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Cancer Screening

  • Methods of looking for cancer before it causes symptoms and is easier to treat
  • Used to detect breast, cervical, colorectal, lung, prostate, skin, head and neck cancers
  • Screening is especially recommended for cancers that respond best to early treatment
  • Involves Smilow Screening & Prevention Program, Yale Cancer Center

Overview

If cancer runs in your family, or you are at high risk because of your age or other factors like your smoking history, talk to your doctor about cancer screenings. These tests are designed to detect cancer early in people with no apparent symptoms.

Yale Medicine recommends screening for certain cancers, especially those for which early treatment is of great benefit in helping patients live better and longer lives. Types of cancer for which early treatment is crucial include:

“We’re here not only for those who have been diagnosed with cancer,” says Beth A. Jones, PhD, MPH, who is the director of the Smilow Screening & Prevention Program at Smilow Cancer Hospital at Yale New Haven, where many Yale Medicine physicians practice. “We also want to do everything we can for people who want to protect themselves and their families by maintaining a healthy lifestyle and by getting regular cancer screening tests as recommended by their health care providers.”

How is breast cancer detected?

Breast cancer can be detected by a woman during a self-exam, but it must be confirmed by a doctor during a clinical exam of the breasts, through diagnostic imaging and by a biopsy.

We recommend that women ages 40 and older receive annual mammograms. If you are at increased risk for breast cancer due to family history or have had chest radiation for other conditions during your lifetime, talk to your health care provider about having a breast cancer screening test before age 40.

“Screening enables us to find breast cancer early when it’s most treatable,” says Anees Chagpar, MD, MPH, a Yale Medicine surgical breast oncologist with the Breast Center.

There are several methods of diagnostic imaging used to screen for breast cancer, including:

  • Mammogram: This is an X-ray of the breasts.
  • Tomosynthesis: Radiologists perform both a 3D and 2D mammogram simultaneously, so the duration of the exam doesn’t increase. Tomosynthesis allows the radiologist to view “slices” of the breast tissue for improved detection of breast cancer.
  • Ultrasound: Sometimes it is necessary to use high-frequency sound waves to produce images of shapes within the breasts.
  • MRI: For women with dense breast tissue, magnetic resonance imagery is sometimes needed in addition to a mammogram to give a radiologist a clear view.

How is cervical cancer detected?

Women are screened for cervical cancer with thePap test, done by a gynecologist or family medicine specialist. If the results of a Pap test are abnormal, a Human Papilloma Virus (HPV) test may also be used since the virus is the leading cause of cervical cancer.

We support screening as follows:

  • Women ages 21 to 29: A Pap test every three years.
  • Women ages 30 to 65: A Pap test and an HPV test every five years or every three years with just the Pap test.
  • Women of who are at high risk of cervical cancer or who have been diagnosed with cervical cancer, cervical pre-cancer or HIV infection should follow the recommendations of their health care providers.
  • Women over 65 years of age who have had regular screening in the previous 10 years can stop cervical cancer screening, as long as they haven’t had any serious pre-cancers (like CIN2 or CIN3) found in the last 20 years. Women with a history of CIN2 or CIN3 should continue to have testing for at least 20 years after the abnormality was found. 
  • Women who have had a total hysterectomy (removal of the uterus and cervix) can stop screening with Pap tests and HPV tests, unless the hysterectomy was for treatment for cervical pre-cancer or cancer. Women who have had a hysterectomy without removal of the cervix (called a supracervical hysterectomy) should continue cervical cancer screening according to the guidelines above.
  • Women of any age don’t need annual screening tests unless the result has been abnormal.      
  • Women who have abnormal screening results may need to have a follow up Pap test (sometimes with a HPV test) done in six months to a year.

How is colorectal cancer screened?

The U.S. Preventive Services Task Force and the American Cancer Society recommend that individuals between the ages of 45 and 75 get screened for colorectal cancer. People ages 75 through 85 should talk to their doctor about whether screening is appropriate for them. Colorectal cancer screening isn’t recommended for individuals over 85 years of age. Screening may begin at a younger age for those who are at increased risk for colorectal cancer (e.g., family history of colorectal cancer, personal history of colorectal polyps or colorectal cancer, or personal history of inflammatory bowel disease).

A number of recommended screening tests are available. People should talk to their doctor about which test is best for them.

Colorectal cancer screening tests include:

Colonoscopy. During a colonoscopy, a doctor inserts a colonoscope—a thin tube equipped with a light and camera—into the patient’s rectum and guides it into the colon (also known as the large intestine). In most cases, patients are given a sedative during a colonoscopy so they do not feel pain.

The test enables doctors to visually examine the colon and rectum, and using instruments inserted through the colonoscope, collect tissue samples or remove polyps. Tissue samples and polyps are examined under a microscope to check for the presence of cancer.

