Screening for cancer has decreased the growth rate of this devastating disease significantly. However, sometimes the results of screening are not positive when they should be, or negative when they shouldn’t be. Is there anything we can do to improve our chances of obtaining accurate results? The leader experts say yes!
Colonoscopies
Death from colon cancer has dropped from 57,000 in 2000 to 53,580 in 2004 according ot the CDC. This decrease is related to the increased screenings for colon cancer.
One should have a colonoscopy starting at 50 years old (younger, if a family history). During a colonoscopy, a doctor inserts a flexible, lighted tube into the rectum and guides it into the colon to look for and remove growths called polyps, which are the source of most colon cancers. If the results are negative for cancer; one does not need another colonoscopy for 10 years.
But the results are not always accurate. Why? Two reasons might be inadequate preparation prior to the test, and ‘hurried’ physicians who do not take the time necessary to look at the colon lining.
What can one do?
Probably the easiest part to fix is the inadequate preparation. Traditionally, the ‘gallons of warm salt water’ one has to drink to clean the colon has been a real detriment to completing the entire preparation. People become nauseated, sometimes even vomiting, and/or lack the fortitude to ‘poop’ every 10 minutes for hours on end. When the lining is clogged with stool, the physician will not be able to detect a polyp that is lurking behind the feces. However, now there is a pill, OsmoPrep, which makes the preparation a lot more palatable. It doesn’t stop the frequent runs to the bathroom; but even a virtual colonoscopy requires one to have a ‘clean inside’.
The second reason one may not obtain accurate results is the physician’s rush to complete the test. One may not be able to control the physician’s practices, but one can weed out which physicians do not do a comprehensive ‘look-see’. Ask the following questions two questions. How many colonoscopies prior to lunch (should be only 10)? Ask how long it generally takes for the physician to withdraw the inserted tube. Eight minutes is the minimal time this should take to obtain accurate results. But the test may not always catch a patient's cancer. One reason: Last December, a New England Journal of Medicine study of one gastroenterology practice found that doctors who rush find fewer polyps. Remember, if you spend more time looking for weeds in your garden, you will find more weeds. The same is true for physicians looking for polyps in your colon.
Cervical Cancer
Pap tests were implemented in the mid-1950s, and marked a cornerstone in saving thousands of women’s lives due to cervical cancer. To have a pap test, the woman has to lay on an exam table with her legs spread, while the doctor inserts a speculum into her vagina and scrapes off a few cells from the cervix. While this test, usually painless, may be embarrassing and inconvenient, the death rates from cervical cancer have dropped 74% since the inception of Pap smears. Every woman over 21, or who is sexually active, should have a Pap test annually.
However, the National Institutes of Health report that for every five women who have cancerous or precancerous cervical cells, at least one will have a test mistaken for normal.
Thankfully, cervical cancer is slow growing, so the next year’s test probably will catch the abnormality. Still, any delay in cancer diagnosis and treatment should not be acceptable. What can one do to improve the accuracy?
What can one do?
Two actions by your physician will dramatically improve the results: one, your doctor should use a ‘spatula and cytobrush’ versus a ‘broom’ for obtaining the specimens; and two, your physician should get a ‘liquid-based’ test such as Thin Prep or Sure Prep, as cells are less likely to clump and become obscured. Your physician will welcome your questions about their technique. Some physicians will even tell you prior to your asking the question, as they know that their consumers are better informed then in the past. Ask about the tools your doctor uses.
At the same time you are getting your annual Pap test, you may also want to request a test for HPV (human papiloma virus). This virus has been indicted as the most common cause of cervical cancer. NOTE: Most women are able to fight off the virus, only those who are unable to eliminate the virus may develop pre-cancerous lesions.
Finally, watch your calendar and know your menstrual cycles. Do not schedule the test when you are menstruating. Additionally, avoid tampons, douches, contraceptive jellies, yeast creams and/or sexual intercourse for 72 hours prior to your exam. If you do use, go ahead and have your exam, if that’s the only time available; however, know that these things make it more likely that you will have a suspicious finding, necessitating unnecessary diagnostic tests.
Breast Cancer
The American Cancer Society advocates a yearly mammogram for every woman over 40 years old. For women 50 and older, the US Preventive Services Task Force says an annual mammogram cuts the risk of dying of breast cancer by 16%% or more; in one recent large study, the risk was cut by up to 45%. There are some women who should have an MRI (e.g. dense breast tissues, family history, and/or genetic mutations such as BRCA 1 or BRCA 2); however, the physician will still always order a mammogram as the initial screening tool.
Still, the mammogram is not perfect. It can indicate an abnormality when one isn't really there, leading to lots of worry and more tests--including biopsy. Out of every three women screened over a period of 10 years, one gets a false alarm. Scarier, studies have shown that in about 20% of cases where cancer is present, a mammogram doesn't detect it.
What can one do?
Ask if your facility is certified to read mammograms. If not, don’t go there. Also, all mammograms should be read by two radiologists; if not, ask that this occurs for your mammogram. This approach is not arrogant. Good Radiologists will readily assent to your request. Also, when you call for an appointment, ask if the facility is using computer-assisted detection (CAD). It is estimated that CAD has improved diagnosis by 20% per the National Cancer Institute
Take your x-rays with you if you change imaging facilities. Screening is more powerful if your doctor can compare new images against old ones to track the changes over time.
The MammoPad may reduce discomfort a few women may feel during the mammogram. The MammoPad is a cushion used during the test, which allows more pressure to be placed on your breasts to flatten them and allowing clearer pictures. Again, ask at your facility. If they don’t currently have this pad, they can easily order one if the need justifies.
And finally, just as with Pap tests, schedule your mammogram in relation to your menstrual period. During the first 2 weeks of your cycle, your breasts will be more tender, and therefore, the amount of compression may not be adequate. Caffeine also increases tenderness, so lay off the caffeine at least 7 days prior to your test. Underarms deodorants may obscure your results, so don’t wear the day of your test, or if you do, please wipe off prior to the mammogram.
Skin Cancer
Amazingly, Melanoma, the most deadly form of skin cancer, has the distinction of being the only cancer with a rise in the death rate and number of new cases; however, the US Preventive Services Task Force does not recommend any screening test. Yet, a simple annual skin check would be sufficient in most cases to provide this screen.
In January, a study found that even a single melanoma screening at age 50 would be a cost-effective way to pick up the disease in the early stages. The American Cancer Society suggests getting a once-over at every checkup. "We know survival is much better when diagnosis is early," says lead study author Elena Losina, PhD, an associate professor of biostatistics at Boston University School of Public Health.
What can you do?
Get an annual screen! Additionally, as melanomas are sneaky cancers and can hide anywhere on your body; make sure your gynecologist, dentists, and eye doctor all know you would like them to specifically check for melanomas.
Everyone should also check their own skin (even better, if a partner can check those parts of your body you can not see). One should never develop a new mole after 30, so if you have, see your doctor. Additionally, look for moles that are larger than a pencil’s eraser, have a ragged or irregular border, or have uneven shades of color. Self-screening is crucial and could save your life.
The American Cancer Society
http://www.cancer.org/docroot/home/pro/pro_0.asp
US Preventive Health Task Force
http://www.cdc.gov/nccdphp/dnpa/hwi/resources/screening_matrix.htm
National Institutes of Health
http://www.cancer.gov/cancertopics/types/melanoma
New England Journal of Medicine, Dec 12,2006
http://content.nejm.org/cgi/content/short/355/24/2533
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