What is Cancer Screening?

Cancer screening is a diagnostic procedure done on healthy individuals who are at risk of developing certain cancers. It can help find cancer at an early stage before symptoms appear. When abnormal tissue is found early, it may be easier to treat.

By the time symptoms appear, the cancer may have grown and spread, making the cancer hard to cure or impossible to treat. In other words, finding it early and starting treatment immediately may prevent the cancer from causing suffering and death.

It is important to remember that when your doctor suggests a screening test, it does not always mean you have cancer. If your screening test shows an abnormality, more tests may be needed to confirm if you indeed have cancer to facilitate prompt treatment. If no abnormal findings are found, screening tests may be repeated at certain time intervals, depending on the doctor’s recommendations.

Cancer Screening tests by Site

LUNG CANCER

Who should undergo lung cancer screening?

• High risk individual
• Men and women ≥ 55 years old
• has smoked ≥ 30 pack years (present or the past 15 years)
• High risk individual
• Men and women ≥ 50 years old
• has smoked ≥ 20 pack years (present or the past 15 years)
• has one additional risk factor
• Exposure to hazardous compounds such as: Radon, Silica, Cadmium, Asbestos, Arsenic, Beryllium, Chromium, Nickel, diesel fumes, coal smoke, and soot
• with prior cancer diagnosis, emphysema, or lung scar
• family who had lung cancer
• Smoking pack years = number of packs per day × years of smoking
• For example: 1.5 packs (or 30 sticks) per day × 20 years = 30 pack years

Screening test for lung cancer

• Low dose computed tomography (LDCT) of the chest- This test detects small and faint abnormalities that may not be seen by chest X-ray. LDCT is not invasive and the amount of radiation is lower than the usual doses of regular CT scans. Screening of high risk individuals, even those without symptoms, can detect lung cancer in its early, curable stages. Studies have shown that the number of people who die from lung cancer have decreased due to screening and it is recommended that high risk individuals undergo LDCT every year. Patients in whom abnormalities are detected are advised to consult a doctor.

Talk to your doctor about Lung Cancer screening.

BREAST CANCER

Who should undergo breast cancer screening?

Women aged 40 and above should undergo breast cancer screening. It may also be recommended for women younger than 40 when there is an increased risk of getting breast cancer.

Risk factors for breast cancer include:

• Aging (risk increases as you get older)
• Family history of breast cancer
• Personal history of breast cancer
• Early onset of menstruation (before age 12)
• Late menopause (after age 55)
• Previous chest radiation as treatment for another cancer
• Having a first live birth after the age of 30
• Continuous use of oral contraceptive for prolonged uninterrupted duration
• Use of combined hormonal replacement therapy (HRT) after menopause
• Excessive weight gain in postmenopausal women

Screening Tests for Breast Cancer

• Clinical breast examination (CBE) - this procedure includes visual inspection and physical examination of both breasts and underarm areas for changes. Women in their 20s and 30s should have CBE as part of a regular health exam by a health professional preferably every three years. Starting at age 40, women should have CBE by a health professional every year.
• Screening mammogram- this is an X-ray of the breast for women who have no signs or symptoms but are risk for breast cancer. It involves taking an X-ray with two views of the breast. The aim of Screening Mammogram is to detect changes seen on the Xray films, such as microcalcifications (tiny deposits of calcium in the breast) that cannot be palpated but may indicate breast cancer.

Mammography however is not very sensitive in subsets of females with greater density of breast tissue such as in;

• Females aged less than 40
• Asians
• Females with dense breasts
• Post-menopausal or combined hormonal replacement therapy (HRT)
• Females with naturally dense breasts
• Females with breast implants

These women may still undergo breast cancer screening using other modalities like breast ultrasound or breast MRI as deemed necessary by the Breast specialist.

Talk to your doctor about Breast Cancer screening.

COLORECTAL CANCER

Who should undergo colorectal cancer screening?