For people at average risk for colorectal cancer, colonoscopy screening is recommended once every ten years. More frequent colonoscopies are recommended for those at increased risk for colorectal cancer.

Prior to getting a colonoscopy, patients must follow a special clear liquid diet for a day or a few days to cleanse the bowels.

Stool-based Tests. A few different tests use stool samples to check for signs of colorectal cancer. Stool samples can be collected at home using special kits available from a health care provider. Unlike colonoscopy, stool-based tests do not require bowel cleansing.

Stool-based colorectal screening tests include:

  • Fecal Immunochemical Test (FIT). Colorectal cancers can cause bleeding in the colon and rectum. The FIT test checks for the presence of blood in stool samples. Blood in the stool can also be caused by many other noncancerous conditions. If blood is detected, a follow-up colonoscopy is usually necessary to check for colorectal cancer.

    FIT testing is done once per year.

    Multi-targeted Stool DNA Test. This test detects DNA biomarkers for cancer that are shed by cells that line the colon and rectum and end up in the stools. It also checks for the presence of blood in the stool sample. If the test is positive for DNA biomarkers or if it detects blood in the stool, a colonoscopy is necessary to determine whether it is caused by cancer or another condition.

    Multi-targeted stool DNA testing is done once every three years.

Computed Tomography (CT) Colonography. Sometimes called a virtual colonoscopy, during this procedure, X-ray images of the colon and rectum are taken from various angles from outside the body. A computer compiles the images into cross-sectional images that doctors can examine. If polyps or other abnormalities are present in the colon and/or rectum, a traditional colonoscopy usually is necessary to biopsy and test tissue samples and to remove polyps. Before undergoing a CT colonography test, patients must follow a special cleanse their bowels. 

CT colonography is done once every five years.

How is lung cancer screened?

If you’re between 55 and 77 years of age and smoke 30 packs or more year (even if you quit within the past 15 years), lung cancer screening is often recommended. However, if you stopped smoking more than 15 years ago, screenings aren’t recommended. Yale Medicine doctors use a low-dose computer tomography (CT) scan of the chest to screen for lung cancer.

How is prostate cancer screened?

The most common cancer in men is prostate cancer. Our doctors believe in discussing the time frame for screening with each man individually. In general, the average man should consider having a baseline prostate-specific antigen (PSA) screening in his 40s. This is especially important for men at greater risk, including black men and men with a family history of prostate cancer.

At age 55, routine screening for prostate cancer should begin every two years for men who are at average risk. For men over 69, screenings are recommended on an individual, case-by-case basis.

How is skin cancer screened?

“We recommend that our patients do a head-to-toe skin check at home in a mirror every month,” says Kathleen Suozzi, MD, a Yale Medicine dermatologic surgeon in Cutaneous Oncology Program. Regular self-evaluation is important for detecting suspicious skin changes early and bringing them to your dermatologist’s attention. When scanning your skin for irregularities, know your A, B, C, D and E’s:

Asymmetry: Moles that might be cancerous generally have an irregular shape.

Border: Irregular borders or jagged edges on a mole could indicate a melanoma, which is the clinical name for skin cancer.

Color: Normal moles tend to be a uniform brown color, whereas melanomas tend to be brown mixed with different shades of black, red, white or pink.

Diameter: Be extra watchful of moles that are bigger than the size of a pencil eraser.

Evolving: Moles that are changing in size, shape, elevation or color should be evaluated as should moles that bleed, itch or are crusted over.

If you notice any of these skin changes, see your dermatologists or family physician for evaluation.

How is head and neck cancer screened?

We advise adults to have their dentists do a yearly mouth and oropharynx (back of the throat) screening. Your dentist will examine your entire mouth, including under the tongue, as well as check the neck and nose for signs of cancer. 

It’s also important to have your primary care doctor examine your neck, mouth and oropharynx as part of regular checkups. In our experience, adults with a history of tobacco use, heavy alcohol use, chewing betel nuts, and/or multiple sex partners or who have Human Papillomavirus (HPV) are at increased risk for head and neck cancer.

Are there ways I can reduce my cancer risk?

Whether or not you have cancer in your family tree, you can reduce your chances of developing it. You can make healthy lifestyle choices such as avoiding smoking or chewing tobacco, eating a nutrient-rich diet with plenty of fruits and vegetables, staying active, limiting alcohol use and protecting your skin and eyes from ultraviolet radiation, says Dr. Jones. Also be sure to report any new and worrisome symptoms you experience to your doctor who can evaluate if you need testing or treatment.

What's distinctive about Yale Medicine?

Because our Yale Medicine oncologists are leading experts in cancer treatment, if cancer is detected during a screening, our physicians are well qualified to treat patients from diagnosis through treatment.

We also run many clinical trials which offer innovative treatment options for many patients. To find out more about cancer screening and how to arrange for a screening exam at Yale Cancer Center, call 203-200-3030 or email screening@ynhh.org for more information.