General

Cancer has become one of the leading health care problems in the United States, both in men and women. In an effort to diagnose cancer at an early stage and in some cases to prevent cancer, the American Cancer Society and National Cancer Institute have recommendations for cancer screening for women. The screening recommendations and basic cancer facts are discussed below.

Breast Cancer

Background: Breast cancer is the most commonly diagnosed cancer in women today and is the second most common cause of cancer-related deaths. One in nine women will be diagnosed with a form of breast cancer in her lifetime. Risks include the following:

• a family history of breast cancer in a first-degree relative (mother, sister, daughter)
• increased age
• early-onset menarche (menses) and late menopause (average age: 52)
• no pregnancies or pregnancy at a later age.
• Diet- and alcohol use have questionable effects on the development of breast cancer, and the use of estrogen post-menopausal is still controversial.

Screening is vital as early detection plays a vital role in the success of therapy.

Screen: Current recommendations are to begin monthly self breast exams at age 18-20. A woman in this age group should also receive a breast exam from a qualified practitioner every three years. At age 40, she should continue self-exams but receive annual exams from a health care practitioner in addition to receivimg a mammogram every 1-2 years. There is no specific age cut-off for mammograms; this is a decision that should be made by the individual and her physician. If there is a family history of early breast cancer (prior to age 40), a baseline mammogram should be obtained earlier than age 40; the exact time is still debated but generally should be at least by age 30.

Cervical Cancer

Background: The use of the Papanicolaou (Pap) smear for widespread screening for cervical cancer has resulted in a dramatic decline in death rate from uterine cancer; there has been a decrease of 70% over the past 40 years since the use of routine Pap testing. Early detection of cancer and precancerous changes actually allow the potential for 100% of cervical cancers to be cured, with use of cryosurgery (freezing) and electrocautery excision. Risk factors for cervical cancer include multiple sexual partners, early age of first sexual encounter, and tobacco use.

Screen: Current recommendations are to have Pap smears yearly starting at age 18 or when sexual activity begins. After three consecutive normal Pap results, the Pap test can be done every 2-3 years, as long as the results remain normal. If an abnormal result occurs, depending on the exact abnormality, the patient will be advised to repeat the Pap smear sooner or possible be referred for a Colposcopy. After an abnormal test, a woman should have yearly Pap smears. There is no universally recommended age to stop taking pap smears, although many institutions feel the risk of cervical cancer is so low after age 65 that Paps are not necessary.

Colon Cancer

Background: Cancer of the colon and rectum is now the third most common cancer in women. Fortunately, there are screening tests that are helpful with early diagnosis.

Screen: Starting at age 40, a rectal exam by a health care provider should be done yearly. At age 50 it is recommended that one have a flexible sigmoidoscopy, a procedure in which a flexible scope is inserted into the rectum to view the inside of the colon. Flexible sigmoidoscopy (flex sig) should be repeated every 3-5 years, along with yearly hemoccult cards, a test in which the patient places stool samples on a special card that allows health care providers to check for blood that may not be visible to the patient. If abnormalities-such as polyps, which can be pre-malignant-are seen on flexible sigmoidoscopy, they are removed and a longer scope, or colonoscopy, is advised. This scope allows viewing of the entire colon. A colonoscopy is advised instead of screening flex sig if one or more of the following conditions are present:

• patient has blood in her stool, either visible or detected on the hemoccult cards
• polyps are detected on flex sig
• patient has a family history of colon cancer

For individuals with a first-degree relative with early colon cancer, screening should begin at an age 10 years younger than the relative’s age at diagnosis. (For example, if the relative was diagnosed at age 50, screening begins age 40). There is no blood test useful in screening for colon cancer.

Ovarian Cancer

Currently there is no screening test for ovarian cancer. A blood test is available to look for a cancer marker (CA-125), but this is usually elevated only when the cancer is already more advanced so it is not a good screening test. Unfortunately, ovarian cancer is the sixth most common cancer in women but is usually silent at onset and often diagnosed when already in an advanced stage.

Lung Cancer

Lung cancer is the most common cause of cancer-related deaths in women, although it is second on the list of cancers diagnosed, behind breast cancer. Tobacco use remains the most significant risk for developing lung cancer, increasing with the number of years and amount of cigarettes smoked. After quitting, the risk declines and is equal to a lifelong non-smoker after 15 years of abstinence. There is no good screening test for lung cancer. Studies have looked into the use of routine chest x-rays or CT scans in smokers, but the results to date have been disappointing. By the time a cancer is seen on a x-ray, it is often already fairly advanced. Smoking cessation remains the best preventive measure.