Over the past several decades, long-term cancer survival rates have been on the rise.¹ These improved outcomes are largely credited to screening measures for certain types of cancers.

In general, cancer that can be detected and treated in its earliest stages, prior to any spread—and often prior to any symptoms—is associated with dramatically higher long-term survival than cancer that is treated once it has spread from its site of origin.² As a result, screening for common types of cancers gives patients the best chances for early detection and effective treatment, which allow for the best chances for survival. People at a high risk of developing a specific type of cancer may also undergo frequent screening for that type.

The bottom line in any circumstance is that getting screened for cancer can save your life.

Christine Murar is forever thankful that her doctor insisted she undergo a screening sigmoidoscopy when she turned 50. Like many women her age, Christine was dragging her feet when she was due for the routine procedure. Fortunately, after she came up with several excuses, her doctor insisted that the procedure no longer be delayed.

It turned out that she was screened just in time. During her sigmoidoscopy, Christine’s physician found and removed polyps, which prompted a subsequent colonoscopy. During the colonoscopy, the physician found five more polyps, one of which was cancerous. Luckily, the cancer was confined to the polyp and was completely removed during the colonoscopy. Had she waited to undergo the initial screening, the cancer would have spread.

Seven years later Christine remains cancer-free and has thanked her physician for insisting that she receive the routine screening. “I told him that he saved my life.” Furthermore, because the cancer was completely removed during the procedure, Christine required no further treatment following the colonoscopy.

The National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) have published guidelines for the screening of some of the most common types of cancers in the general public. These screening measures are based on extensive data, which indicates that following recommended screening measures and schedules results in improved outcomes.

Insurance often pays for these screenings, at least in part, and public health measures have been implemented to offer screening for individuals who do not have insurance or cannot afford a screening.

People who are known to be at a high risk of developing specific types of cancers may also undergo screening for that type. They should discuss their situation with their healthcare provider.

The NCI and the NCCN have established the following guidelines for the screening of common cancers among women:

Breast Cancer

Breast cancer is diagnosed in approximately 211,000 women annually in the United States, with approximately 40,000 deaths per year attributed to the disease.³

Clinical breast examination. During a clinical breast exam, your healthcare provider will feel the entire breasts, underarms, and collarbone area to detect any small lumps and may gently squeeze the nipples of the breast to check for fluid. A thorough clinical breast exam is painless and may take approximately 10 minutes. If any lumps or abnormalities are found, your healthcare provider will discuss the next steps to be taken.⁴

• Women between the ages of 20 and 40 should undergo a clinical breast exam every one to three years.
• At the age of 40, women should undergo annual clinical breast exams. Your healthcare provider will perform a clinical breast exam during a physical examination.

Mammogram. A mammogram is a type of breast X-ray. Your physician or gynecologist can schedule an appointment for a mammogram with a radiation technician in an FDA-approved mammography center. The results from the procedure are read by a radiologist, an expert in deciphering images from scans or tests such as X-rays. Often a mammogram can detect cancers before they can be felt.

• It is recommended that women 40 years and older undergo a mammogram every one to two years. Women who are at a high risk of developing breast cancer should seek expert medical advice regarding the age of initiation, frequency, and type of screening that would provide the most benefit for them.4

Periodic breast self-exams. A breast self-exam (BSE) involves feeling both breasts and underarm areas for small lumps or abnormalities. It also includes looking at your breasts in the mirror to detect any abnormalities such as dimpling, swelling, rashes, or a change in size on one side and not the other.

• It is suggested that women perform BSEs at the same time every month, preferably one week after menstruation, as hormone levels can affect the texture of the breast tissue.⁴

Cervical Cancer

Approximately 4,000 women die annually from cervical cancer in the United States; this is a 70 percent reduction in deaths since the introduction of the Papanicolaou (Pap) test.⁵

Pap test. The Pap test is the standard screening procedure for cervical cancer. The test involves the collection of a sample of cells from the surface of the cervix, which is situated at the lower end of the uterus. For screening purposes a Pap test is generally performed by your regular healthcare provider during a physical examination. The sample collected is evaluated in a laboratory for cancerous or precancerous cells as well as for the human papillomavirus (HPV). Your physician will contact you regarding the results of your Pap test.

