Screening exams!  You might be asking yourself…Colonoscopy? Mammogram? Prostate screening? Do I need this?  How often do I need this? Do these tests really prevent cancer?

Good questions and my-oh-my it is so hard to keep track of the different screening exams.  I get asked all the time…and well….I have cheat sheets I whip out when people ask. So I created one just for you.

Before taking a peek at the cheatsheet below let’s get some things straight.

 What is the difference between screening exam and a diagnostic exam?

Screening exams are look for early stages of disease.  Screening exams are for people who may have increased risk due to age or demographic, but they are not necessarily presenting with signs or symptoms.  Screening usually start at a certain age, but of course if you have high risk, strong family history, then your doctor may recommend certain tests sooner.  

Screening examples:

• Woman getting a PAP starting at age 21, continues to get PAPs every 3 years as long as she continues to have negative PAPs
• A man (or woman) has his (her) blood pressure checked every 3-5 years starting at 18 years old and  yearly after the age of 40.

Diagnostic exams are ruling out suspected disease.  Diagnostic exams are for people who are presenting with symptoms. Examples:

• woman who finds a lump in her breast would be recommended  a diagnostic mammogram.
• A man (or woman) has persistent blood and mucous in his (her) stool would be recommended a diagnostic colonoscopy.   

Do these tests prevent cancer?  It is better to think of it as early detection. The earlier cancer is detected the more time and the “easier” it is to get a handle on it. Cancer is based on exposures, genetics, lifestyle, stress, so testing isn’t really going to prevent abnormal cells from forming.  But finding abnormalities early can, detect abnormal cells before they become “true cancer”, stop the cancer in its tracks, detect and treat early to prevent spread of cancer throughout the body.

There are many different organizations in many different countries that develop guidelines.  A couple of american organizations include:  American Cancer Society, US Preventative Task Force.  These organizations research the risk to benefits and develop guidelines based on age, frequency, and potential benefits for early detection of disease.  The US Preventative Task force, a government agency grades the tests based on benefit.

Grade A– Recommended based on high certainty that net benefit is substantial.

Grade B– Recommended based on high certainty that net benefit is moderate or moderate certainty that net benefit is moderate to substantial.

Grade C– Moderated certainty that net benefit is small. Should be based on individual need, patient preference, and clinical judgement.

Grade D– Not recommended based on moderate to high certainty that the net benefit is low or harms outweigh the benefit.

Grade I– Current data is insufficient to balance benefits to harm of this service.  

Keep in mind guidelines change.  For example for the longest time PAPs were recommended yearly.  Now they are only recommended every 3 years. Guidelines often change because the increased risk of false positives, overdiagnosis, overtreatment, and significant negative side effects from treatment exist (in the event of treating a false positive.)  

You can decline screening exams. Keep in mind the whole purpose of screening is to detect disease or cancer early in order to increase time for successful treatment.  Before you decline a test consider how comfortable you feel with getting cancer, especially after years of declining screening. Consider if getting a positive result would influence the kind of treatment you would be willing to get.  Also consider how a positive (or negative result) would change your behavior and your quality of life.

Many people are concerned with the radiation or discomfort from getting the screening tests;  That is totally understandable. Sometimes we have to accept a little risk to gain some benefit.  And sometimes people are fearful of what might be found; Also understandable. Unfortunately, ignorance is not always bliss.  But with that said, your health, your screening, your decisions on treatment are always your choice. Your doctor’s role is to educate you, let you know the pros and cons.

Are you ready for that screening exam cheatsheet?  Here you go: Screening exams 2018!