If cancer runs in your family, or you are at high risk because of your age or other factors like your smoking history, talk to your doctor about cancer screenings. These tests are designed to detect cancer early in people with no apparent symptoms.

Yale Medicine recommends screening for certain cancers, especially those for which early treatment is of great benefit in helping patients live better and longer lives. Screening is available for several types of cancer, including: 

• Breast cancer
• Cervical cancer
• Colorectal cancer
• Lung cancer
• Prostate cancer
• Skin cancer
• Head and neck cancer

“We’re here not only for those who have been diagnosed with cancer,” says Beth A. Jones, PhD, MPH, who is the director of the Smilow Screening & Prevention Program at Smilow Cancer Hospital at Yale New Haven, where many Yale Medicine physicians practice. “We also want to do everything we can for people who want to protect themselves and their families by maintaining a healthy lifestyle and by getting regular cancer screening tests as recommended by their health care providers.”

Breast cancer can sometimes be detected by a woman who feels a lump in her breast or notices other breast changes during a self-exam. More often, though, breast cancer is detected when a mammogram or other screening test identifies an abnormality in breast tissue. Whether a woman feels a lump or a mammogram detects an abnormality, a diagnosis is made by a doctor based on a clinical exam of the breasts and diagnostic imaging. To confirm diagnosis, the abnormal breast tissue is biopsied, and the sample is examined under a microscope to check for the presence of cancer cells.

The U.S. Preventive Services Task Force (USPSTF) recommends that women between the ages of 40 and 74 who are at average risk for breast cancer get a screening mammogram every two years. If you are at increased risk for breast cancer due to family history or have had chest radiation or if you have other risk factors that put you at increased risk for breast cancer, talk to your health care provider about having a breast cancer screening test before age 40.

“Screening enables us to find breast cancer early when it’s most treatable,” says Anees Chagpar, MD, MPH, a Professor in the Department of Surgery (Oncology, Breast) at the Yale School of Medicine.

There are several methods of imaging used to screen for breast cancer, including:

• Mammogram: This is an X-ray of the breasts.
• Digital Breast Tomosynthesis (DBT): A type of mammography in which a machine takes multiple X-ray images of the breast from different angles. DBT allows the radiologist to view “slices” of the breast tissue for improved detection of breast cancer.
• Ultrasound: This test uses sound waves to produce images of breast tissue.
• MRI: In some cases, for instance for women with dense breasts, magnetic resonance imaging scans are used to check for abnormalities in breast tissue.

Women are screened for cervical cancer with the Pap test and/or a Human Papillomavirus (HPV) test. They should talk to their doctor about when they should begin screening, how frequently they should be screened, and which screening tests are appropriate for their situation.

The USPSTF recommendations for cervical cancer screening are as follows:

• Women ages 21 to 29: A Pap test every three years.
• Women ages 30 to 65: A Pap test every three years, an HPV test every five years, or an HPV test combined with a Pap test every five years.
• The USPSTF does not recommend screening for women under 21 years of age.
• The USPSTF does not recommend screening for women over 65 years of age who have had adequate screening and are not at high risk for cervical cancer.
• The USPSTF does not recommend screening for women who have had a total hysterectomy (when the uterus and cervix are removed) and who do not have cervical cancer or a precancerous condition such as CIN2 or CIN 3. Women who have had a hysterectomy without removal of the cervix (called a supracervical or subtotal hysterectomy) should continue cervical cancer screening according to the guidelines above.

Women who have abnormal screening results may need to have follow-up Pap tests and/or HPV tests at more frequent intervals.

Women who are at high risk of cervical cancer or who have been diagnosed with cervical cancer, cervical pre-cancer, or HIV infection should follow the recommendations of their health care providers.

The USPSTF and the American Cancer Society recommend that individuals at average risk for colorectal cancer between the ages of 45 and 75 undergo regular screening for colorectal cancer. People ages 76 through 85 should talk to their doctor about whether screening is appropriate for them. Colorectal cancer screening isn’t recommended for individuals over 85 years of age. Screening may begin at a younger age for those who are at increased risk for colorectal cancer (e.g., family history of colorectal cancer, personal history of colorectal polyps or colorectal cancer, or personal history of inflammatory bowel disease).

A number of recommended screening tests are available. People should talk to their doctor about which test is best for them.

Colorectal cancer screening tests include:

Colonoscopy. During a colonoscopy, a doctor inserts a colonoscope—a thin tube equipped with a light and camera—into the patient’s rectum and guides it into the colon (also known as the large intestine). In most cases, patients are given a sedative during a colonoscopy, so they do not feel pain.

The test enables doctors to visually examine the colon and rectum, and using instruments inserted through the colonoscope, collect tissue samples or remove polyps. Tissue samples and polyps are examined under a microscope to check for the presence of cancer.

For people at average risk for colorectal cancer, colonoscopy screening is recommended once every ten years. More frequent colonoscopies are recommended for those at increased risk for colorectal cancer.

