An overview of cancer screenings, part 2

Hopefully the case has been made in my last post for why diligent cancer screening is imperative for long-term health, and readers were able to gain effective guidelines and insights regarding colorectal and breast cancer screening. Today, we’re going to focus on cervical, prostate, and lung cancer screening guidelines.

3. Cervical

Starting off with cervical cancer, for which we have fairly straightforward recommendations and understanding of the disease. This cancer is strongly associated with infection of a particular virus called human papillomavirus (HPV), and therefore testing for the virus can actually be synonymous with screening according to guidelines. The United States Preventive Services Task Force (USPSTF) guidelines recommend women in their 20s to have a pap test every 3 years, and then from age 30-65 to continue with this pap test every 3 years, or every 5 years if replaced or supplemented with an HPV test. We don't have as much to add or change on this one, as this regimen tends to be highly effective. Pap tests are excellent tests as they are able to directly visualize the cells of the cervix themselves under a microscope to detect cancers.

4. Prostate

It is a real shame that for a while now, prostate cancer screening has been deemed controversial. The reasoning for this is that our biomarker for prostate cancer, prostate-specific antigen (PSA), is not that helpful when interpreted on an absolute basis. This is a test that is highly sensitive but minimally specific. In other words, it is good at picking up cancer when it's there, however it picks up a lot of false positives when interpreted just as the number itself. For this reason, there is no broad-sweeping USPSTF recommendation for all men to engage in PSA-based or any other screening for prostate cancer. Rather, they simply recommend that men aged 55-69 engage in individualized, shared decision-making with their provider to decide if prostate cancer screening is right for them.

In our opinion, prostate cancer screening is generally something that men should be engaging in, and probably starting at a younger age and performed at least every other year. Just because the absolute PSA number alone is not the best test to use, this doesn't mean we should not screen at all for prostate cancer. In reality, things should be looked at like the velocity of PSA change over time, PSA relative to the size of the prostate in the individual, PSA density, free PSA, MRI, etc. PSA screening itself is the bare minimum to detect that something is there, which can then warrant further investigation with tests like MRI and potentially biopsy if necessary to see if the person has the kind of prostate cancer that is harmful. You may recall us previously stating that prostate cancer is incredibly common, but only sometimes clinically relevant, such as when the individual has an aggressive form of prostate cancer. As the old saying goes, “all men will die with prostate cancer, some will die from it." Like colorectal cancer, this is simply another high-death toll cancer that we feel individuals should not be dying from, since we have multiple tools to catch this early and manage it.

5. Lung

The big message here remains first and foremost: do not smoke. According to USPSTF guidelines, lung cancer screening is only indicated for individuals aged 50-80 who are active smokers, former smokers who quit within the last 15 years, or anyone with a 20+ pack-year smoking history. Again, there’s little to add here on the actual screening guidelines, other than they probably could start earlier as we’re seeing increased rates of several types of cancers recently in younger populations. For most cancers, screening is all we can really do for prevention. However, this is an area where we have identified a clear, unambiguous risk factor to avoid. Individuals who smoke have 15-30x the risk of developing lung cancer. Add onto that the fact that lung cancer is the leading cause of cancer death. Plus, besides cancer you have the increased risk of cardiovascular disease–the number one overall chronic killer–with smoking. It should be clear that, while this screening is recommended for those with a smoking history, the first, second, and third best options are to just avoid smoking for lung cancer prevention.

Subscribe to our monthly newsletter

Support our community projects

DISCLAIMER:

All content and information provided on or through this website is for general informational purposes only and does not constitute a professional service of any kind. This includes, but is not limited to, the practice of medicine, nursing, or other professional healthcare services. The use of any information contained on or accessed through this website is at the user’s own risk. The material on this site or accessible through this site is not intended to be a substitute for any form of professional advice. Always seek the advice of a qualified professional before making any health-related decisions or taking any health-related actions. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and should seek the assistance of their healthcare professionals for any such conditions.