Cancer Screening &
Diagnostics
Mader Chapter 24.3
Cancer Yearly Morbidity &
Mortality by Sex & Site
Introduction to Screening
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Estimates of the premature deaths that could have been
avoided through screening vary from 3% to 35%, depending
on a variety of assumptions. There are, however, several
potential harms that must be considered against any
potential benefit of screening for cancer.
Although most cancer screening tests are noninvasive or
minimally invasive, some involve small risks of serious
complications that may be immediate (e.g., perforation with
colonoscopy) or delayed (e.g., potential carcinogenesis
from radiation).
Another harm is the false-positive test result, which may
lead to anxiety and unnecessary invasive diagnostic
procedures.
A less familiar harm is over diagnosis, i.e., the diagnosis of
a condition that would not have become clinically significant
had it not been detected by screening. This harm is
becoming more common as screening tests become more
sensitive at detecting tiny tumors.
Finally, a false-negative screening test may falsely reassure
an individual with subsequent clinical signs or symptoms of
cancer and thereby actually delay diagnosis and effective
treatment.
Screening-Breast Cancer
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Yearly mammograms are recommended starting at age 40 and
continuing for as long as a woman is in good health.
Clinical breast exam (CBE) should be part of a periodic health
exam, about every 3 years for women in their 20s and 30s and
every year for women 40 and over.
Women should know how their breasts normally feel and report
any breast change promptly to their health care providers. Breast
self-exam (BSE) is an option for women starting in their 20s.
Women at increased risk (for example, family history, genetic
tendency, past breast cancer) should talk with their doctors about
the benefits and limitations of starting mammography screening
earlier, having additional tests (for example, breast ultrasound or
MRI), or having more frequent exams.
Radiological detection- Breast
cancer
Screening- Colon and Rectal
Cancer
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Beginning at age 50, both men and women should follow 1 of
these 5 testing schedules:
yearly fecal occult blood test (FOBT)* or fecal immunochemical
test (FIT)
flexible sigmoidoscopy every 5 years
yearly FOBT* or FIT, plus flexible sigmoidoscopy every 5 years**
double-contrast barium enema every 5 years
colonoscopy every 10 years
People should talk to their doctor about starting colorectal cancer
screening earlier and/or undergoing screening more often if they
have colorectal cancer risk factors
Screening - Prostate Cancer
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Both the prostate-specific antigen (PSA) blood test
and digital rectal examination (DRE) should be
offered annually, beginning at age 50, to men who
have at least a 10-year life expectancy. Men at high
risk (African-American men and men with a strong
family of one or more first-degree relatives [father,
brothers] diagnosed before age 65) should begin
testing at age 45. Men at even higher risk, due to
multiple first-degree relatives affected at an early
age, could begin testing at age 40. Depending on
the results of this initial test, no further testing might
be needed until age 45.
Screening - Cervical Cancer
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All women should begin cervical cancer screening
about 3 years after they begin having vaginal
intercourse, but no later than when they are 21 years
old. Screening should be done every year with the
regular Pap test or every 2 years using the newer
liquid-based Pap test.
Beginning at age 30, women who have had 3 normal
Pap test results in a row may get screened every 2 to
3 years. Another reasonable option for women over 30
is to get screened every 3 years (but not more
frequently) with either the conventional or liquid-based
Pap test, plus the HPV DNA test. Women who have
certain risk factors such as diethylstilbestrol (DES)
exposure before birth, HIV infection, or a weakened
immune system due to organ transplant,
chemotherapy, or chronic steroid use should continue
to be screened annually.
Screening - Endometrial
(Uterine) Cancer
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The American Cancer Society recommends that at
the time of menopause, all women should be
informed about the risks and symptoms of
endometrial cancer, and strongly encouraged to
report any unexpected bleeding or spotting to their
doctors. For women with or at high risk for
hereditary non-polyposis colon cancer (HNPCC),
annual screening should be offered for endometrial
cancer with endometrial biopsy beginning at age 35.
Assessment of Genetic Risk=
family history
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For example, a woman who has a firstdegree relative (mother, sister, or daughter)
who has breast cancer has twice the risk of
getting breast cancer than a woman who
does not have a family history of breast
cancer. Or, a woman who tests positive for
genetic alterations (called mutations) in the
BRCA1 (Breast Cancer 1) gene would have a
55 percent to 85 percent chance of
developing breast cancer by age 70.
