Cancer Screening program for women

Last updated date: 31-Jan-2023

Originally Written in English

Cancer Screening program for women

Overview

Screening tests are an essential component of your healthcare. They are typically able to detect cancer in its early stages, long before any symptoms are apparent. Women should have specific cancer screening tests performed. Each is quite effective and is suggested for all girls, while certain tests are only conducted at specific ages. Learn what to obtain and when to get it so you can play a more active part in your healthcare.

 

Breast Cancer Screening Guidelines

Breast Cancer Screening

Breast cancer is the most frequent cancer in women and the second leading cause of cancer mortality in the United States. Female breast cancer incidence was dropping prior to 2004, but has since climbed at a rate of 0.4 percent per year on average. 

Following an initial fall in the early 2000s due to the discontinuation of hormone replacement treatment, the period from 2004 to 2014 showed an increase, which may be linked in part to the obesity epidemic. Because mammography rates remained unchanged throughout the same time period, the recent increase in incidence cannot be attributable to enhanced detection by mammography.

However, because to breast cancer screening, the majority of cases are discovered at stage I illness, which has a 100% 5-year survival rate. Between 1989 and 2015, there was a 39% decrease in breast cancer mortality. Since 2007, the death rate for women over the age of 50 has been decreasing, while it has been stable for those under the age of 50. Breast cancer screening techniques include mammography, MRI breast, ultrasound of the breast, and self-examination.

According to the United States Preventive Services Task Force (USPSTF) guidelines, women aged 50 to 74 years should have biennial screening mammography, whereas women aged 40 to 49 years should make their own decision because the reduction in breast cancer death is less than the rate of false-positive results and unnecessary biopsy.

This also raises the possibility of overdiagnosis and therapy. This is in contrast to the American Cancer Society's (ACS) recommendations, which strongly suggest yearly mammography beginning at the age of 45. Mammography should be administered to women between the ages of 40 and 44. In women over the age of 55, the ACS also advises a shift to biannual screening or the option to continue screening yearly. Women should not stop having screening mammograms after the age of 75 if their overall health is good and they have a life expectancy of 10 years or more.

According to the USPSTF guidelines, there is insufficient evidence to assess the balance of benefit and harm in women aged 75 years or older, which is the same in women with negative mammograms due to dense breasts, the use of Ultrasound of the breast, MRI breast, and other modalities.

If you have a family history of breast cancer or a personal health history that raises your risk (radiation exposure, genetic mutation, etc.), chat with your clinician about starting mammograms early. The American Cancer Society now advises an annual breast MRI and mammography for women who:

  • Carry a known BRCA 1 or 2 mutation or have a first-degree relative with a BRCA1 or BRCA2 gene mutation but have not been tested themselves, 
  • Those with a lifetime risk of breast cancer that is higher due to a family history of breast cancer. 
  • Have Li-Fraumeni, Cowden syndromes or a first-degree relative with one of them. 

 

Women with High Risk: 

As per ACS guidelines published in 2007, annual mammography with MRI for women with increased risk. This group includes:

  • Women with a known BRCA mutation,
  • Women who have not tested but have a first degree relative with a BRCA mutation, or
  • Women with a 20% to 25% or
  • Higher lifetime risk of breast cancer as predicted by breast cancer risk-estimation models

 

Cervical Cancer Screening Guidelines

Cervical Cancer Screening

Cervical cancer is the second greatest cause of cancer mortality in women aged 20 to 39 years. Cervical cancer was diagnosed in 569,847 women worldwide in 2018, with 311,365 women dying as a result. Cervical cancer is caused by persistent HPV infection. In the previous three years, roughly 80% of women between the ages of 21 and 65 had pap tests. 

HPV test

HPV vaccination also protects against nine forms of HPV and so prevents around 90% of cervical, anal, vulvar, and vaginal malignancies. However, immunization rates among teenage girls and boys remain low. Cervical cancer screening tests include the Pap test, Pap test with HPV co-testing, and high-risk HPV testing solely.

As per USPSTF Guidelines, women aged 21 to 29 years should get cervical cytology every three years. In the age group of 30 to 65 years, screening can be continued with cervical cytology alone every three years or with high-risk HPV testing every five years or only hrHPV test every five years. USPSTF recommends against screening for women less than 21 years of age, in women who have had a hysterectomy with cervix removal and do not have a history of a high-grade precancerous lesion or cervical cancer and in women older than 65 years if prior screening has been adequate and is not high risk for cervical cancer. 

the guideline of American Society of Clinical Pathology screening recommends that women with Atypical squamous cells of undetermined significance (ASC-US) with negative HPV should get the repeat screening in 3 years. HPV vaccination status does not influence the screening practice. 

After age 65, screening can be discontinued if women have had 3 consecutive negative cytology tests or 2 consecutive negative co-test results in the last 10 years before discontinuing screening, with the latest test done within the last 5 years. Women with ASC-US and HPV negative results should be considered as negative to discontinue screening.

Once screening is ceased, it should not be restarted for any reason, including a woman with a new sexual partner. After spontaneous resolution or pertinent management of cervical intraepithelial neoplasia 2 (CIN2), CIN3, or adenocarcinoma in situ, routine screening should not be discontinued for at least 20 years even if this extends beyond age 65 years.

