Cancer Screening: Essential Guide 2024 Edition

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What is Cancer Screening?

Cancer screening refers to the early diagnosis procedures that are used to find precancerous lesions or cancer before any symptoms appear, enabling prompt medical attention. Screening can identify some precancerous lesions and cancer in its early stages when the majority of cases are easier to treat or remove with few side effects.

Why Screening Matters

Screening can identify several cancers and precancerous lesions—from cancers of the breast, colon, and cervical regions to colorectal adenomatous polyps, erythroplakia, etc.—when the disease is more treatable. Age, gender, family history, and personal risk factors should be considered when deciding which screening test is most appropriate for a specific individual. Following recommended screening guidelines substantially increases one’s chances of catching cancer in time for the opportunity to treat it successfully.

Screening vs. Diagnostic Tests

Screening tests must be distinguished from diagnostic tests. Cancer diagnosis refers to the process of determining whether a person has cancer and identifying its type, location, and stage. Diagnostic tests are conducted once the individual starts showing symptoms or on some abnormal findings obtained from screening tests or other diagnostic tests.

Here are some key differences:

Purpose

  • Screening: Detect early cancer in asymptomatic individuals.
  • Diagnostic: Confirm or rule out cancer in symptomatic individuals or after abnormal screenings.

Target Population

  • Screening: For those without symptoms.
  • Diagnostic: For those with symptoms or abnormal findings.

Frequency

  • Screening: Regular intervals (e.g., annual mammograms).
  • Diagnostic: As needed after abnormal results or symptoms.

Test Type

  • Screening: Non-invasive (e.g., mammogram, Pap smear).
  • Diagnostic: Often invasive (e.g., biopsy).

Sensitivity and Specificity (Accuracy)

  • Screening: Focuses on catching as many cases as possible but may sometimes give false alarms.
  • Diagnostic: Confirms the result with more accuracy to avoid false alarms.

Outcome

  • Screening: Detect early cancer or precancerous conditions.
  • Diagnostic: Provides a clear answer on whether the condition is present and determines how advanced it is.

Reference: American Cancer Society on Cancer Screening

Who Should Get Which Cancer Screening?

Cancer screening recommendations vary worldwide based on age, gender, family history, and individual risk factors. International organisations like the World Health Organisation (WHO), the International Agency for Research on Cancer (IARC), and national health bodies in various countries provide guidelines that may differ slightly. Below is a global perspective on cancer screening recommendations.

Cancer Screening Guidelines for Women

Breast Cancer Screening

  • Women aged 50-69 should have biennial mammograms (every 2 years). In some countries, screening can start earlier (age 40) with mammograms every 1-2 years.
  • High-Risk: Women with BRCA1/BRCA2 mutations or a strong family history should begin screening earlier and may require additional MRI scans.

Cervical Cancer Screening

  • Women aged 30-49 should have a Pap smear every 3 years or HPV testing every 5 years. Women over 65 with adequate prior screening can stop, unless at high risk.
  • Low-Resource Settings: Visual inspection with acetic acid (VIA) is an alternative where Pap tests are unavailable. 

Ovarian Cancer Screening

  • Routine screening is not recommended for the general population.
  • High-Risk: Women with BRCA mutations or a strong family history should discuss CA-125 blood tests and transvaginal ultrasound with their doctor.

Cancer Screening Guidelines for Men

Prostate Cancer Screening

  • Men 50+ should discuss PSA testing with their doctor. Screening varies by country due to concerns about over-diagnosis. Some may need to start screening at age 30 or younger.
  • High-Risk: Men of African ancestry or with a family history should consider starting testing earlier, at age 45.

Cancer Screening Guidelines for All Genders

Colorectal Cancer Screening

  • Individuals aged 50-75 should undergo FOBT/FIT every 2 years or a colonoscopy every 10 years.
  • High-Risk: Individuals with a family history of colorectal cancer or conditions like ulcerative colitis should start earlier and have more frequent testing.