Genetic Testing for Hereditary
Cancer
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Myriad Genetic Laboratories is a leader in cancer predisposition
testing. Myriad discovered the BRCA1 and BRCA2 genes that
cause hereditary breast and ovarian cancer, and now offers the
most accurate clinical tests available to determine predisposition
to cancer: BRACAnalysis® for hereditary breast and ovarian
cancer, COLARIS® for hereditary colon and endometrial cancer,
COLARIS AP® for hereditary colorectal polyps and cancer, and
MELARIS® for hereditary melanoma and pancreatic cancer.
These tests are unparalleled in accuracy, quality and customer
service. **
**This is an advertisement from Myriad not my opinion
The value of testing
Genetic testing may help you to:
 Make medical and lifestyle choices.
 Find out you do not have an altered gene.
 Cope with your cancer risk.
 Decide whether to have prophylactic, or preventive,
surgery such as prophylactic mastectomy (removal
of a breast) or oophorectomy (removal of one or both
ovaries).
 Provide useful information to other family members
(if you decide to share your results).
 Contribute to research.
The disadvantages of testing
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There is no proven way to reduce genetic cancer risk,
except through periodic examination and/or surgery.
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There is no guarantee that test results will remain private.
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You may face discrimination in health insurance, life
insurance, or employment.
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You may find it harder to cope with your cancer risk
knowing the results.
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Negative results may provide a false sense of security
because you think you have no chance of getting cancer,
which is not true.
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Genetic testing requires genetic counseling.
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It is costly and may not be covered by your insurance.
Signs & symptoms
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Change in bowel habits or bladder function: Chronic constipation, diarrhea, or a
change in the size of the stool may indicate colon cancer. Pain with urination, blood in
the urine, or a change in bladder function (such as more frequent or less frequent
urination) could be related to bladder or prostate cancer.
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Sores that do not heal: Skin cancers may bleed and resemble sores that do not heal. A
persistent sore in the mouth could be an oral cancer and should be dealt with
promptly, especially in patients who smoke, chew tobacco, or frequently drink
alcohol.
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Unusual bleeding or discharge: Unusual bleeding can occur in either early or
advanced cancer. Blood in the sputum (phlegm) may be a sign of lung cancer. Blood
in the stool (or a dark or black stool) could be a sign of colon or rectal cancer. Cancer
of the cervix or the endometrium (lining of the uterus) can cause vaginal bleeding.
Blood in the urine is a sign of possible bladder or kidney cancer. A bloody discharge
from the nipple may be a sign of breast cancer.
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Thickening or lump in breast or other parts of the body: Many cancers can be felt
through the skin, particularly in the breast, testicle, lymph nodes (glands), and the soft
tissues of the body. A lump or thickening may be an early or late sign of cancer. You
may be feeling a lump that is an early cancer that could be treated successfully.
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Indigestion or trouble swallowing: While they commonly have other causes, these
symptoms may indicate cancer of the esophagus, stomach, or pharynx (throat).
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Recent change in a wart or mole: Any change in color or shape, loss of definite
borders, or an increase in size should be reported to your doctor without delay. The
skin lesion may be a melanoma which, if diagnosed early, can be treated successfully.
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Nagging cough or hoarseness: A cough that does not go away may be a sign of lung
cancer. Hoarseness can be a sign of cancer of the larynx (voice box) or thyroid.
Physical Diagnosis Melanoma
The Gold Standard of
Diagnosis - Biopsy
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The only absolutely
certain way to diagnose
a cancer is to take a
cell sample (a process
called a biopsy) and
look at it under a
microscope. This is
usually done by placing
a needle into the
affected area and
sucking out some cells.
CT image-directed biopsy. A patient with a large retroperitoneal liposarcoma occupying nearly 75% of
the total abdominal and retroperitoneal space. A CT-directed needle biopsy is being performed in an
area of suspected liposarcoma dedifferentiation. The posterior approach through the lumbar
musculature allowed positive identification of dedifferentiation, which led to initial neoadjuvant therapy
prior to an ultimately successful surgical resection.
Tumor specific protein staining
A. Prostate Cancer Stained for HIP-1
B. Normal Prostate Stained for HIP-1
Staining Breast Cancer for p53
Medullary
Cancer
Glandular
Cancer
Unstained
Stained with p53 antibody