Cancer Screenings

In-depth personal cancer risk assessment screenings are available for all common cancers at the Cancer Prevention Clinic. A personal screening plan will be determined by your Cancer Prevention Clinic provider and will be dependent upon your personal cancer history and other factors that can affect your risk.

Typical cancer screenings include:

Mammography for breast cancer screening
PAP smears for cervical cancer screening
Prostate cancer screening
Colorectal cancer screening
Skin cancer screening
Lung cancer screening
Information and recommendations on other proposed cancer screening technologies

Breast Cancer Screening
Early diagnosis gives the best possible chance for a cure for breast cancer. Ideally this means that the cancer will be found before a breast lump is felt. The best way to find breast cancer early is with regular mammograms, read by a doctor who specializes in reading images of the breast.

Women aged 40 and above should have routine screening mammograms once a year. If your cancer prevention plan indicates mammography screening, SCCA’s Women's Center has the largest all-digital mammography clinic in Seattle, where you can receive your results the same day as your exam. SCCA also offers a Mobile Mammography Service that provides on-site mammograms at select clinics, shopping centers, and workplace locations.

Cervical Cancer Screening
Cervical cancer used to be one of the most common causes of cancer death for American women, but widespread use of the Pap test has dramatically shifted detection to early precancerous and highly curable stages. However, more than 4,000 women die of cervical cancer in the United States each year, and an estimated 14,000 new cases of invasive cervical cancer are diagnosed.

If a Pap test shows an abnormality in the cells on the cervix, a doctor will perform a biopsy. A gynecologist will often use a colposcope--a viewing tube attached to magnifying binoculars--to find the abnormal area and remove a tiny section of the cervix surface.

Cervical cancer is usually the result of a common virus: the human papilloma virus (HPV). In 2006, a vaccine, called Gardisil, became available that prevents the HPV virus, and thus the leading cause of cervical cancer, thanks in part to researchers from Fred Hutchinson Cancer Research Center. Clinicians within the Cancer Prevention Clinic suggest that young women follow the advice of their family practitioners or pediatricians about whether Gardisil is the right choice for them.

Prostate Cancer Screening It has been common practice since the prostate specific antigen test (PSA) was created to use this as a screening tool for prostate cancer in conjunction with a digital rectal exam (DRE). The PSA is a blood test that measures a protein that is released in the blood when there are prostate cancer cells present. Although normal and malignant prostate cells secrete the protein, higher PSA levels may indicate the probability of cancer. Because the DRE can sometimes find cancers in men with normal PSA levels, doctors suggest that you have both tests.

The American Cancer Society recommends annual screening (a PSA test and digital rectal exam) for all men after age 50 who have a life expectancy of at least 10 years. Men who are at higher-than-average risk—including African American men and men with a family history of prostate cancer—should begin annual screening at age 40.

The U.S. Preventive Services Task Force (USPSTF) warns however that even though there is good evidence that PSA screening can detect early-stage prostate cancer, there is "mixed and inconclusive evidence that early detection improves health outcomes." Screening may cause "frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient's health." Therefore, the USPSTF believes there is insufficient evidence to support whether the benefits of regular screenings outweigh the potential harms.

SCCA's Cancer Prevention Clinic providers are faculty at University of Washington School of Medicine as well as Fred Hutchinson Cancer Research Center members. They are well equipped to work with you to discuss the potential benefits and risks of screening and to determine if regular screenings are appropriate for you.

Colorectal Cancer Screenings
Colorectal cancer can be very sneaky, appearing in your body with no signs or symptoms. For this reason it is important for people over 50 to be screened for colorectal cancer. Screening tests allow doctors to spot the disease at an early, curable stage. Screenings also help prevent cancer by finding polyps that can be removed before they become cancerous. Screening is recommended by all major expert groups, including the American Cancer Society and USPSTF.

Several test options are available for screening:

Fecal occult blood test to detect any blood in your stool
Flexible sigmoidoscopy, which examines your rectum and the lower part of your colon for polyps or tumors
Colonoscopy, allowing your doctor to see your entire colon.

