Cancer is the No. 2 cause of death in US. What you should know about screenings

By Katia Hetter, CNN

Many people postponed routine medical care because of disruptions related to the Covid-19 pandemic. That includes a decline in cancer screenings, such as mammograms and colonoscopies. In the meantime, cancer remains one of the major causes of death in the United States, second only to heart disease.

Why is cancer screening so important, and who should be screened for what types of cancer? How can people find out when their last exam was and what they are due for now? What if someone has fallen behind on their cancer screenings? And what should people do if they remain very concerned about their risk of contracting the coronavirus?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Why is getting screened for cancer so important?

Dr. Leana Wen: Regular cancer screening is key to detecting cancer early. That allows for cancers to be found before someone has symptoms. In general, early detection of cancer results in better outcomes. A small, localized tumor may be removed before it has spread to other parts of the body, for example. Screening can also find abnormal cells that could become cancer, and prompt treatment could prevent that cancer from developing and spreading.

CNN: Who should be screened for which cancers, and when?

Wen: The three primary types of cancer screenings supported by the US Centers for Disease Control and Prevention are for breast, cervical and colorectal cancer. The US Preventive Services Taskforce (USPSTF), an influential national organization that makes disease prevention recommendations, advises mammograms every two years for women who are between 50 and 74 years old, who are at average risk for breast cancer.

A mammogram is a type of X-ray and available at most hospitals and outpatient radiology centers. According to the USPSTF, those at higher risk within this age group, and those under 50, should speak with their physician to determine the frequency of screenings. Some other medical organizations, including the American Cancer Society, recommend more frequent annual screening mammograms.

Cervical cancer screening is done through a Pap test, in which a health-care provider does a gynecological exam to collect a few cells and mucus from the patient’s cervix. The USPSTF recommends that for women and other people who have a cervix to receive a Pap test every three years starting at age 21, until age 65. Some individuals may receive more frequent screenings, depending on their risk factors.

The USPSTF also recommends that for all adults ages 45 to 75 to be screened for colorectal cancer. There are several screening tools involved. One is a stool-based test that detects the presence of certain markers in your stool. Another is the colonoscopy, which involves a procedure that uses a long flexible scope to look into your rectum and colon. The colonoscopy is generally recommended every 10 years. Which tests, and how often, will also depend on the individual’s medical history and family history.

CNN: What about lung cancer, which is another leading cause of death?

Wen: Lung cancer screening is also supported by the CDC, specifically for individuals between 50 and 80 years old with a history of heavy smoking, who smoke now, or who have quit within the past 15 years. The USPSTF recommends annual low-dose computed tomography screening, which is a type of CT scan that can be done in many hospitals and radiology facilities.

CNN: Are there other cancers people should screen for — for example, what about ovarian cancer or pancreatic cancer?

Wen: There are a lot of cancers, including ovarian, pancreatic, thyroid and skin cancer, for which there isn’t sufficient evidence to justify regular, ongoing screening tests in individuals with average risk factors. If there is a particular type of cancer that runs in your family, you should ask your physician about the benefits of screening. Of course, if you develop symptoms — for example, you discover a new growth on your neck or there is a discoloration of your skin that’s changing in appearance — you should definitely consult your healthcare provider.

CNN: A lot of people may not recall when they had their last screening test, especially if they moved or changed healthcare providers. How should they find out if they’re due?

Wen: If you’ve had the same doctor throughout, you could call your physician’s office and find out the dates of your last screening tests. If you changed physicians but they are in the same hospital network, your healthcare system should have these records — and you might be able to access them if your provider offers an electronic patient portal.

Another possibility is to contact your insurance company, if you’ve had the same insurance company over the last several years. They should also have records of your last preventive tests. And you can always contact previous providers. In general, it’s a good idea to have copies of your old medical records so they can be compared with new test results.

CNN: What if you missed several screening tests? Would you recommend that people catch up with them as soon as possible?

Wen: Yes. A lot of patients missed screening tests for all kinds of reasons. Perhaps fear of Covid-19 resulted in delays. Perhaps they moved or changed jobs. Perhaps they had kids or grandkids or other new caregiving responsibilities, and life got busy. Find out which tests you are due for and start scheduling them now.

I’d add that this goes for other preventive services too. Make sure you are also on track with screenings for high blood pressure, diabetes, high cholesterol and other chronic conditions. The sooner these conditions are detected and flagged as potential problems, the sooner you can know and begin to address them.

CNN: There are some people who remain very concerned about their risk of contracting Covid-19 while undergoing screenings. What’s your advice for them?

Wen: Healthcare settings tend to be very cautious and have been taking many steps to reduce Covid-19 risk. People who are concerned about contracting Covid-19 should ask the facility where they’d get the tests what type of mitigation measures are being used. Are all staff masked while seeing patients, for example? Remember that one-way masking with a high-quality mask works very well. For mammograms and Pap tests, and for visits with your doctor, you can wear an N95 or equivalent throughout the exam. For colonoscopies, this might not be possible during the whole procedure, but almost certainly the colonoscopy will be done in a room where others are masked the entire time.

You can also reduce your risk of severe illness further by making sure you are up-to-date on your coronavirus boosters. If you are eligible for the preventive antibody Evusheld, that’s something you should take advantage of too.

Finally, it’s important to put the risk of Covid-19 into context. Absence of the coronavirus is not the only marker of good health, and we need to consider good health, both physical and mental health, in a holistic way, which includes keeping on track with preventive healthcare like cancer screenings.

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