Cancer is the second leading cause of death in this country exceeded only by heart disease. According to Cancer Facts & Figures 2021 published by the American Cancer Society, in 2021, there were an estimated 1.9 million new cancer cases and 608,570 deaths.
The disease is more common among white people, but the death rates are higher among Black people. Yet, the news is promising. Although the number of deaths remains high, it is on the decline. The most recent Annual Report to the Nation shows that from 2014 to 2018, overall cancer death rates decreased by 2.2% per year among men and 1.4% per year among women. The report is jointly issued by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute and the North American Association of Central Cancer Registries.
The improvement is due largely to improved detection and treatment. Screening tests are available for 48% of all cancers diagnosed each year ─ breast, prostate, lung and colon. Most screenings detect cancer in the early stages when treatment is more successful. The tests for colon and cervical cancer, however, can actually prevent cancer. They can detect changes in cells allowing removal of suspicious tissue even before a malignancy begins.
Below are the up-to-date recommendations for available cancer screenings. Keep in mind that these are suggestions only. Individual circumstances and risk factors may require different guidelines. Regardless of the schedule followed, for most plans the Affordable Care Act mandates screenings at no cost to consumers.
Digital mammograms called tomosynthesis, or 3D, are the recommended tests for breast cancer. Research suggests that 3D mammograms may be more effective not only in earlier detection of small breast cancers but also in greater accuracy pinpointing the size, shape and location of abnormalities. 3D technique may decipher abnormalities in dense breast tissue more clearly and reduce the rate of breast biopsy.
- Age 45 to 54: Yearly mammograms
- Age 55 and older: Mammograms every two years or continue yearly screening
Screening should continue if a woman is in good health and is expected to live 10 years or longer.
Pap tests, or Pap smears look for abnormal changes in the cervix, while the HPV test looks for human papilloma virus, the leading cause of cervical cancer.
- Age 25 to 65: Begin screening. Three choices are offered:
- Primary HPV test every five years, or
- Co-test of HPV test and Pap smear every five years, or
- Pap smear alone every three years.
- Age 66 and older: Discontinue screening in women who have had regular cervical cancer testing in the past 10 years with normal results. Women with a history of a serious cervical pre-cancer should continue testing even past age 65.
- Hysterectomy with removal of the cervix: No screening is required if no history of cervical cancer
- Hysterectomy without removal of the cervix: Continue cervical cancer screening according to the guidelines above.
People who have been vaccinated against HPV should still follow the guidelines for their age groups.
Yearly lung cancer screening with a low-dose CT scan is recommended for certain people at higher risk for lung cancer who meet the following conditions:
- Aged 50 to 80 years and in fairly good health, and
- Currently smoke or have quit smoking in the past 15 years, and
- Have at least a 20 pack-year smoking history. A pack-year is one pack of cigarettes per day per year. For example, one pack per day for 20 years or two packs per day for 10 years would both be 20 pack-years.
Men of average risk can follow the guidelines below. Black men and those with a history of prostate cancer are advised to initiate screening at age 40. The tests are PSA (prostate-specific antigen) and DRE (digital rectal exam).
Age 45 to 75
- PSA < 1 and a normal DRE if done: Repeat testing every two to four years
- PSA 1-3 and a normal DRE if done: Repeat testing every one to two years
- PSA >3 or a very suspicious DRE: Evaluate for biopsy
Age 75 and older
- PSA <4 and a normal DRE if done: Repeat testing every one to four years
- PSA >4 or DRE results are very suspicious: Evaluate for biopsy
Regular screening for colon cancer should start at age 45. Some tests look for signs of cancer in a person’s stool, while others visually examine the colon and rectum. Your health care provider can best advise which one works best for you. Colonoscopy is considered the gold standard of testing. Colonoscopy allows not only a view of the entire colon, but also the removal of polyps before cancer develops.
- Fecal immunochemical test (FIT) every year
- Guaiac-based fecal occult blood test (gFOBT) every year
- Stool DNA test (MT-sDNA) every 3 years
Visual exams of the colon and rectum
- Flexible sigmoidoscopy every 5 years
- Colonoscopy every 10 years
- CT colonography (virtual colonoscopy) every 5 years
If you choose to be screened with a test other than colonoscopy, any abnormal test result needs to be followed up with a colonoscopy.
If you’re in good health, you should continue regular screening through age 75. For people ages 76 through 85, talk with your health care provider about whether continuing to get screened is right for you.
People over 85 should no longer get colorectal cancer screening.
The bottom line
According to the American Cancer Society, if you combine screening with healthy lifestyles, such as not smoking, physical activity, good nutrition and healthy weight it is possible to prevent 42% of the cases of cancer.
Resources: American Cancer Society, National Comprehensive Cancer Network