Lung Cancer Screening

  • Adults aged 50-80 with a 20-pack-year smoking history should get annual low-dose CT scans (LDCT).
  • High-Risk: Those exposed to environmental carcinogens or with a heavy smoking history need regular screenings.

Skin Cancer Screening

  • Regular skin exams (annually) are recommended for people with fair skin, a history of sunburn, or prolonged sun exposure. Countries like Australia and New Zealand recommend more frequent (every 6 months) screening due to higher UV exposure.
  • High-Risk: Individuals with a personal or family history of skin cancer should have annual skin checks.

Oral Cancer Screening

  • Oral cancer screening should be included in routine dental exams for all ages, especially in regions like South Asia. This is crucial for early detection in high-risk individuals, such as those using tobacco, consuming heavy alcohol, or being exposed to HPV.
  • High-Risk: More frequent screenings for those with a history of head and neck cancers.

Cancer Screening Guidelines for Transgender Individuals

Cancer screening guidelines for transgender individuals should be tailored to their gender identity, hormone use, and surgeries:

Transgender Women (Male to Female)

  • Breast Cancer Screening: If hormone therapy (estrogen) has been used for more than 5 years, follow breast cancer screening guidelines for cisgender women (mammograms starting at age 50-69, every 2 years).
  • Prostate Cancer Screening: If the prostate is intact, PSA screening should still be considered, based on family history and age (50+).

Transgender Men (Female to Male)

  • Breast Cancer Screening: If mastectomy (top surgery) has not been performed, follow standard guidelines for breast cancer screening (mammograms). If a mastectomy has been performed, the risk is significantly reduced but not zero; individual risk should be assessed.
  • Cervical Cancer Screening: For those who still have a cervix, follow the standard guidelines for cervical cancer (Pap smear every 3 years or HPV test every 5 years). Discomfort with the procedure should be addressed with the healthcare provider to ensure regular screening.
  • Ovarian Cancer: If ovaries are intact, screening is typically not recommended unless there is a family history or BRCA mutation.

Common Types of Cancer Screening

Skin Cancer Screening

  • Screening Test: A dermatologist conducts a full-body visual examination.
  • What to Expect: For the screening, you will have to undress and wear a medical gown. The dermatologist will then thoroughly inspect your skin; keep in mind that the inspection is not limited to one particular area. Her or his scrutiny will extend to parts of your body that you may not have suspected. These include the scalp, behind the ears,  between the toes etc. This non-invasive test should take some 10-15 minutes. There is no special preparation needed for it. However, once suspicious moles or spots are detected, biopsying might be advised.

There are different forms of skin cancer, and one of the deadly ones is melanoma. Be aware of any unusual moles or spots on your skin. The best way to identify moles is by using the ABCDE rule:

  • Asymmetry: The two sides are not equal.
  • Border irregularity: The border is rough or fuzzy.
  • Colour Variation: Pottily mottled browns with various black or other colours.
  • Diameter: A mole is bigger than 6 millimetres in diameter.
  • Evolution: The mole changes shape, size, or colour or becomes larger/smaller.

Reference: American Academy of Dermatology

Breast Cancer Screening

  • Screening Tests: Mammogram as the gold standard, MRI for high-risk individuals, and ultrasound in women with dense breast tissue.
  • What to Expect: To perform a mammogram, your breast will be placed between two flat surfaces; for a few seconds, it will be compressed to take X-ray images. You may feel some discomfort or a bit of pain from the compression, but the procedure is short, normally taking about 10-15 minutes to complete. No special preparation is needed, though you may be asked to avoid using deodorants or lotions on the day of testing because they interfere with the images. For an MRI, you will lie face down in a scanning machine for 30-60 minutes. Contrast dye may be injected into your arm to help improve the detail of the images that the machine is capturing.

