Cancer screenings 101: Determining what to get screened for and when

December 22, 2020
Dr. Sarah Tucker Price examines a patient
Dr. Sarah Tucker Price encourages patients to stay current with cancer screenings and preventive care. During the pandemic, a virtual visit is a safe first step to discuss options with your health care provider. Photo by Brennan Wesley

The COVID-19 pandemic may have forced Sarah Tucker Price, M.D., Ph.D., to change her exercise routine, but it hasn’t kept her from remaining physically active. Instead of playing organized sports, she enjoys running, walking her dog, biking, playing soccer with her kids and getting outside as much as possible.

As a family physician, Price recognizes the abundance of health benefits that exercise can bring, including lowering the risk of developing multiple types of cancers. But if there’s one thing that’s just as important to cancer care as prevention, it’s early detection — something that is often made possible through routine, recommended cancer screenings.

Despite their importance, many people have delayed getting their screenings due to concerns over the public health risks caused by COVID-19. A recent study published in JCO Clinical Cancer Informatics found a significant drop in cancer screenings in April 2020 compared with April 2019, including screenings for breast (-85%), colon (-75%), prostate (-74%) and lung cancer (-56%).

While reductions in routine preventive care were expected at the height of the pandemic, screening rates have still not bounced back to normal, even as states have reopened, causing concern for providers like Price that patients may begin presenting with later-stage cancers that could have potentially been detected sooner.

“It’s incredibly important to be on top of your cancer screenings because it makes such a big difference when it comes to the ability to detect and treat cancers.”
— Dr. Sarah Tucker Price

“It’s incredibly important to be on top of your cancer screenings because it makes such a big difference when it comes to the ability to detect and treat cancers,” said Price, who leads an innovative program providing in-house primary care to cancer patients at MUSC Hollings Cancer Center. “Even during COVID-19, it’s still worthwhile to have a discussion with your primary care physician about what screenings you may be due for and what the best timing for them may be.”

Having that conversation can easily be done through a virtual visit, said Price, where patients can work with their providers to determine the safest ways to stay up to date on their regular health maintenance. They can also discuss screening options that may not require an in-person visit, such as using stool-based kits for colorectal cancer screening that can be done at home in place of a typical colonoscopy.

Developing a personalized cancer screening plan

While standard screening guidelines exist based on a person’s age and gender, screening recommendations may change based on individual factors such as a person’s family history or lifestyle. That’s why it’s important to have a discussion with a physician who knows your personal history when determining which screenings to get and when to get them, says Price.

Things to consider include current and prior medical conditions, previous surgeries, smoking history and whether a person is maintaining a healthy weight. It’s also important to know which family members have had cancer, which type of cancers they had and the age at which they were diagnosed.

mammogram image 
Despite their importance, people have delayed getting screenings for breast and other cancers during the pandemic, potentially leading to cancers that present at a later stage. iStock

“For certain cancers, if family members were diagnosed below the age of 50, that’s often when we start to change our cancer screening recommendations. We see that especially with breast and colorectal cancer screenings,” said Price.

Having certain medical conditions can increase a person’s cancer risk and may lead to a recommendation for earlier screening for certain types of cancer. A history of inflammatory bowel disease, for example, means that people will often get a colonoscopy at a younger age. People who have had a history of high-dose chest radiation may get screened for breast cancer at a younger age. However, lifestyle choices and family history tend to have more of an impact when it comes to changing the standard screening recommendations.

Other factors to consider include when a person’s last screening took place, which screening procedure was used and what the results were. For colorectal cancer, the recommended follow-up window could be as soon as one year or as late as 10 years, depending on which screening test was used.

Any unusual or concerning symptoms, such as a new lump in the breast, blood in your stool or unexpected weight loss, should also be discussed with a doctor who can see you regularly, as screening tests may be given earlier if a person is symptomatic.

Considerations for people under age 40

While most recommended cancer screenings begin when a person reaches age 45 or older, it’s still important for people in their 20s and 30s to have a discussion with their doctor about how their personal screening timeline might look. According to Price, it’s often easier for people to gather the details of their personal and family health histories at an earlier age, and those factors can help to inform decisions about regular preventive care and lifestyle goals that may not be related to cancer screenings but that are important for reducing cancer risk.

“People should be aware that their behaviors when they’re younger influence their cancer risks as they get older. Obesity is a strong risk factor for multiple cancers, including gastrointestinal, breast, colon, pancreatic, lung and other cancers. There are also certain dietary factors that play a role, including alcohol consumption and whether you are regularly including fruits and vegetables in a balanced diet,” said Price.

“These factors start during childhood and your teenage years and impact your risk of developing cancer at a later time. Trying to follow some of those healthy lifestyle habits when you’re younger can make a significant difference in your risk for developing cancer.”

Because some cancer screenings, such as those for cervical cancer, begin at an early age regardless of family history, that’s also an important time to discuss preventive strategies such as the human papillomavirus (HPV) vaccine, which is typically given between the ages of 11 or 12 but can often be given later if a person hasn’t yet received it. The vaccine can prevent six types of cancers in both men and women.

What if I already have cancer?

Regular screenings are also important for people who already have a cancer diagnosis, as having one cancer type increases the risk of developing another type. Screening recommendations for cancer patients are unique and are often dependent upon the cancer the person has, their personal history and the type of treatment they’re receiving.

While it may be a challenge to focus on primary care during cancer treatment, regularly seeing your primary care provider is especially important, as the management of other chronic health conditions can have a profound impact on your cancer-related outcomes.

“I get calls on a regular basis from people whose blood pressure is prohibiting them from getting their scheduled infusion,” said Price. “If you have a new diagnosis of cancer and you don’t have a primary care physician, it’s important to establish with one, because there are things that are going to come up.”

Other ways to increase the likelihood of early cancer detection

Aside from staying on top of regular screenings, it’s important to be on the lookout for any unusual signs or symptoms and to discuss any concerns with your doctor. Be aware of any new spots on your skin or sores inside your mouth that may be developing, changing or not going away. Women should also conduct regular self-breast exams to catch any new lumps or bumps. Having your regular teeth cleaning every six months is also important, as dentists will be able to detect any oral lesions that you may not be able to see.

While genetic testing may be a good idea for some people who are at increased risk of cancer due to their family histories, people should only do so if they have the guidance of someone who is properly trained to interpret the findings, which can be easily misconstrued.

“The earlier a cancer can be detected and referred to oncology teams, treatment outcomes are better and may be less involved,” said Price. “It’s important to have regular conversations about cancer screenings with your primary care physician to give yourself the best opportunity to live a healthy life.”

About the Author

Kelsey Hudnall
MUSC Hollings Cancer Center

Keywords: Cancer, Fitness and Wellness, COVID-19