Feb. 4, 2011— -- Adhering to cancer screening recommendations can save lives and empower women to take control of their health. But different options and recommendations have left some patients confused at best; at worst, they are so frustrated that they dismiss their screenings all together.
"In the interest of scientific integrity, people want to know the definitive answer for screening," said Dr. Harry Bear, chairman of the division of surgical oncology at Virginia Commonwealth University. "But as long as we keep arguing, we continue to keep women confused."
Early detection has been the mantra in preventing cancer deaths. The following pages intend to clear up any confusion that some women may have regarding their own screenings.
The American Cancer Society currently recommends that women in good health start getting yearly mammograms at 40 years old. Women should also get a clinical breast exam at least every three years starting at age 20, and every year after age 40.
But some oncologists question the recommendation by the ACS.
"There are some uncertainties," said Dr. Harold Burstein, a medical oncologist at Dana-Farber Cancer Institute. "Everyone agrees that, by age 50, women should start screening mammograms. The utility of mammograms in women aged 40 to 50 is more controversial."
Burstein said that the incidence of breast cancer is lower in younger women, so the test is less likely to find a real cancer. Younger women also tend to have greater density in their breasts, which can reduce the ability for the mammogram to find small lesions.
"Finally, younger women are more likely to develop breast cancers that are more aggressive, which means that early detection may be slightly less valuable," continued Burstein.
Despite the limitations, Burstein, along with many other breast oncologists, follow ACS guidelines and encourage women to start their screening around 40 years old. That is, if the woman is not at an elevated risk of the disease.
Women who have a mother or sister who had breast cancer or carry the BRCA1 or BRCA2 genetic mutations are at a substantially higher risk of the cancer.
"Women who are at particularly high risk based on family history or known genetic mutations should consider starting at a younger age," said Bear. "One suggestion is that those women who are at high risk should start getting mammograms five years earlier than (the age when) their youngest, close relative was diagnosed with breast cancer."
When Should Women Have Cancer Screenings?
The American Cancer Society also recommends that women who are at high risk be screened with an MRI in addition to a standard mammogram. But that number is small: only about 2 percent of American women will need to have the supplemental tests.
For years, breast oncologists highly recommended the monthly breast self-exam, but recent research shows that the self-exams may do more harm than good by increasing anxiety and causing unnecessary biopsies and follow-ups in women.
"Doctors have gone back and forth on the self-exam," said Bear. "I think it's worthwhile for women to know what their own breast feels like, but there has been less emphasis on the monthly self-exam, as it generated more anxiety than useful information."
Despite the uncertainty of self-exams, a woman should always see her health care provider if she feels a lump, hard knot or thickening, swelling, warmth, redness or darkening, change in the shape or size of the breast, dimpling or puckering of the skin, an itchy, scaly rash on the nipple, the pulling in of the nipple or other part of the breast, sudden nipple discharge, or a new pain in the breast that doesn't go away.
But it's important to know that screenings do not come without risk. Dr. Anne Wallace, director of the breast care unit at the University of California at San Diego, said that many doctors feel that anxiety sometimes outweighs the benefits with early screening.
Only about 20 percent of women who have follow-up biopsies are found to have cancer, said Wallace.
"But if you're that 41-year-old who has a high-grade cancer, you don't care about the numbers because you have a two-year-old at home," said Wallace. "We're talking very valuable lives raising children that cost society a great deal if we were to lose that life."
When asked if she thought that women can get over screened, Dr. Diane Harper replied, "Absolutely yes." Harper is director of the Gynecologic Cancer Prevention Research Group at University of Missouri-Kansas.
And Burstein, from Dana-Farber, agreed.
"The greatest risks relate to false-positive findings, wherein there is an abnormality seen that requires further testing or biopsy and which proves to be benign," said Burstein. "For many women, the experience of getting the mammogram is physically uncomfortable, and stressful."
Cancer Screenings Come With Benefits, Risks
Women should know the risks and also the benefits of screenings, said Wallace. There is no doubt that mammograms have saved many lives.
It's important to note that some doctors recommend women ease up on the screening if they are in their elderly years without prior signs of cancer.
"Women, as they get older, should stop being screened when it's not considered useful to know the answer," said Bear. "If you found a little cancer that may be clinically evident in five years, but the person is not likely to live for another five years, then they probably don't need to be screened, but that is something subjective and should be discussed with family."
Women should begin cervical cancer screening about three years after having vaginal intercourse for the first time, or no later than 21 years old.
The American Cancer Society also recommends that a 30-year-old woman who has had three normal Pap test results in a row can lower the screening schedule to every 2 or 3 years. And women aged 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal results in the last ten may choose to stop getting Pap tests altogether.
"Paps seems to be most important in younger women, so the test doesn't seem as necessary the older that people get, but it all depends on HPV status and results," said Wallace.
The most important risk factor for cervical cancer is the human papilloma virus, or HPV. The virus can infect cells on the surface of the skin, genitals, anus, mouth and throat. It can be spread during sex, but a person can also contract it through skin-to-skin contact with an area of the body infected with HPV.
HPV is also associated with vaginal, vulvar and anal cancers in women.
If a woman's mother or sister had cervical cancer, her chances of developing the condition are 2 to 3 times higher than someone who comes from a family that did not have any cervical cancer.
When abnormal cells do appear after a Pap smear, many treatment options are available. Women with healthy immune systems are often advised to wait and watch for three to six months. The screening is then repeated to see if the infection has cleared up or further diagnostic measures need to be taken.
Colon Cancer An Issue for Women, Too
Women (and men) should begin regular screening for colon cancer at age 50. The U.S. Preventive Task Force recommends screening for the disease by using a colonoscopy, sigmoidoscopy or a highly sensitive fecal occult blood test.
The fecal occult blood test is able to find blood in the stool by placing a small sample of stool on a chemically treated card. If the card turns blue, there is blood in the stool, which can be a symptom of colorectal cancer. The simple test is the least invasive of the three and should be done every year.
A flexible sigmoidoscopy is when a physician uses a lighted tube that is used to look at the interior walls of the rectum and part of the colon. The sigmoidoscospy should be done every five years.
And the colonoscopy, dreaded by some, but important to all, should be done every 10 years. A physician uses a tube to look at the interior walls of the rectum and entire colon to check for polyps and lesions.
While the colonoscopy can be uncomfortable for some, doctors say it is so important to get the proper testing, since colon cancer has a very high survival rate if found early.
To put it bluntly, Wallace said: "Colonoscopy after 50 saves lives and mammograms save lives."
While all women should follow screening recommendations for optimal health, Wallace said it's important for women to know that women are empowered to make many of the most important changes and healthy lifestyle choices.
"Women need to rely on themselves for their health," said Wallace. "Keep your body weight where it was when you graduated healthy, eat healthy and make time to exercise. I think we've gotten to a technological society where we want everyone to do that stuff for us."