March is Colorectal Cancer Awareness Month
In some parts of the world, March is Colorectal Cancer Awareness month. Mention colorectal cancer and people get squeamish, about both the screening for the disease, and the disease itself. This therefore seems a good opportunity to discuss cancer screening.
As a general rule, having an annual physical is a good time to address this issue, bearing in mind that with the low risk of death from other once life-threatening diseases, cancer is the leading cause of death for those in the Westernized world, specifically: Cancer is the leading cause of death in Americans under the age of 65.
Whilst there is much debate about cancer screening, we emphasize the difference between population based screening protocols done by Government bodies, such as the UK NHS – where the cost effectiveness of a test is studied – and individual recommendations.
Cancer Screening Can Save Your Life
As private doctors, we are concerned about the individual and with screening tests for prostate, ovarian and breast cancer, Dr. Jamieson has picked up a handful of patients with early stages of cancer. They were diagnosed at a very early stage and successfully treated, and she feels this outweighs the mild anxiety patients may have over false positive test results.
Below is some information you may find useful. The statistics shown are for average cases. Lifestyle, genetics and other medical conditions may put you more or less at risk.
Of course, screening is one thing. Prevention is another. Eat healthily and keep fit!
Lifetime risk of being diagnosed: 1 in 8 (women); 1 in 769 (men)*
In the UK 81% of breast cancer occurs in women over the age of 50. Mammogram screening is usually only recommended in those over 40. Over 90% of women diagnosed in the earliest stages of breast cancer go on to lead normal lives when treated. In the UK, since the NHS national screening programme was introduced in 1988, deaths from breast cancer have fallen dramatically.
Mammography is the most commonly used screening method and has 80% sensitivity, meaning it may miss up to 20% of cancers. Mammography is less effective in younger women. It is now common to also have an ultrasound scan together with a mammogram. Ultrasound scans have an 83% sensitivity rate in all age groups, and ultrasound has the ability to detect some cancers missed by mammography. Note that cancer diagnosis can only be done with a biopsy, screening simply calls attention to abnormalities.
Genetic factors contribute significantly to the risk of developing breast cancer, so you should discuss with your doctor a suitable screening programme to suit you.
Lifetime risk of being diagnosed: 1 in 147 (women)*
Cervical cancer is common, killing over 270,000 women per year worldwide according to Cancer Research UK. One of the main causes is the HPV virus, however secondary factors such as smoking and poor diet will also lead to this cancer.
Unfortunately, a high percentage of women already have HPV. Fortunately, the virus goes on to cause cervical cancer in only a tiny fraction of those infected. Therefore, whilst diagnosis of HPV is helpful, it does not mean the patient will get cancer, and this has to be taken into consideration with other risk factors.
Regular cancer screening usually detects abnormal cells before they become cancerous and in the UK, since the introduction of cervical screening in the 1980s, rates of cervical cancer have almost halved. Regular screening is not usually recommended for younger women as the cells of the cervix are are in continuous change. Note that even though a patient may have had the HPV vaccine, they are still advised to undergo screenings, because the vaccine only protects against the most common strains of the virus.
Lifetime risk of being diagnosed: 1 in 71 (women)*
If ovarian cancer is caught while still confined to the ovary, the 5-year survival rate is 92% however most women with ovarian cancer are diagnosed with advanced stage disease. Current screening methods – the CA125 blood test or the transvaginal ultrasound – are not as reliable as we would like as they can produce false negative (as high as 50% in a recent study) and false positive (8.4% in a recent study) results.
Having said this, Dr. Jamieson has picked up a few cases of ovarian cancer by doing this routine screening test so is keen to continue with it, warning women that nothing is 100% accurate. False positives may occur, leading to further investigations such as ovarian scanning.
Colorectal (bowel) cancer
Lifetime risk of being diagnosed: 1 in 19 (men) and 1 in 20 (women)*
In the UK 80% of people diagnosed with colorectal cancer are aged over 60, so screening is only usually recommended after the age of 60. However, lifestyle choices such as smoking, lack of exercise and diet, a family history of bowel cancer, and illnesses such as diabetes, and Crohn’s Disease can increase your risk. If caught early, treatment is usually successful and finding and removing polyps or other areas of abnormal cell growth may be one of the most effective ways to prevent colorectal cancer development.
There are several screening methods, including the faecal occult blood test (FOBT), colonoscopy, double contrast barium enema (DCBE) and a simple rectal exam. We can advise on the most suitable screening test(s) for you.
Lifetime risk of being diagnosed: 1 in 6 (men)*
Because of inconclusive studies the medical profession is undecided as to whether this type of cancer screening saves lives or not. In the UK about 75% of cases are in men aged over 65. However, doing a prostate cancer enzyme blood test as part of your yearly medical is easy to do, and it often picks up abnormalities.
Concerns surround false positive and false negative results, as well as the fact that some prostate cancers grow so slowly that they may never threaten the patient’s life, especially as the patient may be in his later years. However, if diagnosed and caught early, treatment can be 90% effective. Prostate screening is definitely a decision to be made on discussion with a doctor.
Lifetime risk of being diagnosed: 1 in 270 (men)
Although this is a rare cancer, the ‘screening’ is simple and should be done by your doctor at annual physical time, and she or he can then show you how to do a testicular self examination. The cancer, if it does occur, is most commonly found amongst young men aged 15-35 and treatment is usually successful.
* National Cancer Institute, USA