Ref.: American Cancer Society—Breast Cancer Screening Guidelines

Colon and Bowel Cancer Screening

  • Screening Test: Colonoscopy (the gold standard), FIT (faecal immunochemical test), or stool DNA test, for example, Cologuard.
  • What to Expect:
    • For a colonoscopy, you’ll need to follow a strict diet and drink a bowel-cleansing solution the day before to clear out your colon. This can cause frequent, watery bowel movements. The procedure itself takes 30-60 minutes, during which you’ll be sedated. A long, flexible tube with a camera is inserted through the rectum to examine the colon. You may feel bloated or have mild cramping afterwards, but you’ll need someone to drive you home due to the sedation.
    • For FIT and stool DNA tests, you collect a stool sample at home by following the instructions provided with the kit. You then mail the sample to a lab. No special preparation is needed, and results are sent to your healthcare provider.

A colonoscopy could remove adenomatous polyps before they develop into cancer, while some noninvasive screening tests, such as the FIT test, can detect even tiny droplets of blood concealed in stool, an early possible indicator of colon cancer.

Reference: American Cancer Society—About Colorectal Cancer Screening

Lung Cancer Screening

  • Screening Test: Low-dose CT scan (LDCT).
  • What to Expect: During an LDCT scan, you will lie on a motorized table that moves through a large, doughnut-shaped CT scanner. The scan itself is painless and takes just a few minutes. No special preparation, such as fasting, is required, and you can resume normal activities right after the procedure. You may be asked to hold your breath for a few seconds during the scan to ensure clear images.

Reference: USPSTF Guidelines for Lung Cancer Screening

Prostate Cancer Screening

  • Screening Test: PSA (Prostate-Specific Antigen) test, Digital Rectal Exam (DRE).
  • What to Expect:
    • The PSA test involves drawing blood from a vein in your arm. The test only takes a few minutes, and no preparation is needed. Results are typically available in a few days.
    • During a DRE, the doctor will insert a gloved, lubricated finger (digit) into your rectum to feel for abnormalities in the prostate. This may feel uncomfortable, but it’s usually brief, lasting less than a minute.

Refer: American Urological Association—Prostate Cancer Screening

Cervical Cancer Screening

  • Screening Test: Pap smear and HPV test.
  • What to Expect: For a Pap smear or HPV test, you’ll lie on an exam table with your feet in stirrups. The doctor will insert a speculum into the vagina to hold it open, allowing them to collect cells from the cervix using a small brush or spatula. The procedure takes about 5 minutes and may cause mild cramping or discomfort. It’s best to avoid scheduling the test during your period, and you may be advised to avoid intercourse, douching, or using tampons 24 hours before the test.

Pap smears and HPV tests help detect alterations in the cervix that lead to cancer, thus preventing it effectively. However, appropriate screening until the age of 65 may mean that women don’t need further screening, but this depends on consulting your healthcare provider.

Ref.: ACOG—Cervical Cancer Screening Guidelines

Ovarian Cancer Screening

  • Screening Test: CA-125 blood test, transvaginal ultrasonography.
  • What to Expect:
    • For a CA-125 blood test, a blood sample is drawn from your arm, and results are typically available within a few days. No special preparation is needed.
    • For a transvaginal ultrasound, a probe is inserted into the vagina to capture images of the ovaries and other reproductive organs. This may cause mild discomfort or pressure. The exam takes 20-30 minutes, and you may need to have a full bladder for clearer images.

Reference: American Cancer Society—Ovarian Cancer

Oral Cancer Screening

  • Screening Test: Oral diagnosis by the dentist, with a biopsy if abnormalities are detected.
  • What to Expect: During a routine dental exam, your dentist will check your mouth, gums, tongue, and throat for any lumps, sores, or abnormal tissue. If an abnormal area is found, the dentist may perform a biopsy by removing a small tissue sample for further testing. A visual exam is painless and takes only a few minutes, while a biopsy may cause slight discomfort and may require local anaesthesia.

Reference: American Dental Association—Oral Cancer Screening

Cancers Without Standardised Screening Protocols

Not all cancers have standardised screening protocols. This means there aren’t universally accepted tests used routinely to detect these cancers early in people without symptoms. The absence of such protocols can be due to several factors, including the lack of reliable screening tests or insufficient evidence that screening reduces mortality rates for those cancers.