Prior to getting a colonoscopy, patients must follow a special clear liquid diet for a day or a few days and, in many cases, take a laxative to cleanse the bowels.

Stool-based Tests. A few different tests use stool samples to check for signs of colorectal cancer. Stool samples can be collected at home using special kits available from a health care provider. Unlike colonoscopy, stool-based tests do not require bowel cleansing.

Stool-based colorectal screening tests include:

• Fecal Immunochemical Test (FIT). Colorectal cancers can cause bleeding in the colon and rectum. The FIT test uses antibodies to check for the presence of blood in stool samples. Blood in the stool can also be caused by many other noncancerous conditions. If blood is detected, a follow-up colonoscopy is usually necessary to check for colorectal cancer.
  
  FIT testing is done once per year.
• Guaiac-based Fecal Occult Blood Test (gFBT). An annual test that uses a chemical called guaiac to check for the presence of blood in stool samples.
• Multi-targeted Stool DNA Test. This test, sometimes called a FIT-DNA test, detects DNA biomarkers for cancer that are shed by cells that line the colon and rectum and end up in the stools. It also checks for the presence of blood in the stool sample. If the test is positive for DNA biomarkers or if it detects blood in the stool, a colonoscopy is necessary to determine whether it is caused by cancer or another condition.
  
  Multi-targeted stool DNA testing is done once every three years.

Computed Tomography (CT) Colonography. Sometimes called a virtual colonoscopy, during this procedure, X-ray images of the colon and rectum are taken from various angles from outside the body. A computer compiles the images into cross-sectional images that doctors can examine. Patients are not sedated for this test. If polyps or other abnormalities are present in the colon and/or rectum, a traditional colonoscopy usually is necessary to biopsy and test tissue samples and to remove polyps. Before undergoing a CT colonography test, patients must change their diet for a day or a few days before the procedure and may need to take a laxative to cleanse their bowels. Patients may need to drink a contrast solution before the procedure. The contrast agent helps the doctor distinguish between tissue and any stool that remains in the colon or rectum.

CT colonography is done once every five years.

The USPSTF recommends annual lung cancer screening for people ages 50 to 80 who have a 20 pack-year or greater smoking history and currently smoke or quit smoking within the previous 15 years. Screening involves an imaging study called a low-dose computed tomography (LDCT scan).

Prostate cancer is the second most common cancer among men in the United States. The USPSTF recommendations state that men between 55 and 69 years of age should make an individual decision about whether to undergo a prostate specific antigen (PSA) screening test. The agency recommends that men talk to a health care provider about the benefits and harms of getting screened for prostate cancer given their family history, race, and whether they have other medical conditions. The USPSTF does not recommend PSA screening for men ages 70 and older.

“We recommend that our patients do a head-to-toe skin check at home in a mirror every month,” says Kathleen Suozzi, MD, a Yale Medicine dermatologic surgeon in Cutaneous Oncology Program. Regular self-evaluation is important for detecting suspicious skin changes early and bringing them to your dermatologist’s attention. When scanning your skin for signs of cutaneous melanomas, know your A, B, C, D and E’s:

• Asymmetry: Moles that have an irregular, nonsymmetrical shape
• Border: Moles with irregular or blurred borders
• Color: Moles with multiple colors and areas of darkening
• Diameter: Moles over 6 millimeters (just under a quarter inch) in diameter
• Evolving: Moles that change in size, shape, shape, or color, or that itch or bleed

If you notice any moles that meet any of the above criteria, see a dermatologist for evaluation.

People who have had skin cancer should have a doctor perform regular skin checks. If any skin abnormalities are found, doctors routinely biopsy them and send the tissue samples to a pathologist who will look at the samples under a microscope to check for the presence of cancer cells.

While there is no screening test for cancers of the head and neck, dentists and doctors can check these areas for symptoms and signs of cancer. During routine dental appointments, dentists typically inspect the lips, mouth, throat, and neck for sores, lumps, swelling, or other signs and symptoms that should be further assessed by a doctor. Similarly, during routine check-ups, doctors examine the ears, nose, mouth, throat, and neck to screen for head and neck cancer.

People can also use a mirror to do regular self-checks of the mouth for white or red patches, lumps, or other sores.

Whether or not you have cancer in your family, you can reduce your chances of developing it. You can make healthy lifestyle choices such as avoiding smoking or chewing tobacco, eating a nutrient-rich diet with plenty of fruits and vegetables, staying active, limiting alcohol use, and protecting your skin and eyes from ultraviolet radiation, says Dr. Jones. Also be sure to report any new symptoms you experience to your doctor, who can determine whether you need testing or treatment.

Because our Yale Medicine oncologists are leading experts in cancer treatment, if cancer is detected during a screening, our physicians are well qualified to treat patients from diagnosis through treatment.

We also run many clinical trials which offer innovative treatment options for many patients. To find out more about cancer screening and how to arrange for a screening exam at Yale Cancer Center, call 203-200-3030 or email screening@ynhh.org for more information.