Cancer screening saves lives. Despite this, screening for cancer is not utilized as widely as recommended in the United States. In liver disease, patients with cirrhosis of any cause should be screened regularly with imaging and a blood test called an alpha-feta-protein or AFP. Any imaging modality such as ultrasound, CT scan or MRI is acceptable and the appropriate screening interval is every six months. When small cancers are found, they are readily treatable and screening regimen has been shown to save lives. There are some liver conditions, however, such as hepatitis B and non-alcoholic steatohepatitis, where screening for liver cancer should be undertaken even in the absence of cirrhosis. This screening should also be at an interval of every six months.
Colon cancer is a preventable cancer and a cancer that if found early, can be easily treated with excellent survival rates. The screening method of choice for colon cancer is colonoscopy as it is both a diagnostic and therapeutic test. Colonoscopy is able to find polyps and cancers and therefore it can be a preventative test as well. Stool testing, such as fecal occult blood testing and stool DNA, screen for colon cancer, not polyps. If either of there tests are positive, a colonoscopy is recommended. Regarding colonoscopy, the current recommendation for colon cancer screening is a colonoscopy starting at age 50 for all persons in the United States except for African-Americans who should begin colon cancer screening at age 45. Pre-malignant polyps found at colonoscopy can be removed and therefore cancer prevented. The timing of a second colonoscopy is dependent upon the findings at the initial colonoscopy and varies from repeating the test in one to 10 years. In special circumstances such as a family of history of colon cancer in a first-degree relative, a history of inflammatory bowel disease or a history of a hereditary polyposis syndrome, colon cancer screening may begin earlier than age 50. There appears to be a trend of an increased incidence of colon cancer in people younger than age 50. While screening is not recommended younger individuals, anyone with symptoms such as bright red blood per rectum or a change in bowel habits should undergo colonoscopy regardless of age.
Breast cancer is the most common cancer affecting women. When found early, the prognosis of breast cancer is excellent. Mammography is the method of choice for breast cancer screening. The current recommendation for screening for breast cancer is a mammography every year starting at age 40. In addition, a clinical breast exam should be performed every three years for women in their twenties and thirties and yearly starting at age 40. For certain women at high risk for breast cancer, an MRI is recommended for screening. Women at high risk for breast cancer include those with a family history of breast cancer, those with a BRCA1 or 2 mutation, and those with a history of radiation to the chest between the ages of 10 and 30. The difference in breast cancer survival between early and late detection is dramatic and following the American Cancer Society guidelines listed above cannot be over emphasized.
Skin cancers are the most common cancers diagnosed in the United States each year. The best screening for skin cancer is self-examination. If any changes are noted in your skin, you should seek medical attention. Although not recommended in a guideline, I am a firm believer in having a routine total body skin examination performed by a dermatologist every one to two years.
There are several other common cancers for which screening is recommended. These include prostate and cervical cancer.
Prevention and early detection are the keys to cancer care. I encourage all people to follow these guidelines and get tested. When found early, all of these cancers are treatable with excellent survival. When found late, none of these cancers have good outcomes. Please take control of your health and be pro-active. Several simple steps can improve your health and prevent cancer. These include staying away from tobacco, exercising regularly and avoiding becoming overweight, eating healthy, minimizing sun exposure, knowing yourself and your family history and have regular check-ups and cancer screening tests.
David Bernstein, MD, FAASLD,FACG, AGAF, FACP, is the chief of hepatology at Sandra Atlas Bass Center for Liver Diseases and a professor of medicine at Hofstra-Northwell School of Medicine.