Screening for colorectal cancer
A 2020 draft recommendation of the USPSTF is that beginning at age 45 the initiation
of these tests that find polyps and cancer:
• Flexible sigmoidoscopy every five years*, or
• Colonoscopy every 10 years, or
• Double-contrast barium enema every five years*, or
• CT colonography (virtual colonoscopy) every five years*
* If the test is positive, a colonoscopy should be done.

A different schedule may be indicated based on previous findings, personal or family
history. Colonoscopy is considered the “gold standard” of testing, the other tests
are less reliable, but they have the advantage of being less invasive. An annual
fecal occult blood test, or an annual immunochemical test (FIT), or an annual stool
DNA test that can detect abnormal DNA from cancer or polyp cells may be helpful
in detecting polyps and cancer. The American Cancer Society provides information on colorectal cancer screening
at http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/
colorectal-cancer-early-detection-toc.

Screening for cervical cancer
Based on increasing evidence, the trend in recommendations for cervical cancer is
less frequent screening. Current guidelines call for cervical cancer screening with
a cytology (Pap) test every three years beginning at age 21 up to age 65. Because
women frequently clear HPV infections without treatment, women under age 21
should not be tested. The trend is to replace the Pap test with HPV testing that can
detect the presence of the high-risk cancer-causing strains of HPV. Depending on
age, a history of cervical cancer or findings of cervical pre-cancer, HPV testing, and
a different screening schedule may be indicated.

In 2018 the U.S. Preventive Services Task Force recommended screening for cervical
cancer every three years with cervical cytology alone in women aged 21 to
29 years and screening every three years with cervical cytology alone, every five
years with DNA testing for high-risk HPV (hrHPV) alone, or every five years with
hrHPV in combination with cytology (co-testing) in women aged 30 to 65 years.
The USPSTF recommends against screening for cervical cancer in women younger
than 21 years, against screening for cervical cancer in women older than 65 years
who have had the adequate prior screening and are not otherwise at high risk for
cervical cancer, and against screening for cervical cancer in women who have had a
hysterectomy with removal of the cervix and do not have a history of a high-grade
precancerous lesion or cervical cancer. As with all cancer screening recommendations,
ongoing research will help identify better cervical cancer screening recommendations,
so check with your health care provider for up-to-date information and
a discussion of how it best fits your own situation.
The American Cancer Society offers a cervical cancer guide at http://www.cancer.
org/cancer/cervicalcancer/detailedguide/index.

Screening for endometrial (uterine) cancer
Women should know that post-menopausal or any unexpected vaginal bleeding or
spotting can be symptoms of endometrial cancer that should be evaluated by their
health care provider. Based on symptoms and history, endometrial biopsies may be
indicated. The American Cancer Society offers an endometrial cancer guide at http://www.
cancer.org/cancer/endometrialcancer/detailedguide/endometrial-cancer-deP
tailed-guide-toc.

Screening for ovarian cancer
Similar to women with lung and pancreatic cancers, women with ovarian cancer
may have few symptoms, so they are typically diagnosed in late stages, resulting in
poor outcomes. Only 20% of patients with ovarian cancer are diagnosed with stage
I disease; their five-year survival rates are greater than 90%. For women diagnosed
with stage III or IV ovarian cancer, five-year survival rates are approximately 17%
to 39%. In 2017 the U.S. Preventive Services Task Force (USPSTF) updated recommendations
on screening for ovarian cancer and reiterated the recommendation
against screening for ovarian cancer in asymptomatic women at average risk who
are not known to have a high-risk hereditary cancer syndrome. The task
force concluded that there is no current test for the early detection of ovarian cancer
suitable for widespread population use in women that could reduce ovarian cancer
mortality.

Screening for lung cancer
Lung cancer is the leading cause of cancer-related mortality in the U.S., with
159,000 deaths in 2014. Survival is greatly increased by early diagnosis and is underused
by the heavy smokers for whom it is indicated. X-ray screening has a very
high likelihood of false-positive results and has not been demonstrated to save lives
when carried out among individuals at average risk. So routine screening is not
indicated except for individuals who are at high risk of lung cancer due to cigarette
smoking with at least a 30 pack-year smoking history and are either still smoking or
have quit smoking within the last 15 years.
The American Cancer Society offers information on lung cancer prevention and
screening at http://www.cancer.org/cancer/lungcancer-non-smallcell/moreinformation/
lungcancerpreventionandearlydetection/lung-cancer-ped-toc.

This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel.