Despite the fact that the Affordable Care Act eliminated much of the expense for breast, cervical and colorectal screenings for cancer, the Center for Disease Control(CDC) reports the number of adults undergoing the screening in the U.S. has not increased. The data was collected by the CDC using the National Health Interview Survey(NHIS) where 61.5% of adults responded. (This survey is done annually). According to those surveyed, women were more likely to go for a mammogram than a pap smear or colonoscopy. Those without health insurance or without a regular Healthcare Provider were more likely to skip the recommended cancer screenings. These individuals who skipped the screenings were also more likely to have an advanced form of cancer when they did decide to seek medical care.
Representatives from the American Cancer Society and the U.S. Preventive Services Task Force(USPSTF) recently met and updated cancer screening recommendations this year. Healthy People 2020 is a government program based on the most recent guidelines formulated by these two groups for early detection and prevention of cancer in both men and women.
Here is a summary and explanation of their current recommendations:
-Breast self-awareness should be taught in the teenage years and may be used to detect cancer.
-Annual breast cancer screening is determined by a patient’s risk, personal and family history. This usually begins at the age of 40. Breast cancer is the most common cancer in women and affects 1 in every 8 women. It can also be found in men. There are hereditary breast and ovarian cancer syndromes that run in families that are linked to mutations in two genes called BRCA1 and BRCA2. Inheriting one of these mutations increases the risk of getting breast, ovarian and other types of cancer. Individuals who screen positive for this mutation will need to have annual mammograms and breast MRI’s starting in their 20’s based on the youngest person to have breast cancer in the family. These patients should also be offered an annual pelvic ultrasound and a CA 1-25 blood test.( This is a substance made by the ovarian cancer cells.)
-Health care providers should discuss breast cancer screening with all patients. High risk patients should have a mammogram every year. For average risk women between the ages of 50-74, it may be appropriate to have a mammogram every two years.
-Pap smears with co-testing for the HPV virus that causes cervical cancer should begin at the age of 21. The frequency of follow up pap smears will be determined by these results. If a woman has never had an abnormal pap smear and has been negative for the HPV virus, this screening may stop at the age of 65. If a woman has had her cervix removed with a hysterectomy for benign reasons, this screening can stop after the hysterectomy. If a woman still has her ovaries after the hysterectomy, however, a yearly pelvic exam is needed. A vaccine to prevent HPV induced cancers is available to both men and women and is given between the ages of 9-26. The long term efficacy of this vaccine in prevention of cancer has not yet been established.
-Endometrial cancer is the most common pelvic cancer in women. Any woman with abnormal uterine bleeding should be offered a pelvic ultrasound and an endometrial biopsy if indicated. This cancer usually occurs in women over the age of 50, but may occur in younger women who have chronic hormone imbalance due to obesity, polycystic ovaries, taking estrogen without taking progesterone, and taking Tamoxifen to prevent recurrence of breast cancer. Screening may start earlier in individuals with “Lynch Syndrome”, an inherited disorder that presents with polyps in the colon that can turn to colon cancer at a young age. Women with this disorder are more susceptible to developing endometrial and other cancers. These women may be offered screening with pelvic ultrasound and endometrial biopsy by the age of 35.
-Testing stool for blood should be done every year and when to start in the adult years will depend on the patient’s personal and family history. This usually starts at 35-40 . For those between the ages of 50-75, colonoscopy is recommended every 10 years or sooner depending on risk, personal and family history.
-The big news in lung cancer prevention is screening and smoking cessation. If you are between the ages of 55 and 80 and have a 30 pack year history of smoking, or quit in the past 15 years, your Provider may recommend a chest x-ray or other testing.( Pack year history is the number of packs of cigarettes smoked per day time the number of years you have smoked).
-Screening for skin cancer and melanoma can be done at your annual exam or by a Dermatologist. Any raised, darkened, irregular or spreading lesions should be evaluated ASAP. The use of sunscreen SPF 15 or higher is recommended to protect the skin.
Ladies and Gentlemen of Richland County, be proactive and don’t become a statistic. See a Provider for your annual exam and find out what preventive screens are appropriate for you! The Richland Center Medical Staff is your Home Town Team and we are hear for you!
Janice H. Alexander, RN,MD