Many people often think: “If the body is not in pain, is not tired, or does not lose weight suddenly, it definitely does not have cancer.”
However, the naked truth is that many types of cancer do not cause any obvious symptoms at all in the early stages. By the time the body begins to emit clear warning signals, the disease has sometimes progressed to a late stage.
cancer screening helps us find pathogens at a very early stage, when the opportunity for treatment is most effective. With some specific types of cancer such as cervical cancer and colorectal cancer, the screening process also helps doctors detect and promptly treat pre-cancerous lesions before they have a chance to transform into real cancer.
However, screening does not mean doing more and more tests is better. The most important thing is to perform the right type of test, at the right age and in accordance with each individual’s risk level.
1. Health insurance benefits when screened for cancer in the US
An extremely important economic benefit that you need to know when performing cancer screening in the US: Many core screening tests are classified by the system as preventive care.
Depending on the health insurance plan you have, these qualifying services may be 100% covered by the insurance company. You will not need to pay out-of-pocket for copays or meet the annual deductible threshold, especially if you have services performed at in-network facilities.
However, an important note is that if you go to the doctor when you already have symptoms, or your body needs to do more in-depth tests after having a previous abnormal screening result, the service will now be considered diagnostic (diagnosis) and will incur costs according to your insurance package regulations.
2. Instructions for screening for breast and cervical cancer for women
Breast cancer screening
Breast cancer is the most commonly diagnosed cancer in women in the United States (if skin cancer is not included), accounting for about 30% of all new cancer cases in women. To put this in perspective, about one in every three new cancers detected in women is breast cancer.
On average, about 1 in 8 American women will develop invasive breast cancer in her lifetime. This is also the second leading cause of cancer death in American women, after lung cancer.
- Who should be screened: Women at average risk are recommended to start having mammograms at age 40.
- Frequency in the US: There are many different guidelines available from reputable organizations. The USPSTF recommends screening every two years for ages 40–74 years. Meanwhile, the American College of Radiology recommends regular mammograms every year from age 40. Therefore, mammograms can be performed every year or every two years depending on each specific clinical case.
- Who needs to start earlier: You will need a specialized screening plan and earlier than age 40 (can combine annual mammogram with breast MRI) if you belong to the high-risk group: carry high-risk genetic mutations such as BRCA1, BRCA2; have a strong family history of breast cancer (mother, sisters, daughters had the disease at a young age); had radiotherapy to the chest area as a teenager; or have had previous high-risk breast lesions.
Cervical cancer screening
Cervical cancer used to be an obsession and one of the leading causes of death in American women. However, thanks to the widespread application of medical screening measures, the incidence of the disease has decreased by more than half from the mid-1970s to the mid-2000s. This is a rare type of cancer that doctors can treat thoroughly right from the stage of pre-cancerous lesions.
- Who needs screening: According to current recommendations of the USPSTF, people aged 21–65 years old and with a cervix should have regular screening.
- Specific schedule: From 21–29 years old, you should have a Pap test every 3 years. From 30–65 years old, you should have a Pap test combined with an HPV virus test every 5 years. You need to remember that even if you have received the HPV vaccine, you still should not skip the screening schedule because the vaccine cannot protect the body from all cancer-causing HPV strains.
- In case of hysterectomy: Whether or not to continue having a Pap test depends on whether the cervix is still present or has been removed. People who have had a total hysterectomy (including the cervix) and have no history of cancer or high-grade precancerous lesions do not need further screening. On the contrary, if only the uterine body is removed and the cervix is still retained, you still need to continue regular screening.
(Note: People who have had abnormal Pap/HPV results, HIV infection, or immunodeficiency need a separate monitoring schedule).
3. Screening for colorectal cancer and lung cancer: Vital milestones
Screening for colorectal cancer
Excluding skin cancer, colorectal cancer is the third most commonly diagnosed cancer in both men and women in the United States. In particular, this disease is no longer limited to the elderly, but the incidence in young people has been increasing alarmingly in recent decades.
Many cases of colorectal cancer originate from silent precancerous tumors (polyps). These polyps are completely painless and do not change bowel habits, so screening is the only way to find and remove them before they progress to cancer.
- Who needs screening: People at average risk should start screening from age 45 to 75. From age 76–85, continuing or stopping will be individualized based on overall health, expected life expectancy, previous screening results and the patient’s own wishes.
- Optional methods: It is not necessary that screening requires endoscopy. You can choose to have the FIT test for fecal occult blood every year; Cologuard stool test every 3 years; or perform a colonoscopy every 10 years if the results are completely normal. However, if stool tests show positive results, you must undergo a colonoscopy to find the exact cause.
- Who needs earlier screening: You need an earlier and thicker schedule if you have a close relative (parent, sibling, child) with colorectal cancer or was diagnosed at a young age; personally had high-risk polyps; or have ulcerative colitis, Crohn’s disease, or hereditary cancer syndromes.
Lung cancer screening
Lung cancer is the second most common cancer in both men and women in the United States. The disease is extremely dangerous because in the early stages there are no symptoms. By the time the patient shows signs such as coughing up blood, chest pain, difficulty breathing or severe weight loss, the disease is often in a late stage of progression.