• Screening for cervical cancer should begin approximately three years after a woman starts having sexual intercourse.
• Screening should begin no later than 21 years of age.
• Women should undergo a Pap test every one to two years.
• Women who are 30 years or older who have had at least three consecutive normal Pap tests may undergo screening every two to three years, at the discretion of their healthcare provider.
• Women with no history of screening for cervical cancer or no information regarding prior screening results should undergo a Pap test.
• Women who have tested positive for HPV should continue screening at the discretion of their healthcare provider.
• Women aged 65 to 70 years who have had no abnormal Pap test results in the past 10 years (with at least three Pap tests done during this time), may decide, with the consultation of their healthcare provider, to stop screening for cervical cancer.
• Women who have undergone the surgical removal of their cervix and uterus do not need to undergo screening for cervical cancer unless the surgery was for removal of cervical cancer.
• Women with serious or life-threatening coexisting medical conditions may choose to not undergo screening for cervical cancer.
• Women with a history of cervical cancer, prior abnormal Pap tests, or a disease that compromises the immune system such as human immunodeficiency virus (HIV) or who had exposure in utero to DES (diethylstilbestrol, a synthetic form of estrogen) should continue normal screening for cervical cancer.
• Women should speak with their healthcare providers to determine the optimal timing of initiation, frequency, and continuation of Pap tests.⁶

Colorectal Cancer

Colorectal cancer is the second-leading cause of cancer-related deaths in the United States every year.⁷ Patient compliance with screening measures for colorectal cancer remains low because patients may perceive the procedures as invasive.1 Colorectal cancer does, however, have high cure rates if detected and treated in its earliest stages.

There are four general screening tests for colorectal cancer, although a colonoscopy is the preferred screening method.

Colonoscopy. During a colonoscopy a lighted tube is inserted into the rectum and through the entire large intestine. The physician performing the procedure can visualize the colon on a monitor screen. Patients receive a laxative the day before and are gently sedated for the procedure. Your general healthcare provider can either perform the procedure or refer you to another physician.

Sigmoidoscopy. During a sigmoidoscopy a lighted tube is inserted into the rectum and through the lower part of the large intestine. Patients may receive a laxative the day before and require no sedation for the procedure. Your healthcare provider may either perform the sigmoidoscopy or refer you to another physician. Often a sigmoidoscopy can be performed during a routine physical examination in the office.

Fecal occult blood test. A fecal occult blood test (FOBT) detects small amounts of blood in the stool. An FOBT may be performed from home, where a small scraping of stool is placed in a sterile container, which can be sent to or dropped off at your physician’s office. Your doctor will provide you with the packaging and the instructions.

Double-contrast barium enema. This procedure involves an enema consisting of barium that allows abnormalities within the large intestine to show up on an X-ray.

• Patients should begin screening for colorectal cancer at the age of 50, unless they have a family history of the disease, an inflammatory disease of the colon, or a history of cancerous or precancerous growths in the colon.
• A colonoscopy should be performed every 10 years if the results are normal; or a sigmoidoscopy plus FOBT should be performed every five years if results are normal; or a double-contrast barium enema should be performed every five years if the results are normal.
• If results from a sigmoidoscopy, an FOBT, or a double-contrast barium enema are abnormal, patients should undergo a subsequent colonoscopy.
• Patients who have had abnormalities on any of the screening procedures should discuss with their healthcare provider follow-up screening for colorectal cancer because schedules differ, depending on specific variables.
• Patients with a family history of colorectal cancer, an inflammatory disease of the colon, or a history of cancerous or precancerous growths in the colon should speak with their healthcare provider regarding their individualized screening measures, including the age at which screening should begin as well as a specific schedule for screening.⁸

Skin Cancer

There are three main types of skin cancer: melanoma, basal cell, and squamous cell. Melanoma is by far the most deadly and aggressive type of skin cancer, whereas basal cell and squamous cell carcinomas do not tend to spread quickly.

Skin self-checks. Individuals should perform a monthly skin check on themselves or with the help of a spouse or other partner. Standing in front of two mirrors, check both sides of the body for any changes in moles or abnormalities on the skin. It may be helpful to use a handheld mirror to check areas that are difficult to examine, such as the soles of the feet and the backs of the thighs.

Remember the ABCD rule when evaluating moles during a skin exam:

• Asymmetry: the two halves of a mole should be symmetrical.
• Border irregularity: the edges of a mole should not be ragged, irregular, notched, or blurred.
• Color: the color of the entire mole should be the same.
• Diameter: moles should not be greater than ¼ inch in diameter, which is approximately the size of a pencil eraser.

If you find any changes, irregularities, or fast-growing moles or are concerned about an area on your skin, contact your healthcare provider or a dermatologist for further examination.

Clinical skin examination. Your healthcare provider may perform a skin examination during a regular clinical exam.⁹

Conclusion

All women should speak with their usual healthcare provider regarding screening measures for cancer. Your healthcare provider will help guide you with the appropriate information, referrals, and scheduling if necessary to fulfill standard screening guidelines. It is important to discuss with your physician your family history and other illnesses you have so that your risk for certain cancers can be accurately assessed. If you are at an increased risk for the development of any type of cancer, screening guidelines will be individualized to provide added measures to detect these cancers in their earliest stages.

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¹ Cancer Trends Progress Report—2005 Report Highlights. National Cancer Institute Web site. Available at: http://progressreport.cancer.gov/highlights.asp. Accessed June 19, 2006.