Screening for Cancer

Cancer screening is looking for cancer before a person has any symptoms. Some cancers can be found early before they have a chance to grow and spread. Some pre-cancerous conditions can be found and removed, preventing cancer from occurring. Depending on your individual cancer risk and family history, your doctor may have personalized recommendations for how often you should be screened and what types of screenings should be completed. 

Screening tests are not meant to diagnose cancer. When a screening test is abnormal, more tests, like a biopsy, may be done to diagnose cancer.

Breast Cancer

Mammography, an X-ray imaging exam of the breasts, is the most widely studied screening test available. Over the past 50 years, it has been proven to save lives from breast cancer.

Getting regular mammograms increases the chances of finding breast cancer early. Screening mammography finds tumors that cannot be felt by a patient or her doctor so they can usually be treated more easily and more successfully.

In general, it is recommended that women talk to their doctors about their breast cancer risk at or before age 30. Women who are higher risk may need to begin screening around this time. Some women may also benefit from additional screening with breast ultrasound or breast magnetic resonance imaging (MRI). Higher risk women include those who have a strong family history of breast cancer or certain genetic mutations.

Women who are at an average risk for breast cancer benefit most from screening mammography performed once each year beginning at age 40. For this reason, the American College of Radiology and the Society of Breast Imaging recommend annual screening mammography beginning at age 40 for all average-risk women. The American Cancer Society recommends that average-risk women between 40 and 44 years have the option of starting screening mammograms every year. They recommend that women who are 45 to 54 years have a mammogram every year and that women older than 55 have a mammogram every year or every other year.

Find out more about mammograms at Columbia and NewYork-Presbyterian:

Colorectal Cancer

Colonoscopy is the examination of the colon and rectum using a flexible tube with a camera attached to the end.  Colonoscopy can prevent colorectal cancer because it can find and remove the abnormal growths (polyps) that cause colorectal cancer before they become cancer. 

Additional options for screening are using stool-based tests like a high-sensitivity fecal blood test and a stool DNA test that detects abnormal DNA in cells in the stool and blood.  If either test is positive, a colonoscopy is needed.

Guidelines

Individuals should speak with their doctor about which colorectal screening is best for them. Individuals at risk for colon cancer including those with previous polyps, family history of colon cancer, and certain genetic diseases of the colon will screen more frequently and at a younger age.

The United States Preventive Services Task Force (USPTF) recommends colorectal cancer screening (fecal occult blood testing, sigmoidoscopy, or colonoscopy) beginning at age 50 years old and until age 75. 

The American Cancer Society recommends several options for colorectal cancer screening. Average risk individuals should start screening at age 45 and continue through at 75.  Speak with your doctor about when to start and stop screening and the best test for you.

  • High sensitivity fecal immunochemical test (FIT) or fecal occult blood test (FOBT) to detect blood in the stool every year or
  • Multi-targeted stool DNA test (MT-sDNA) every 3 years
  • Colonoscopy every 10 years
  • Virtual colonoscopy every 5 years
  • Flexible sigmoidoscopy every 5 years

Talk to your doctor about getting a test to screen for colorectal cancer.

Find out more about colorectal cancer screening at NewYork-Presbyterian Hospital and the Manhattan Cancer Services Program at New York-Presbyterian Hospital for uninsured New Yorkers.

Cervical Cancer

The cervix is tissue located at the opening of the uterus.  Cervical cancer begins with changes to the cells in the cervix.  To find these changes, women should have cervical cancer screening tests.

A Pap test or smear is a test where cells in the cervix are collected and examined under a microscope by a doctor to look for certain types of cell changes that could be early signs of cancer or cervical cancer.  Most cervical cancer is caused by types of the human papillomavirus (HPV), a sexually transmitted infection.  Additional testing done at the same time as a Pap test can also test for HPV DNA to determine if the HPV virus is also present.