- Who needs screening: According to the USPSTF, annual low-dose lung CT is recommended for people who meet the following conditions: Age 50–80 years old; have a smoking history of at least 20 pack-years; and are still smoking or have only quit within the last 15 years.
- How to calculate pack-year index: Calculated by multiplying the number of packs of cigarettes smoked per day by the number of years of smoking (For example: smoking 1 pack/day for 20 years = 20 pack-years; smoking 2 packs/day for 10 years = 20 pack-years; smoking half a pack/day for 40 years = 20 pack-years).
- Screening stopping milestone: The annual screening process will be stopped when the person has quit smoking for more than 15 years, or has a serious health condition that makes them unable or no longer willing to participate in lung cancer treatment.
(Technical note: Conventional chest X-rays absolutely cannot replace low-dose CT scans in screening. Because CT can detect many benign lung nodules leading to unnecessary worry, this method is only properly indicated for groups of people at high enough risk).
4. Prostate cancer screening and misunderstandings about mass blood testing
Prostate cancer screening
Except for skin cancer, it is the most commonly diagnosed cancer in American men (about 1 in 8 men will be diagnosed in their lifetime) and is the second leading cause of death after lung cancer. However, not all prostate cancer cases are equally dangerous. There are types that progress very quickly, but there are also many cases that develop extremely slowly and never cause symptoms throughout the patient’s life.
- Age and method: According to the USPSTF, men aged 55–69 years old should proactively discuss carefully with their doctor about the benefits and risks before deciding to perform a test to measure PSA blood levels. This discussion can start earlier if you are in a high-risk group (have a father/brother with the disease, have many sick people in the family, or discovered the disease at a young age).
- Clinical Note: A high PSA index does not mean you definitely have cancer, because it can increase due to benign conditions such as prostate enlargement or inflammation. On the contrary, over-screening can detect extremely slow-growing tumors, leading to unnecessary biopsies or interventional treatments, causing severe side effects such as urinary incontinence or erectile dysfunction. Therefore, this is a decision that needs to be individualized for each person.
Is routine screening for ovarian cancer necessary?
Although ovarian cancer is often detected late due to vague symptoms, for asymptomatic women at average risk, there are currently no proven routine screening methods that reduce mortality.
Therefore, medical organizations do not recommend routine use of the following methods: CA-125 blood test, transducer ultrasound, or simple pelvic examination to screen for ovarian cancer in healthy people at average risk. CA-125 index can increase due to many benign conditions (endometriosis, fibroids, menstruation, inflammation), overuse of ultrasound can detect benign cysts leading to unjust surgery.
(Groups of people who carry BRCA mutations or have familial cancer syndromes will need a separate risk assessment process).
Can a blood test “screen for all types of cancer”?
The answer is definitely NO. Blood cancer marker indices such as CEA, CA 19-9, CA-125, AFP are absolutely not recommended for use as a mass cancer screening test for healthy people at average risk.
These indicators can completely increase due to many different benign diseases. On the contrary, a person may still be carrying an advanced cancer even if these blood indicators are within completely normal limits. In medicine, these tests are often only used to assist in the assessment of a specific clinical situation, monitor a patient’s response to treatment, or monitor recurrence after diagnosis.
Doctor’s advice: You absolutely should not arbitrarily buy mass “blood cancer screening test packages” and mistakenly believe that normal results are proof that your body is completely free of cancer.
5. Clearly distinguish between routine screening and going to the doctor when symptoms appear
You need to understand clearly: All the above screening instructions only apply to people who are completely healthy and have never had clinical symptoms.
If your body has been showing one of the following warning signs, you absolutely must not subjectively wait until the right age for periodic screening, but must immediately see a doctor:
- A new tumor appeared in the body.
- Abnormal vaginal bleeding outside of the cycle or after menopause.
- Detection of blood in stools or urine.
- Persistent cough or coughing up blood.
- Rapid weight loss with no known cause.
- Symptoms of persistent choking and difficulty swallowing.
- Sudden change in daily bowel habits.
- Moles on the skin change in color, shape or bleed.
- Abdominal bloating, dull abdominal pain or prolonged loss of appetite.
When the body has developed symptoms, the medical process is no longer called preventive screening, but has moved to the stage of disease diagnosis and assessment. These signs can be caused by benign causes, but seeing a doctor early is the only way to protect your own safety.
Conclusion
Medical screening is not a 100% guarantee that you will never get cancer in your life. But performing screening with the right method and at the right time is the biggest opportunity to help us detect pathogens or pre-cancerous lesions early, making treatment much easier and more effective.
You don’t have to try to memorize all the complicated age milestones in this article. During your next annual physical examination with your family doctor , you just need to proactively open the discussion:
“Doctor, given my current age, health status and family history, do I need to have any cancer screening tests done?”
When going for a checkup, try to provide the doctor with the most detailed information possible about your family history: Who in the family has had cancer? What specific type of cancer do you have? At what age were you diagnosed? And is that person from the paternal or maternal side? These detailed information will help the doctor design the most accurate and safe screening map just for you.
What do you think about this shared information? Have you had the appropriate screenings for your age? Please leave a comment below to let me know. Don’t forget to share the article widely to join hands to protect the health of loved ones around you!
Dr. Christina Nguyen
Phoenix Medical Academy