 

Endometrial Cancer Screening

The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, especially those with a history of hereditary non-polyposis colon cancer, may want to consider having a yearly endometrial biopsy starting at age 35. Please talk with your provider about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

 

Colon and Rectal Cancer Screening

Most men and women over the age of 45-50 should undergo routine screening for colon and rectal cancer, up until age 75. The American Cancer Society suggests starting screening at age 45 whereas the United States Preventive Services Task Force suggests starting at age 50. Insurance may not cover screening before the age of 50 so you should talk with your provider and insurance company before screening. Testing may be appropriate for younger people with a high-risk personal or family health history. 

Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). 

The preferred screening recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 45 unless you are considered high risk, using one of the following testing schedules:

Tests that find polyps and cancer:

If any of these tests are positive, a colonoscopy should be done:

  • Flexible sigmoidoscopy every 5 years, or
  • Colonoscopy every 10 years, or
  • CT colonography every 5 years

 

Tests that primarily test for cancer:

  • Yearly guaiac-based fecal occult blood test (FOBT), or
  • Yearly fecal immunochemical test (FIT), or
  • Stool DNA test (sDNA), every 3 years

The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

  • People who have a family history of colon or rectal cancer.
  • People who have a history of polyps.
  • People suffering from inflammatory bowel illness (Crohn's disease or ulcerative colitis).
  • Individuals who have a hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome, which predisposes them to colon or rectal cancer.
  • Individuals who have had radiation to the abdomen or pelvic region to treat a previous malignancy.

 

Lung Cancer Screening

Screening is not generally suggested for persons who are at moderate risk. The US Preventative Task Force, on the other hand, has screening criteria for people who are at high risk of lung cancer as a result of cigarette smoking. If you match the following criteria, screening may be suitable for you:

  • 50 to 80 years old and in quite excellent health
  • Smoke now or have quit within the last 15 years.
  • Have a smoking history of at least 20 pack-years (A pack-year is the number of cigarette packs smoked per day multiplied by the number of years a person has smoked). A person who smoked a pack of cigarettes per day for 20 years has a 20 pack-year smoking history, as does someone who smoked two packs per day for ten years).
  • If they are current smokers, they have had smoking cessation therapy.

An annual low-dose CT scan (LDCT) of the chest is used for screening. If you fulfill the criteria above, you and your physician should discuss whether you want to begin screening. Low-dose CT scans include risks, advantages, and restrictions that you should explore with your healthcare provider.

 

Sun Exposure and Skin Cancer Risk

Skin cancer

Skin cancer is the most frequent kind of cancer, and its prevalence is increasing. However, it is one cancer that, in the majority of instances, may be avoided or discovered early. While it is true that you need the sun to produce vitamin D, you just need a few minutes every day to do so. Skin cancer can be caused by exposure to ultraviolet (UV) radiation, which can occur from natural sunshine or tanning beds.

UV radiation also cause wrinkles, loss of skin suppleness, dark patches (also known as age spots or liver spots), and pre-cancerous skin alterations (such as dry, scaly, rough patches). Although dark-skinned persons are less prone to acquire skin cancer, it can and does occur, most commonly in places that are not exposed to sunlight (on the soles of the feet, under nails, and genitals).

There are several things you can take to protect yourself from harmful UV radiation and to diagnose skin cancer early. Begin by practicing sun safety, which includes applying a broad-spectrum sunscreen that protects against UVA and UVB rays every day, avoiding peak sun hours (10 a.m.-4 p.m.), and wearing protective clothing such as hats, sunglasses, and long-sleeved shirts.

Examine your skin on a daily basis to become acquainted with any moles or birthmarks. If a mole has altered in any manner, you should have it examined by a healthcare expert. This includes a change in size, shape, or color, the appearance of scaliness, bleeding, oozing, itching, or discomfort, or the formation of a persistent sore. If you have a lot of moles, it may be useful to keep track of them using pictures or a "mole map." 

 

Clinical Significance

Clinical Significance

Screening for cancer is undertaken in an otherwise healthy population when the risk of overdiagnosis and overtreatment is warranted. Cervical cancer screening has reduced the incidence and fatality rates associated with the disease.

Cancer mortality in the United States has fallen by 25% between 1990 and 2015. The death rates for colon cancer (47 % in males and 44 % in women) and breast cancer have both decreased significantly (39 percent in women). This can be due in part to the implementation of cancer screening for colorectal and breast cancer.

The five-year survival rate for early-stage breast, cervical, and colorectal cancer ranges from 84 percent to 93 percent. However, several studies have found that certain segments of the community are unaware of the benefits of cancer screening. Community outreach activities that raise cancer awareness and encourage individuals to talk to their doctors about cancer risk and screening will be extremely effective.

 

Can Cancer Be Detected in a Blood Test?

Cancer screening test

Researchers are aiming to develop a blood test that can detect many forms of cancer. The test searches for protein markers and DNA fragments known as circulating tumor DNA in the blood. The test diagnosed cancer with a sensitivity of 69 percent to 98 percent (depending on the kind of cancer) and a specificity of 99 percent, according to the results.

The highest precise findings were obtained for detecting ovarian and colorectal malignancies. The liver and lung malignancies had the least accurate results. The researchers conclude that, while the test was not flawless, it was a step in the right direction. They intend to develop a single blood test that can identify several forms of cancer in the future; for the time being, the test is only accessible in research trials.

 

Conclusion

Stop cancer

Cancer screening tests are intended to detect cancer or pre-cancerous regions before symptoms appear and, in general, when treatments are most effective. Women's cancer screening recommendations have been produced by a number of organizations. While these guidelines varied significantly amongst groups, they all cover the same basic screening tests for breast, cervical, and colorectal cancers and advocate starting as early as the late teens.