Early detection of precancerous cells and testing for the HPV virus can prevent cervical cancer. Cervical cancer can also be prevented by receiving the HPV vaccine during adolescence and especially before becoming sexually active. Other things you can do to prevent cervical pre-cancer and cancer is to use condoms, limit sex partners, and quit smoking

The United States Preventive Services Task Force (USPTF) recommends the following for screening for cervical cancer:

  • Women age 21 – 29 should be screened every three years with a Pap test alone
  • Women age 30 - 65 years should be screened with a Pap test and HPV DNA test every five years
  • Women 66 and older should stop screening if have had two or more consecutive NEGATIVE pap tests and HPV testing in the last 10 years
  • Woman who have had a total hysterectomy should stop screening for cervical cancer
  • Women who have been vaccinated or the HPV virus should continue screening

Talk to your doctor about getting screened for cervical cancer. 

Find out more about Pap tests and HPV DNA tests at the Herbert Irving Comprehensive Cancer Center and the Manhattan Cancer Services Program at New York Presbyterian Hospital Ambulatory Care Network for uninsured New Yorkers.

Lung Cancer

Lung cancer is the leading cause of cancer death in the United States. Almost all people who get lung cancer have smoked tobacco.  Lung cancer is often diagnosed at late stages when there is no cure.  The low dose computed tomography scan (also called LDCT) is now recommended for lung cancer screening for people who have been heavy smokers for many years.

LDCT can find lung cancer at an earlier stage and reduce the chance of dying from lung cancer. The LDCT is a very sensitive test and may find other conditions in your lungs that are not lung cancer.  These other conditions may require additional tests.  You should speak with your doctor to discuss the advantages and disadvantages of having and LDCT lung cancer screening test.

These low-dose CT scans have been found to reduce the risk of dying from lung cancer by 15-20% compared to people who were screened with standard chest X-rays.

Heavy smokers are at a higher risk of developing lung cancer. The United States Preventive Services Task Force (USPSTF) recommends that heavy smokers between the ages of 50 and 80 years have annual lung cancer screening with LDCT. “Heavy smoking” is defined as a smoking history of 20+ “pack years”, which is smoking an average of 1 pack of cigarettes a day for a year (ex. 20 pack years = 1 pack a day for 20 years or 2 packs a day for 10 years).

If you are a former heavy smoker who quit smoking within the past 15 years, USPSTF recommends an annual LDCT for you too.

Talk to your doctor about whether you should be screened for lung cancer with low dose CT scan.

Learn more about low dose CT scans at Columbia University Irving Medical Center.

Prostate Cancer

Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among men in the United States. African American men and older men are at higher risk of developing prostate cancer. 

The prostate gland is a walnut-sized gland located between the bladder and penis.

Routine prostate cancer screening is not recommended but can be beneficial in certain cases.  It is important to discuss the decision to be screened with your doctor as screening may be able to slightly reduce the chance of death from prostate cancer for some men.

Guidelines

The US Preventative Services Task Force (USPSTF) recommends that men aged 55-69 speak with their doctors to determine how beneficial PSA testing may be in your individual situation. There are other conditions that may result in an abnormal PSA test and additional testing for a positive screen might mean that a biopsy has to be completed, so discuss your need for this test with your physician before making any decisions.

Find out more about prostate cancer screening at Columbia University Irving Medical Center

Skin Cancer

Skin cancer is the most common type of cancer in the United States. Most skin cancers are caused by too much exposure to ultraviolet (UV) rays from the sun or from indoor tanning beds. According to the National Cancer Institute, skin cancer is more common in fair skinned people, though people with darker skin tones who do not burn as easily are also at risk for skin cancer.

There are several different types of skin cancer. The most common types of skin cancer are basal and squamous cell skin cancer and develop on areas of skin exposed to the sun. This kind of skin cancer is very treatable. Melanoma is less common type of skin cancer but is more serious and likely to spread to other parts of the body.

To reduce your chances of getting skin cancer the CDC recommends:

  • Seek the shade, especially between 10 a.m. and 4 p.m.
  • Never use UV tanning beds.
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
  • Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming or excessive sweating.
  • Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.

There are no screening tests for skin cancer. Those at risk for skin cancer should have a skin exam by their doctors. A skin exam looks for abnormal moles, birthmarks, or other pigmented areas. If an area of skin seems abnormal, a doctor will likely complete a biopsy to determine if cancer cells are present in the area.

Learn more about annual skin exams from ColumbiaDoctors experts.

 

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