Thank you to Dr. Shirnett Williamson, medical director of Radiation Oncology Services at Capital Health, for her timely presentation on cancer screening.  May is National Cancer Research Month, Bladder Cancer Awareness Month, Brain Cancer Awareness Month, and Melanoma and Skin Cancer Awareness Month so what better way to kick off the month than talking about cancer prevention methods.  Not all cancers can be detected through screening, but many of the most common and deadly cancers can be found through various screening methods.  Knowing what to look for and finding it early can make all the difference.

Cancer Facts and Figures

Cancer can develop almost anywhere in the body and each type of cancer has its own unique set of symptoms, tests, and treatments.  In 2022, it is predicted that almost 2 million adults will be diagnosed with some form of cancer; over 500,000 are predicted to die from cancer.

The top three cancers in men are prostate, lung and bronchus, and colon and rectal while for women, the top three are breast, lung and bronchus, and colon and rectal.

The top 3 cancers causing death for men are lung and bronchus, prostate, and colon and rectal while for women it is lunch and bronchus, breast, and colon and rectal.  The great news is that many of the top cancers have effective screening protocols that can be used to hopefully detect the cancer early and increase the chances of beating it.

Cancer Screenings

Let’s take a look at the different types of cancers, organized by sex, and their respective screening options.

Women

• Breast – Often found through a mammogram.  It is recommended that women aged 45 and over get a mammogram annually.   If you have a family history of breast cancer, then starting at age 30 is recommended.  A MRI may also be used to narrow down the type of cancer or if the mammogram is inconclusive.  A 3D option is now available, but not all offices offer it, is generally more expensive, and not all insurance companies may cover it.  Signs of breast cancer may include lumps, discharge, dimpled or red skin, retracted nipples, enlarged lymph nodes around the chest and underarms, or swelling of the breast.
• Cervical – Women aged 24-65 should have an HPV test done every 5 years, or a Pap test every 3 years.  Those over age 65 with regular screening for past 10 years with normal results and no serious diagnosis can top cervical cancer screening.  If you have a history of pre-cancer, screening should continue until 25 years after the condition was found, even after 65 years of age.  There are usually no signs or symptoms with early stage, but some signs may include abnormal vaginal bleeding (after sex, after menopause, between periods), unusual discharge, pain during sex or in the pelvic region, swelling of the legs, blood in the urine, or problems urinating or having a bowel movement.
• Uterine – Can only be found through pelvic exams; Pap tests will not work.  Usually occurs after menopause so report any unexpected spotting or bleeding after menopause.
• Ovarian – There is no screening option for low-risk women, but high risk women (Lynch Syndrome, BRCA 1/2 gene mutation) should get a transvaginal ultrasound or CA-125 blood test.  Note that these screenings are not 100% accurate and false positives or negatives may occur.

Men

• Prostate – Detected through PSA blood test or rectal exam.  Men with average risk should undergo routine rectal exams starting at age 50; men with high risk (African American, Family history of 1 first degree relative) should start at age 45; men with higher risk (Family history of 2 first degree relatives) should start at age 40.  Sings may include problems urinating (slow or weak stream, going more often, especially at night), blood in urine or semen, trouble getting an erection, pain the hips, spine, or ribs, or other areas cancer may have spread to, weakness or numbness in the legs or feet, or loss of bladder or bowel control.
• Testicular – Can only be found through a physical examination.  It is recommended that men regularly exam their testicles starting after puberty and look for lumps or swollenness.  However, some testicular cancers may not cause symptoms until they’ve reached an advanced age.

Men and Women

• Lung – Detected through low dose CT scans, but usually only reserved for high-risk individuals, which include anyone aged 50-80 currently smoking, quit within the last 15 years, or smoked a 20 pack year (2 packs per day for 10 years or 1 pack per day for 20 years).  Some signs may include persistent or worsening cough, coughing up blood or rust-colored sputum, chest pain that is worse with deep breathing, coughing or laughing, hoarseness, loss of appetite, unexplained weight loss, shortness of breath, feeling tired or week, new onset of wheezing, or infections (bronchitis, pneumonia) that don’t go away or keep coming back.
• Colorectal -Beginning at age 45, men and women should follow 1 of 2 testing schedules: testing that finds polyps and cancer (Flexible sigmoidoscopy, double-contrast barium enema, or CT colonography every 5 years or a colonoscopy every 10 years) or testing that primarily finds cancer (Yearly fecal occult blood test, yearly fecal immunochemical test, or a stool DNA test).  In many cases, following a positive result, a colonoscopy should be done.  1 in 5 colorectal cancers are found in people aged 20 to 54 so be aware of the risk factors, including obesity, inactivity, family history (HNPCC, Lynch syndrome), cigarette smoking, alcohol use, or diets high in red and processed meats.
• Head and Neck – A dental exam should be conducted every 6 months to look for leukoplakia, sores, and lumps.  Some signs of head and cancers include a sore on the lip or in the mouth that does not heal, pain in the mouth the does not go away, trouble swallowing, chewing, or moving the jaw or tongue, a red or white patch on the gums, tongue, tonsil, or lining of the mouth, numbness of the tongue, lip, or other area of the mouth, or a lump or mass in the neck or back of the throat.
• Pancreatic -Can be found in a multitude of ways including an endoscopic ultrasound, an ECRP, KRAS genetic test, MRI, or a CA-19-blood test.  Screening is generally only done after symptoms manifest or if there is a genetic or strong family history, such as Lynch syndrome, or BRCA 2 or P16 genetic mutations.  Some symptoms may include jaundice of the skin and eyes, dark urine, light-colored or greasy stools, itchy skin, weigh loss or poor appetite, belly or back pain, nausea or vomiting, diabetes, or blood clots.
• Skin -Only detectable through physical examinations, either by yourself or a medical profession, oftentimes a dermatologist.  There are 3 different types of skin cancers; Basal cell carcinoma, Squamous cell carcinoma, and melanoma.  Some risk factors include exposure to ultraviolet light, light colored skin or moles, being older and male,  smoking, radiation exposure and exposure to chemicals, weakened immune system, or family history/genetics with melanoma.

More Information

If you have any questions, please contact Dr. Shirnett Williamson at swilliamson@capitalhealth.org or visit the Capital Health Cancer Center online at https://www.capitalhealth.org/medical-services/cancer-center.  A recording of this program is available at https://youtu.be/hGoK0fAzBK8.  You can download a copy of the presentation slides at https://www.njstatelib.org/wp-content/uploads/2022/05/Cancer-Screening-Presentation-Slides.pdf.