A popular question from my patients is: “Which blood test screens for cancer?”
Another frequent question is: “Can I get an MRI to check my entire body for cancer?”
Though these questions seem simple, the answers are more complex. However, there is no screening blood test for cancer, nor is MRI used as a screening test for cancer.
On the other hand, in honor of “National Black Family Cancer Awareness Week,” I do want to share information about the evidence-based screening tests that are available. It is important to remember that recommendations shared with patients have gone through rigorous studies, have been validated, and reproduced.
Over time, sometimes the guidelines change when new information becomes available. Furthermore, not everything that you read on GOOGLE, Facebook, or TikTok is true. Some articles and patient testimonials are just anecdotal and are not scientifically sound. Please consider using reliable sources such as cdc.gov or medlineplus.gov for health information or better yet, discuss with your trusted provider.
With that in mind, let’s talk about those guidelines that have been recommended by organizations such as the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG), and the United States Preventive Services Task Force (USPSTF).
Colon Cancer Screening
Per the American Cancer Society, people with average risk of colon cancer should begin screening at age 45. Average risk includes persons without a family history or personal history of colon cancer, people without a history of polyps, and persons without a history of inflammatory bowel disease like Crohn’s or ulcerative colitis. Screening is typically every ten years but can occur more frequently depending on the medical history and the results of the screening test. There are basically two categories of testing options for colorectal cancer screening: stool-based tests and visual (structural) tests. The stool-based options include Highly sensitive fecal immunochemical test (FIT) – testing is every year. Highly sensitive guaiac-based fecal occult blood test (gFOBT) – testing is every year, and the multi-targeted stool DNA test (commonly known as Cologuard) – testing is every 3 years. The visual tests include Colonoscopy – testing is every 10 years, CT colonography (virtual colonoscopy)- testing is every 5 years, and the Flexible sigmoidoscopy (FSIG) – testing is every 5 years.
Cervical Cancer Screening
Per ACOG, pap smears should occur every 3 years in average risk women from age 21-29. At age 30, testing should occur every 3 years if performing pap smear only, every 5 years if testing with an FDA-approved primary hrHPV test, or every 5 years using the co-testing technique (pap smear plus hrHPV testing). Women who have undergone surgical removal of their uterus and cervix for non-cancerous reasons, no longer need pap smears as well as women over the age of 65.
Breast Cancer Screening
For breast cancer screening, ACOG and the ACS recommend starting yearly mammography at age 40 for average risk women. Women without a personal or family history of breast cancer, women without a known history of a genetic mutation that increases breast cancer risk (BRCA gene), or women without a history of chest radiation prior to age 30 are considered low or average risk. Women with a family history of breast cancer may need to start screening earlier and receive additional imaging studies such as ultrasound and MRI. Women should consult with their primary care provider to discuss their risks and develop the appropriate screening schedule.
Prostate Cancer Screening
Screening guidelines for prostate cancer are probably the most controversial and depend upon which governing body providing the guidelines. In 2012, the USPSTF recommended against routine prostate cancer screening for several different reasons. As a result of advocacy from several organizations, the USPSTF revised their guidelines in 2018 to say that for men aged 55-69, the decision to screen should be an individual one. The USPSTF and the American Urological Association recognize that for some men, such as African American men and men with a family history of prostate cancer, their risk is higher, and testing may need to reflect their risk of developing prostate cancer. Therefore, men should discuss with their providers about the proper time to begin screening.
Following evidence-based guidelines are important and can potentially be lifesaving. As always, please discuss with your provider for more information.
Denise Hooks-Anderson, M.D., FAAFP is an associate professor and SLUCare Family Medicine interim assistant dean of Diversity Equity and Inclusion.