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Early Detection and Support in the Fight Against Cancer

By: Mark Cronin


 

Every week, 74 Monroe County residents learn that they have cancer. Each person faces the initial shock of diagnosis and subsequent search for the right treatment.

As regional vice president for the American Cancer Society, one would think I had all the answers and special insider information. But the truth is—the most valuable information I have access to is also available to every resident of the greater Rochester community.

The American Cancer Society is the only organization that provides assistance by a live person—a cancer information specialist—any time of the day or night, 365 days a year at 1.800.227.2345. And we're the only cancer organization with local offices to serve people in every region in New York State. When a doctor says you have cancer, that's all you hear. What comes after that is a blur. Then at night, when you are lying in bed, questions begin to pop up. What are my treatment options? Will I lose my hair? Can my cancer be cured? A simple phone call right from the comfort and privacy of your own home, provides answers, support, and most of all, hope.

Many make use of the online help at www.cancer.orgLink1 by logging on to our confidential Cancer Survivors Network to learn more about personalized treatment options and what to expect based on a specific diagnosis. This reliable information is the basis for an informed discussion with a patient's physician.

Navigating the cancer journey

Whether you come to the American Cancer Society through your local physician, the 800 number or Web site, cancer specialists are ready to support and guide patients and caregivers through the cancer journey.

Prevention and early detection save lives

We are a nation of 11 million cancer survivors and even more of what I call pre-survivors. A pre-survivor is an individual who has had pre-cancerous cellular changes detected and treated even before malignancy occurs. For example, a 50-year old has pre-cancerous polyps removed during a routine colonoscopy and is able to avoid cancer completely. She is a pre-survivor.

In coming years, we can expect additional, less invasive, and more sensitive screening tests that will identify pre-cancerous conditions and genetic mutations that indicate increased risk. As a nation, we need to ensure that every single person has access to health care, including lifesaving cancer screening tests. By taking action, we will avoid and successfully treat many of the most common cancers.

It is important for all of us to recognize that our lifestyle choices play an important role in determining our risk for cancer. This means that YOU can take action to substantially reduce your risk of getting cancer! Avoiding tobacco, eating a healthy diet, exercising every week and minimizing sun exposure are important steps to reducing the chances that you will face cancer in your lifetime. We also know that mammograms for women over the age of 40 and colorectal cancer screening for people over the age of 50 can detect cancer early and save lives.

Guidelines for the early detection of cancer*

The following cancer screening guidelines are recommended for those people at average risk (unless otherwise specified) and without any symptoms. People who are at increased risk for certain cancers may need to follow a different screening schedule, such as starting at an earlier age or being screened more often. Those with symptoms that could be related to cancer should see their doctor right away.

For people aged 20 or older having periodic health exams, a cancer-related checkup should include health counseling, and depending on a person's age and gender, might include exams for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some non-malignant (non-cancerous) diseases.

Special tests for certain cancer sites are recommended as outlined below.

Breast cancer

  • Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
  • Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.
  • Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
  • Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Colon and rectal cancer

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below. The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you. Talk to your doctor about which test is best for you.

Tests that find polyps and cancer

  • flexible sigmoidoscopy every 5 years1
  • colonoscopy every 10 years
  • double contrast barium enema every 5 years1
  • CT colonography (virtual colonoscopy) every 5 years1

Tests that mainly find cancer

  • fecal occult blood test (FOBT) every year1,2
  • fecal immunochemical test (FIT) every year1,2
  • stool DNA test (sDNA), interval uncertain1

1 Colonoscopy should be done if test results are positive.

2 For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.

People should talk to their doctor about starting colorectal cancer screening earlier and/or being screened more often if they have any of the following colorectal cancer risk factors:

  • a personal history of colorectal cancer or adenomatous polyps
  • a personal history of chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in 2 or more first-degree relatives of any age)
  • a known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

Cervical cancer

  • All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
  • Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years. Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.
  • Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
  • Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

Endometrial (uterine) cancer

The American Cancer Society recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary non-polyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.

Prostate cancer

Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives [father, brothers] diagnosed before age 65) should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.

Information should be provided to all men about what is known and what is uncertain about the benefits, limitations, and harms of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

Men who ask their doctor to make the decision on their behalf should be tested.

Finding help in your community

When you face cancer, you realize the priceless value of local services that touch patients and caregivers, helping them to heal. By collaborating with health care professionals and hospitals, the American Cancer Society has assisted more newly diagnosed patients and caregivers in 2008 than ever before. The best way to access them is by calling 1.800.227.2345 or visiting the American Cancer Society Web site.

Programs like Reach to RecoveryLink4 offer hope by pairing newly diagnosed breast cancer patients with volunteers who have battled the disease and won. Man to Man educates men about treatment options as well as how to cope with side effects that often accompany some of treatments. And Look Good…Feel BetterLink2 shows women undergoing cancer treatment how to manage the physical and emotional side effects that often occur.

It takes a lot of hope to fight cancer. Sometimes it takes Hope Lodge

When diagnosed with cancer, the best hope for survival is often specialized treatment or clinical trials simply unavailable at home. That's why the American Cancer Society created Hope LodgeLink3—a place of connection, compassion, and comfort. Hope Lodge provides free lodging and support that reduces financial and emotional burdens—real obstacles to the best possible treatment.

In 2009, the American Cancer Society will partner with the Colgate Rochester Crozer Divinity School to build a new Hope Lodge in Rochester for cancer patients, transplant patients, and their families. This unique partnership will expand our commitment to provide free lodging and support for people who must leave home and travel to Rochester for their best chance for cure.

Support of the community

I've always been proud of the American Cancer Society's $3 billion research program—over $5 million at work here in Rochester at the U of R and RIT—and the breakthroughs we've made. I'm also proud of the thousands of Relay For Life and Making Strides Against Breast Cancer volunteers that raise awareness and funds right here in the greater Rochester community.

It takes a community to fight cancer and there are many ways to get involved. From driving a patient to and from treatment, to forming a team at your hometown Relay For Life event, there are volunteer opportunities to fit even the most hectic schedule. Learn more by calling 1.800.227.2345 or www.cancer.org.Link1


Please note that Internet links can change over time—the following links were verified during the most recent review of the Healthnote.

Link1: American Cancer Society

Link2: Look Good…Feel Better

Link3: Hope Lodge

Link4: Reach to Recovery


References

American Cancer Society. Cancer Facts & Figures 2008. Atlanta, Ga: American Cancer Society; 2008.

Levin B, Lieberman DA, McFarland, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Published online March 5, 2008. CA Cancer J Clin. 2008;58.

Saslow D, Boetes C, Burke W, et al for the American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57:75-89.

 

 

About the Author 

Mark Cronin Mark Cronin

Mark Cronin is Regional Vice President, Lakes Region, American Cancer Society

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The Rochester Healthnote Library consists of locally-authored articles either commissioned by Rochester Health or republished with the author's permission. The information provided in the Rochester Healthnote Library is for general informational purposes only and is not meant to be a substitute for professional medical advice and treatment. You should always seek the advice of your physician or other medical professional if you have questions or concerns about a medical condition.


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