Stop cancer before it starts: 7 essential screenings you can't ignore

Every year, over 20 million people globally are diagnosed with cancer and close to 9.5 million people will reportedly succumb to this dreaded disease. An important public health effort in the war against cancer is to highlight ways in which it can be prevented.

Increasing education and spreading awareness has been one of the strategies that has been employed to sensitise people on the need to abstain from activities like consuming tobacco products and other harmful habits that increase a person's risk of getting cancer. In an interview with HT Lifestyle, Dr Ashok Gopinath, Head – Partner Development at Strand Life Sciences, shared, "Early detection of cancer has been clinically demonstrated to significantly improve the outcomes (5 year survival) of cancer patients. Nearly every person detected with stage 0 and stage 1 breast cancer will survive; however this reduces to a 30% survival chance when detected in an advanced stage."

Increasing education and spreading awareness has been one of the strategies that has been employed to sensitise people on the need to abstain from activities like consuming tobacco products and other harmful habits that increase a person's risk of getting cancer. In an interview with HT Lifestyle, Dr Ashok Gopinath, Head – Partner Development at Strand Life Sciences, shared, "Early detection of cancer has been clinically demonstrated to significantly improve the outcomes (5 year survival) of cancer patients. Nearly every person detected with stage 0 and stage 1 breast cancer will survive; however this reduces to a 30% survival chance when detected in an advanced stage."

He further stated, "Similarly 90% of people detected with bowel cancer will survive the disease when detected early but only 10% will survive if detected at an advanced stage. 6 in 10 people are likely to survive lung cancer if detected in early stages but this plummets to less than 10% survival if detected in an advanced stage. Like most diseases very often cancer is detected after a person displays symptoms that have sufficiently impacted their leading a normal lifestyle. Unfortunately very often by this time the cancer may have advanced to a stage that is detrimental to the survival of a person despite access to the best treatment."

Great progress has been made to "screen" people early for cancer and strict clinical guidelines have been articulated and established for diagnostic and treatment modalities. Dr Ashok Gopinath said, "It's important to highlight that "screening" is a term used for assessing risk in a "non-symptomatic" or "healthy" person. A diagnostic test is often conducted after there is an indication of an elevated risk to a patient revealed by a "screening protocol". There can be a few barriers to early screening. Apart from making the time to conduct routine screening tests, the cost of tests, and the fact that some tests can be invasive and uncomfortable to undergo all contribute to the decreased adoption."

The risk of getting cancer increases with age and hence age is a significant risk factor. Dr Ashok Gopinath revealed, "Most screening tests are recommended in concert with a defined "age risk". Cancer can affect many different organs and tissues in the human body and so the tests for screening and diagnosis of cancer are diverse and varied."

He highlighted some essential cancer screenings that help characterise the risk one has of getting cancer:

1. Annual visits to the physician –

This is the simplest type of screening test to perform. It only requires one to take the requisite time and effort to visit your family physician once a year. Very often this will involve enquiries, discussions and documentation of family history of cancer and/or any abnormal physiological features (bleeding, pain, discomfort, etc). Occasionally based on age or other risk factors (family history, physiological symptoms) one may also be subjected to a physical exam particularly for breast cancer and also digital rectal exam for prostate cancer. Very often this visit will include conducting a thorough blood test and presentation of report details to the physician.

2. Pre-emptive genetic testing –

Many cancers are known to be inherited. This means that there are certain changes in one's genetic material that could increase the risk of getting cancer, and these changes are passed on from parents to offspring. Tests such as the Genomic Health Insights by Strand Life Sciences are once-in-a-lifetime test that informs the risk of getting specific types of cancers and when coupled with information on family history can enable pre-emptive decisions that prevent cancer as well as the implementation of slightly more aggressive surveillance protocols to detect cancer early. It's important to note here that a "low risk" genetic test result does not mean that one can never get cancer and all cancer prevention lifestyle habits must continue to be observed.

3. Screening for cervical cancer –

The Pap smear is a commonly recommended test for women aged 21 years and above. The general recommendation is to conduct this test once in 3 years from the age of 21 up to the age of 65. Additionally a HPV test can also be conducted, periodically usually once every 5 years. More recently HPV vaccinations are being recommended to prevent and reduce the occurrence of cervical cancer in women.

4. Screening for breast cancer –

Monthly physical breast self-exams after the age of 21, coupled with genetic testing discussed above are important pre-emptive screenings to be conducted for breast cancer. Additionally family history increases the risk of getting breast cancer. Mammograms are suggested to be conducted annually after the age of 40 even in the absence of other risk factors. If there are other risk factors it is likely that annual mammography will be recommended earlier.

5. Screening for colorectal cancer –

Once familial and other symptomatic risks have been conducted it is common for a doctor to recommend a fecal occult blood test (FOBT). This test would involve the submission of a stool sample. Additionally for low risk individuals an annual sigmoidoscopy may be recommended for people above the age of 45. Based on increasing risks this screening test may be conducted annually at younger ages. (Below 40). Other tests may include Colonoscopy to be conducted once every 10 years after the age of 40.

6. Screening for prostate cancer –

Men at average risk for getting cancer should be screened annually for prostate cancer after the age of 50. Typically screening would start at the age of 50, but for men with higher risk the screening could start at 45 years. The main screening test involves a blood test that estimates the level of the Prostate Specific Antigen (PSA) and a digital Rectal Exam (DRE) which is a physical exam. Typically, age is the biggest risk factor for prostate cancer in men.

7. Screening for lung cancer in high risk individuals –

Mostly screening for lung cancer is recommended for people who engage in high risk habits, including smoking and consumption of tobacco products. Low dose computed tomography (LDCT) is an annual screening method recommended for persons 50 years and older who have high risk habits. In general this screening is not recommended for people in the average and below average risk categories.

Dr Ashok Gopinath opined, "As is evident from the above brief list of screening methodologies that the protocols and tests differ based on age, gender, family history, symptoms and of course organ/tissue that can be impacted by the disease. In this setting it is important to note that the ideal screening test for the "early detection of cancer" should be a single, minimally invasive test that can not only identify the early onset of all cancer types but also be able to indicate the organ/tissue of origin."

He concluded, "Such a test actually exists, but is currently in various steps of evaluation, by several different companies. This test involves testing the individual's blood for traces of tumor DNA/cells. The progress made in the area of genomics and the continued decrease of costs associated with DNA sequencing makes this form of detection more attractive because it is minimally invasive and has the potential to discover many types of cancer with just a single test. As more and more companies get involved in this space the chance that we will have routine annual cancer screening conducted as a blood test keeps increasing; and the ability to catch cancer in its earliest stages increases; and thereby the chance of therapeutic interventions saving lives increases."