Nobody wants to get cancer, however most people would want to know as soon as possible if they have it. As we age, continue to avoid once highly-prevalent infectious diseases, and are now surviving what used to be fatal cardiac events, our risk of getting cancer is increasing. Unfortunately, the area of ‘cancer screening’ is very complex, highly controversial, and constantly changing.
In order to know if, when, how, and how often to screen for cancer, we must perform many long-term research studies in large populations, comparing those with and without cancer, and those who have or have not undergone conventional treatment for their disease. In some cases cancer screening is helpful, as it identifies early-stage tumors that can be treated immediately, leading to reduced risk of recurrence and prolonged duration and quality of life. However, in other cases, cancer screening is detrimental, as it may lead to over-treatment of early cancers that otherwise may not have progressed, resulting in significant side effects, and possibly reduced quality of life, sometimes permanently. This is complicated when we begin to question the exact method of screening for cancer, and compare tools in terms of rates of false positive and false negative findings.
Routine guidelines for cancer screening will vary based on the organization. Generally, the United States Preventive Services Task Force (USPSTF) serves as a gold standard in assessing evidence for and against cancer screening. Clinical research and guidelines are continuously being re-assessed and updated; however, current USPSTF guidelines support the screening of five cancer types (breast, cervical, colorectal, lung, and prostate), which we will discuss below. These guidelines apply to otherwise healthy, asymptomatic individuals, who have not had cancer before.
Breast Cancer (as of 2009):
- For women aged 50 to 74 years, the USPSTF recommends screening by mammography every 2 years
- Screening may be initiated before the age of 50, if there is significant evidence to suggest increased risk (such as other estrogen-sensitive cancer, positive family history, or BRCA-gene testing)
- Currently, there is insufficient evidence to assess the potential benefit or harm in screening by mammography after the age of 75
- Breast screening by self-examinations (BSE) is currently NOT recommended
- There is currently insufficient evidence to assess potential benefit and harm of clinical breast examination (CBE), in addition to mammography, in women 40 years or older
- There is currently insufficient evidence to assess potential benefit and harm of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography
- Breast thermography is currently NOT recommended by Health Canada as a valid or reliable screening tool
Cervical Cancer (as of 2012):
- For women aged 21 to 65 years, screening by cytology (Pap smear) is recommended every 3 years
- For women aged 30 to 65 years, the screening interval may be extended to every 5 years if human papillomavirus (HPV) testing is performed in addition to cytology (Pap smear) and found normal
- Screening (HPV testing or Pap smear) is NOT recommended for women younger than 21 years
- Screening is NOT recommended after the age of 65 years, unless there is evidence of previous abnormal findings or a high-risk individual
- Screening by HPV testing, alone or in combination with cytology (Pap smear), is NOT recommended in women younger than 30 years of age
Colorectal Cancer (as of 2008):
- For adults aged 50 to 75 years, screening is recommended via fecal occult blood testing, sigmoidoscopy, or colonoscopy; the frequency of screening depends on clinical findings and other known risk factors
- Routine screening is NOT recommended after the age of 75 years
- There is insufficient evidence to assess potential benefit and harm of computed tomographic (CT) colonography and fecal DNA testing as screening modalities
Lung Cancer (as of 2013):
- For adults aged 55 to 80 years with a 30 pack-year history of cigarette smoking, and who currently smoke or have quit in the past 15 years, screening is recommended annually via low-dose computed tomography (CT) scan
- Screening is NOT recommended for non-smokers, or those who have quit more than 15 years ago
Prostate Cancer (as of 2012):
- Routine prostate cancer screening, via measurement of prostate-specific antigen (PSA), is NOT recommended
- Clinicians are encouraged to consider family history, symptomology, and physical (digital rectal) examination findings in assessing the potential risk of prostate cancer
Of course, every patient is unique and different. In a naturopathic visit, we discuss your overall health history, but also consider various risk factors for cancer, such as dietary and lifestyle factors, environmental factors (such as household and/or workplace exposure to toxic chemicals, pollutants, and heavy metals), social factors (such as sexual health history, cigarette smoking, alcohol use, and recreational drug use), genetic factors (such as BRCA testing), and family history. It is your naturopathic doctor’s job to combine this information with your current presenting health status when considering the possibility of cancer. Not every patient with cancer will have the typical signs or symptoms, and some patients with many risk factors may still never develop cancer.
For more detailed information about these screening recommendations, visit the USPSTF website at www.uspreventiveservicestaskforce.org/. For a complete health and cancer risk assessment, contact me for more information! I offer free 15-minute phone consultations.