Early cancer detection is a way to potentially improve patient outcome. Unfortunately we can not screen for all types of cancer. However we do have good screening tools for certain types. Review of family history, social habits and life style in addition to other risk factors can help tailor a good screening for cancer unique to individual patients.
Breast Cancer
Risk of breast cancer increases with age, increased estrogen exposure, and family history of breast cancer. Self breast exam should be done in all women starting at young age. In patients without risk factor, breast cancer screening using mammogram starts at age 40. The annual mammogram is an important way to screen for this cancer. There are limitation to this test (the test may not detect the mass, and can have low sensitivity based on body habitus or history of breast augmentation). Frequency of testing does not have to be annual and there are certain advantages and disadvantages to testing frequently.
Ultrasound may be used in women with palpable mass who are younger than age 35. It helps distinguish between solid mass versus a cyst (fluid filled mass). It can also help detect if the cyst appears benign or suspicious for cancer.
Colon Cancer
Colon cancer is the third most common cancer, the third leading cause of cancer death in women, and the second leading cause of cancer death in men. It is often a preventable disease if polyps are discovered and remove. Screening in patients without risk factor starts at age 50. There are different methods of screening. The type of screening used depends on patients history, risk factors, and level of comfort.
Colonoscopy
Lesions can be removed during the same procedure. Furthermore, colonoscopy detects proximal lesions that would be missed with sigmoidoscopy. It does have higher risk of perforation and bleed in comparison to the other methods of screening. It is the most invasive of the four recommended options and has the highest sensitivity and specificity to pick up polyps. It is recommended to be done every 10 years for average risk patients without polyps.
Double-Contrast Barium Enema
The lower intestinal mucosa is coated with barium, with multiple radiographs taken under fluoroscopy. Patients must undergo bowel preparation. Sedation is not given.
Sigmoidoscopy
The 60 cm flexible sigmoidoscope can reach to the splenic flexure. Bowel preparation is required. Sedation is not given. Can be done in the office. If a polyp is detected, colonoscopy should be performed.
Fecal occult blood test plus sigmoidoscopy
Testing for occult blood in the stool in addition to sigmoidoscopy improves sensitivity.
Cervical Cancer
Cervical cancer is caused by Human Papilloma virus (HPV) that is transmitted sexually. Therefore, all sexually active women should be screened with pap smear. Currently there is a vaccine, Gardisil, that is offered to women starting at age 9-26.
Prostate Cancer
This is a common cancer found in men. Early detection and monitoring can help prevent metastasis of this cancer. Digital rectal exam and Serum PSA level is used for screening, however this level can be up with infection and benign prostate hypertrophy. If these 2 benign conditions have been ruled out, in order to screen for cancer, patient will be send to urology for prostate biopsy.