Doctors at the Cancer Prevention Clinic have expertise in these tests and can discuss each to help find the best one for you.

Skin Cancer Screening Most melanomas that appear in the skin can be seen by the naked eye. There is usually a fairly lengthy period when the tumor expands beneath the top layer of skin but doesn’t go any deeper. This allows time for screening, early detection, treatment, and a full recovery if the tumor is discovered before it spreads.

Check Yourself
The best means of finding early warning signs of skin cancer is an examination of the skin. Give yourself a good head-to-toe skin examination once a month. When you check your own body, get to know your mole patterns, freckles, and other markings on your skin and note them on a paper body chart. This way, you will be able to notice changes over time. Some parts of our body are difficult to see, like our lower back, back of our thighs, and our scalp. Ask your spouse, partner, or a good friend to help you.

Most of us have some brownish spots on our skin, freckles, birthmarks, and moles. Most of these spots are normal, but some may be precancerous or skin cancer. The Signs and Symptoms section covers each major skin cancer, where it is usually found, who is most likely to get it, and what it looks like. Here’s what to look for during your monthly self exams. Common moles and melanomas do not look alike.

Use this “ABCD” guide when doing your self exam:
A = Asymmetry Common moles are symmetrical. This means that if you draw a line down the center of a mole, the two halves will look the same. Early melanomas are asymmetrical (not symmetrical).
B = Border Early melanomas often have uneven borders. They may even have scalloped or notched edges.
C = Color Common moles are usually a single shade of brown or black. Early melanomas are often varied shades of brown, tan, or black. As they progress, red, white, and blue may appear.
D = Diameter The diameter is the outside circle of the mole. The diameter of a melanoma is usually larger than a mole’s, though they can be smaller. Early melanomas generally grow to at least the size of a pencil eraser (about a ¼-inch diameter).

Other changes in your moles to look for:

Size - a mole is suddenly bigger or continues to get bigger.
Spreading color - Melanomas can be a variety of colors and the color may spread from the edge of the mole into the surrounding tissue.
Elevation - A flat or slightly raised mole grows higher very quickly.
Surrounding skin - The skin around a mole becomes red or develops colored blemishes or swelling.
Surface - Mole surface changes from smooth to one with scaliness, erosion, and oozing. When a mole becomes crusty, ulcerated, or bleeds it is a sign of advanced disease.
Sensation - Itching is the most common early symptom. Skin cancers are usually painless, but there can be tenderness and pain.
If any of these changes or symptoms appears, make an appointment with your doctor immediately. A dermatologist specially trained in skin cancer should be able to recognize a melanoma at its earliest stage.

The American Cancer Society recommends that if you are between ages 20 and 39, you should have a skin exam by your personal doctor or a dermatologist every three years, and once a year from age 40 on. If your doctor finds something of concern, he or she will order diagnostic tests to rule out, or identify skin cancer.

Cancer screening involves examinations and tests to catch cancer in its earliest stages of development even though you have no symptoms. Don’t be alarmed if your doctor suggests skin cancer screening. This does not necessarily mean you have it. But catching skin cancer early is crucial to increasing the positive results of treatment.

Lung Cancer Screening Lung cancer is a leading cause of all cancer deaths in the United States and in our state. Like most cancers, detecting it at its earliest stage provides the best opportunity for a cure.

If you are a smoker, or even an ex-smoker, consider visiting SCCA’s Lung Cancer Early Detection and Prevention Clinic. Even if you have already quit smoking, you are still at risk for lung cancer and other tobacco-related lung diseases.(Provided separately from the Cancer Prevention Clinic services.)

Other Screening Information
The U.S. Preventive Services Task Force (USPSTF) presents many guidelines regarding screenings for the prevention of cancer online. For more details, go to http://www.ahrq.gov/clinic/cps3dix.htm#cancer

National Cancer Institute: http://www.cancer.gov/cancertopics/wyntk/skin/page13

December 2007