• Men and women 50 years old and above; screening may be performed on men and women who are younger and who have a higher than average risk of getting the disease based on family history
• Anyone with at least one first-degree relative with colorectal cancer
• Anyone with a history of polyps or inflammatory bowel diseases like Ulcerative Colitis and Crohn’s disease
• Patients with a personal history of colorectal cancer, cancer of the endometrium (uterus), or cancer of the ovary

Screening Tests for Colorectal Cancer

Your doctor may suggest one or more of the following tests for colorectal cancer screening:

• Fecal occult blood test (FOBT) – this test detects hidden blood in stool samples. FOBT is less invasive but it does not allow direct visualization of the lining of the colon and rectum. It has been recommended that FOBT be done every year along with sigmoidoscopy to help reduce the number of deaths due to colorectal cancer. FOBT using immunochemical tests are best repeated yearly after age 50. If the test is positive for blood, colonoscopy is recommended.
• Colonoscopy- this test allows the doctor to examine the rectum and the entire colon using a scope. During the procedure, pre-cancerous and cancerous growths may be found, biopsied or removed. A normal colonoscopy may need to be repeated after five to 10 years.
• Flexible sigmoidoscopy- this is an alternative to colonoscopy if the latter cannot be performed. This involves visualization of the rectum and only the lower colon. Biopsies or removal of polyps or tumors can still be done but abnormal growths in the upper colon may be missed. A normal sigmoidoscopy may need to be repeated every three to five years. An abnormal sigmoidoscopy will need a full colonoscopy.

Talk to your doctor about Colorectal Cancer screening.

CERVICAL CANCER

Who should undergo cervical cancer screening?

Regular screening for cervical cancer is recommended for all women starting at the age of 21 years old.

Risk factors for cervical cancer include:

• Multiple sexual partners
• Intercourse at a very young age
• Smoking
• High number of pregnancies
• Long term use of oral contraceptives
• Sexually transmitted infections

Screening Tests for Cervical Cancer

• Pap smear- during the test, your doctor brushes cells from your cervix - the narrow neck of the uterus - and sends the sample to a laboratory to be examined for abnormalities.
• HPV DNA tests-these tests will determine if you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer.

Talk to your doctor about Cervical Cancer screening.

PROSTATE CANCER

Who should undergo prostate cancer screening?

It is recommended that a baseline PSA, along with digital rectal exam (DRE) is done starting at the age of 40.

Screening Tests for Prostate Cancer

• Digital rectal examination (DRE) is a quick way for your urologist to physically examine the prostate. A lubricated gloved finger is inserted in the anus and the prostate is palpated to assess its size and character, specifically looking for lumps and hard areas which are characteristics of cancer.
• Prostate-specific antigen (PSA) is a substance produced by the prostate gland. The PSA level is determined through a blood test. It is an important marker of several prostate diseases, including prostate cancer.

Where can I go for cancer screening?

Cancer screenings can be done at The Medical City as they are supervised by well- trained and professional medical practitioners. More importantly, the implications of whatever results obtained can be competently discussed with you by the doctors.

You can contact the Cancer Center for more information and scheduling of your screening tests.

EARLY WARNING SIGNS OF CANCER

• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or any other part of the body
• Indigestion or difficulty in swallowing
• Obvious change in a mole or wart
• Nagging cough or hoarseness of voice
• Weight gain or weight loss with no known reason
• Feeling weak or very tired

Most often, these symptoms are not due to cancer. They may also be caused by other problems. Only a doctor can tell for sure. Anyone with these symptoms or other changes in health should see a doctor to diagnose and treat problems as early as possible.

For more information, please call or visit:

The Cancer Center

8/F Nursing Tower B, The Medical City
Ortigas Ave, Pasig City
Tel. No.: 988-1000/988-7000 Ext. 6214

References:
The Medical City Cancer Center
Philippine Cancer Facts and Estimates 2010
http://www.cancer.gov(What You Need to Know About Breast Cancer by National Cancer Institute, USA)
http://www.cdc.gov/cancer