need to start at 40, but it doesn’t mean you should ignore the issue until age 50.
”After you start, frequency should be a topic of discussion at your regular gynecology visits. Your clinician’s recommendation will depend on which guideline he or she follows. You can make the final decision yourself.
“Breast cancer risk goes up until you are 70 years old, so your underlying health is the single most important factor to determine when to stop screening,” Wender says. “If you are a healthy 70, your life expectancy is 90. Breast cancer takes about a decade to become deadly, so you can do the math.” No one over 90 should be screened, he adds.
This test for cervical cancer is done by a swab at the tip of the cervix. It used to be an annual routine started at age 21. Since 2012, less frequent testing is recommended, and the human papillomavirus (HPV) test has been added to the mix. Guidelines are now more age-specific. According to the American Cancer Society: Women 30 to 65 should have a Pap smear plus an HPV test done every five years.
Women over age 65 who have had regular testing and normal results in the past 10 years should no longer be tested for cervical cancer. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing goes past age 65.
The prostate-specific antigen (PSA) test is the most controversial cancer screening test. This is because the side effects of the subsequent biopsies and treatment (incontinence, impotence) can outweigh the risk of undetected cancer for some men.
Also, a man can be positive for prostate cancer that will never really affect his quality of life. In April of this year, the USPSTF further clarified its 2012 guideline. It maintained that the PSA test not be used routinely, and added that doctors should discuss its harms and benefits with men aged 55 to 69 as part of their care. The USPSTF still recommends against PSA screening for men age 70 or older.
Wender notes that doctors are getting better at doing less aggressive treatment for prostate cancer and taking a “watch and see” approach.
“By switching more men into active surveillance, we have improved the benefit/risk balance,” he says. “The vast majority of people who develop prostate cancer will die of something else, but it is still the third-leading cause of cancer-related death in men.”