If you’re in a high-risk group for these cancers—perhaps due to family history, certain infections, or lifestyle factors—it’s especially important to be proactive about your health. Work closely with your healthcare provider to monitor for any unusual symptoms and discuss whether individualised screening options might be appropriate for you. Personalised medical advice can help identify the best approach based on your specific risk factors.

Anal Cancer Screening

  • Screening Test: Anal Pap smear and High-Resolution Anoscopy (HRA).
  • What to Expect: An Anal Pap smear involves collecting cells from the anal canal, similar to a cervical Pap smear. This test is non-invasive and usually takes a few minutes. If abnormal cells are detected, a High-Resolution Anoscopy (HRA) may be recommended. During HRA, a magnifying instrument is used to closely examine the anal canal for precancerous or cancerous lesions. Some discomfort may be experienced, but it’s typically brief.
  • High-Risk Groups: Individuals with a history of HPV, HIV-positive individuals, and men who have sex with men (MSM) are at higher risk for anal cancer.


Reference: American Cancer Society, WHO​

Bladder Cancer Screening

  • Screening Test: Urine cytology, cystoscopy, and urinary biomarker tests.
  • What to Expect: Urine cytology involves examining cells in urine for cancerous changes, typically collected in a simple sample. Cystoscopy is more invasive, using a thin camera to inspect the bladder lining; it can cause mild discomfort and requires local anaesthesia. Urinary biomarker tests check for specific proteins linked to bladder cancer, but they are typically used only in high-risk individuals.
  • High-Risk Groups: Smokers, those with occupational exposure to chemicals, and individuals with a family history of bladder cancer.
    Reference: Mayo Clinic, WHO

Gastric (Stomach) Cancer Screening

  • Screening Test: Upper endoscopy (EGD) and H. pylori testing.
  • What to Expect: An upper endoscopy involves passing a thin, flexible tube through the mouth into the stomach to visually inspect the stomach lining for abnormalities. It requires sedation and may cause mild throat discomfort afterwards. H. pylori testing is non-invasive and can be done through a blood, breath, or stool test to detect the bacteria associated with increased gastric cancer risk.
  • High-Risk Groups: Individuals with H. pylori infection, a family history of gastric cancer, and smokers in high-incidence regions like Japan and Korea.
    Reference: WHO, IARC​

Thyroid Cancer Screening

  • Screening Test: Neck ultrasound and thyroid function tests.
  • What to Expect: A neck ultrasound is a non-invasive procedure where a transducer is used to capture images of the thyroid to detect nodules or other abnormalities. It’s painless and takes about 20-30 minutes. Thyroid function tests, including TSH, help assess whether the thyroid gland is working properly.
  • High-Risk Groups: People with a family history of thyroid cancer, radiation exposure, or genetic syndromes like familial medullary thyroid carcinoma.
    Reference: American Thyroid Association, IARC​

Pancreatic Cancer Screening

  • Screening Test: Endoscopic ultrasound (EUS), MRI, or MRCP.
  • What to Expect: Endoscopic ultrasound (EUS) involves inserting a flexible tube into the stomach to get detailed images of the pancreas, typically requiring sedation. Magnetic Resonance Cholangiopancreatography (MRCP) or MRI can also provide clear images of the pancreas, often without sedation.
  • High-Risk Groups: Those with genetic predispositions (e.g., BRCA2 mutations), chronic pancreatitis, and a family history of pancreatic cancer.
    Reference: American Cancer Society, IARC

Conclusion

Probably the most important thing you can do for your health is to get regular cancer screenings. If cancer or precancerous conditions are caught early, you will have far better chances of having a successful treatment. What you require in terms of screenings depends on your age, gender, family history, and personal health risks; hence, it is always best to talk to your doctor about what’s best for you.

You’ll want to be periodically seen by your healthcare provider to track when you might need screenings. It just makes all the difference in the world to take a proactive role, ensuring you’re following recommendations and catching things before they get serious. It’s just part of taking care of your health throughout your lifetime.

References

American Cancer Society:

American Academy of Dermatology:

U.S. Preventive Services Task Force:

American Urological Association:

Mayo Clinic:

National Cancer Institute:

American Dental Association:

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