Cancer

Diagnosis & Tests

Regular Screening Can Help You Stay Healthy

The American Cancer Society and other groups involved with cancer education recommend regular check-ups and specific tests. You should get these regardless of how you feel or whether you have any symptoms.  Early screening can help find many cancers before symptoms start, while the cancer is small and before it has spread. Early screening often leads to treatment of the cancer and a complete cure.

Screening tests aren’t recommended for all older adults. They are recommended for older adults at normal risk who are interested in pursuing treatment if the screening test finds cancer. They are also recommended for people who are expected to live long enough to benefit from cancer treatment.

The screening tests below are recommended for older adults at normal risk who:

  • would be interested in pursuing cancer treatment if one were found
  • are expected to live long enough to benefit from detection and treatment of an early cancer
  • have overall goals for care that are consistent with the treatment

The age at which various screening tests should be stopped is controversial.  This is because there may be a low benefit to screening for cancer or because the screening test itself is burdensome.  Most importantly, the decision to screen has to do more with a person’s overall health and prognosis than age. 

If you have already been treated for cancer, or have a family history of cancer, talk to your healthcare provider about the need for additional or more frequent tests.

Unfortunately, there is not a screening test for every type of cancer. The below section describes screenings for the more common kinds of cancer:

Breast Cancer

Older women at normal risk should receive a mammogram every one to two years.

 

Cervical Cancer

A Pap test is used to screen for cervical cancer. Approximately half of cervical cancers diagnosed in the United States occur among women who never had a screening test, and an additional 10% occur among women who had not been screened in the previous 5 years.

However, many older women no longer need to receive Pap tests. Regardless of your sexual history or current sexual partners, you may stop having Pap tests if you meet ALL of the following conditions:

  • you are over 65 years old
  • you had at least 3 normal Pap tests in a row
  • your last Pap test was within the past 5 years
  • you had no abnormal Pap tests in the last 10 years
  • you are not otherwise at high risk of cervical cancer

If you have had a total hysterectomy (removal of the uterus and cervix), you don’t need Pap tests any longer, unless you had cervical cancer or pre-cancer. If your cervix was not removed during the hysterectomy, you should continue to have Pap tests.

Colorectal Cancer

Screening tests for colorectal cancer may take several forms. Talk with your healthcare provider about which tests are right for you and when you should stop screening for colon cancer. For older adults with average risk, the most common types of screening are one of the following:

  • colonoscopy every 10 years
  • flexible sigmoidoscopy every 5 years
  • fecal occult blood test (a test for blood in your stool) every year.

Lung Cancer

Lung cancer is the leading cause of cancer death in the United States. There is a screening test available that uses low-dose computed tomography. This yearly screening test is recommended for long-time smokers 55 years or older. It is also recommended for previous smokers over 55 who quit smoking within the past 15 years.

Prostate Cancer

There are routine screenings for prostate cancer. One is a digital rectal exam (DRE), where your healthcare provider puts a lubricated, gloved finger into your rectum. The other is a blood test called PSA (prostate-specific antigen).

However, PSA screening for prostate cancer is fairly controversial. This is because the risk of prostate cancer-related death is very low (one death out of a thousand people screened over 10 years).  These screening tests may pick up abnormalities, which may lead to a prostate biopsy (where a small sample of prostate tissue is removed). However, biopsies have their own risks, and may lead to unnecessary surgeries with possible permanent side effects. This means it is really difficult to know which men should have screening for prostate cancer, and for which men the downsides of screening outweigh the benefits.

Therefore, most expert panels recommend that men aged 55-70 discuss the potential harms and benefits of screening with their healthcare provider. This will allow you to work with your provider to make a decision about screening that is appropriate for your individual situation.

However, it is recommended that men over age 70 should not undergo screening. This is because the potential benefits of screening in men 70 years and older do not outweigh the expected harms.

Skin Cancer

Melanoma is the most dangerous form of skin cancer. The incidence of melanoma continues to increase. Fortunately, there have been new breakthroughs in the treatment of advanced melanoma. Some people should be checked regularly by a dermatologist (a doctor who treats skin conditions) or a trained healthcare professional. You should have regular checkups if you have already had melanoma, if you have more than one family member who has had the disease, or if you have many unusual moles.

Cancer of the Uterus (Endometrial Cancer)

All older women who have reached menopause should report unexpected vaginal bleeding or spotting to their healthcare provider. These symptoms might be signs of uterine cancer.

Tests

If you have been diagnosed with cancer, your healthcare provider or oncologist will order more specific tests. This will help to analyze the type of cancer more precisely. This helps identify the stage or grade of the cancer. The stage indicates the extent of the cancer—how much it has grown and spread.

These tests may include some of the following:

  • biopsy of the tumor (surgical removal of a small piece of tissue)
  • blood tests (to look for chemicals such as tumor markers)
  • bone marrow biopsy (if testing for lymphoma or leukemia)
  • x-rays
  • complete blood count (CBC)
  • CT (computed tomography) scan, MRI (magnetic resonance imaging) scan, ultrasound studies, PET (positron emission tomography) scan, or combination PET/CT.
Bring a close friend or family member with you to the oncologist’s office when you are getting your diagnosis. They can remind you to ask important questions and help you remember what the oncologist said. It is helpful to write down your questions before your visit, as well as take notes during your visit. This helps you ask additional questions later if there is anything you didn’t understand. 

 

 

 

 

Last Updated February 2018 ​​​​​​​