Cancer has been making headlines for years, primarily projecting into our minds images of people going bald from chemotherapy or statistics about the deadliness of various cancers. Fortunately, our knowledge about cancer disease processes has advanced greatly in recent years, and the medical community has been able to devise various cancer screening tools to detect the illness before it has progressed too far.
Breast cancer is likely the most highly publicized type of cancer, thanks largely to the Susan G. Komen Breast Cancer Foundation. We’ve all seen the commercials about the breast cancer walk, we know that October is Breast Cancer Awareness month and we recognize what a pink ribbon symbolizes. I’m sure many of us have even saved the pink tops from our yogurt and sent them off to raise money for research. As a result of all this publicity, breast cancer treatment has made progress, but mostly from the prevention and early detection standpoint. A push has been made in recent years for women to start monthly self-breast examinations in their teenage years, as well as getting a head start on that first mammogram. For women without a family history of breast cancer, it is recommended that they receive their first mammogram at the age of 40, and then every one to two years after that, depending on their individual risk. For women with a family history or other risk factors, the first mammogram can be as early as 20 years old. In addition to these tests, genetic screening can be done. There are two genes that have been linked to breast cancer: BRCA1 and BRCA2. These genes have been found to also increase the risk of developing ovarian, fallopian and even prostate cancers; thus, a woman with a sister who had ovarian cancer and a mother with breast cancer might have a BRCA gene mutation and should probably start being screened for breast cancer early in life. It should also be noted that the family history for people with these gene mutations often involves the onset of cancers at a young age — meaning, younger than 50. Additionally, men also are at risk for developing breast cancer, especially if they have a BRCA gene mutation. Therefore, men with female relatives who developed breast or ovarian cancers should be screened for prostate and breast cancer at a younger age, too.
Another type of cancer that medical professionals can screen for is colon cancer. Oftentimes, the symptoms of colon cancer — such as rectal bleeding — are ignored. Additionally, colon cancer is often asymptomatic in the early stages, which makes looking for it extremely important to find it early and allow for better outcomes. There are several screening tests for colon cancer because we know colon cancer always begins as polyps, or growths, inside the colon. A simple, relatively noninvasive test is called a fecal occult blood test, which looks for blood in stool that isn’t obvious to the naked eye. Perhaps unfortunately, this test requires someone to use a stick and place stool from their toilet paper onto little cards that then have a reagent added to them to determine the presence or absence of blood, based on color change. Another manner of doing this — one that may be less off-putting — is to have a doctor do it as part of a rectal exam. There are two endoscopic techniques that can be used to look for colon cancer: a colonoscopy and a flexible sigmoidoscopy. Both involve a long, flexible tube with a camera on the inside, inserted into the rectum and snaked through the colon so a doctor can see polyps forming, even before blood could be detected on a stool test. The difference between a colonoscopy and sigmoidoscopy is that a colonoscopy looks through the entire colon from the rectum to the junction with the small intestine and a sigmoidoscopy only looks at the very end of the colon. The current recommendations suggest screenings begin at 50 years old for people without risk factors and earlier for those with a family history or known genetic mutation, which can lead to hereditary nonpolyposis colorectal cancer or familial adenomatous polyposis. Unfortunately, the tricky thing about these particular genetic mutations is that they also increase the risk for developing other types of cancers. HNPCC is often associated with ovarian cancer and other cancers of the gastrointestinal tract, and FAP has been linked to pancreatic cancer and the development of other growths that can cause problems by impinging on surrounding structures.
Two other types of cancer easily screened for are cervical cancer and prostate cancer. Cervical cancer, as I’m sure we’ve all heard, is caused by the human papilloma virus and is screened for during Pap smears that detect cancerous cellular changes of the epithelium of the cervix. It is recommended that women receive this test annually beginning within three years of the onset of sexual activity or when she turns 21, whichever comes first. Fortunately, if cervical cancer is detected early enough, as is the goal of cancer screening, there are many treatment options. Screening for prostate cancer involves a rectal exam to feel for nodules or surface texture changes on the prostate, as well as a blood test called a prostate specific antigen test, that looks for the level of a prostate-produced protein in the blood. If this level is too high, it indicates the prostate cells are multiplying and possibly cancerous. A major problem with a PSA test, though, is that other conditions, such as benign enlargement of the prostate can also increase the PSA level and can lead to an false diagnosis of prostate cancer. That is why the rectal exam is still used when screening for prostate cancer.
Obviously, there are other cancers out there, but the ones I’ve covered are those with the currently most effective screening tools. Hopefully, we will soon develop effective screening tools for cancers of all types and develop ways to improve the outcomes of post-detection cancer therapies.
Clarification (2/11/2009):
Following last week’s publication of my column, “Needles in a Haystack,” Christine Peterson, gynecology director and physician at Student Health, brought to my attention that monthly self-breast exams have not been shown to be as beneficial as previously thought. In fact, in low-risk, healthy women, overly aggressive screening through monthly self exams is equivocal because it can cause just as much harm as good. In other words, a woman might find a lump in her breast on a monthly exam that is then extensively worked up by her physician and leads to her having unnecessary surgery to remove a benign mass. On the other hand, it is possible for a woman to find a mass that is cancer and is then able to be treated at an early and curable stage. The current recommendations from the American Cancer Society are:
- Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
- Clinical breast exams should be part of a periodic health exam about every three years for women in their 20s and 30s and every year for women at least 40-years-old.
- Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.
- Women at high risk — greater than 20 percent lifetime risk — should get an MRI and a mammogram every year. Women at moderately increased risk — 15 to 20 percent lifetime risk — should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15 percent.
Katie is a University Medical student. She can be reached at k.mcbeth@cavalierdaily.com.
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