For most people, early detection involves an awareness of changes in their body and raising concerns with their physician. Cancer is often detected when an individual notices a change in their health — excessive fatigue, for example, or unusual bleeding, a lump that doesn’t go away, unexplained weight loss, night sweats, or a persistent change in bowel or bladder habits. A physician can help determine whether these problems are caused by cancer or some other disorder.But in some cases, more involved screening can be helpful.
“If you see something suspicious, say something to your doctor,” advises Huma Q. Rana, MD, clinical director of Cancer Genetics and Prevention at Dana-Farber.
Most cancer self-exams haven’t been shown to be effective, but it’s important to be aware of changes to your body.
For most people at average risk for cancer, formal self-exams for breast cancer and testicular cancer are not recommended by most medical organizations because they haven’t been shown to be effective in detecting cancer. However, it is important to be aware of changes in your body and to report them to your physician.
Everyone should check themselves regularly for signs of skin cancer, such as a mole that’s new or changing in size, shape, or color, a new growth or bump, or a sore that bleeds and doesn’t heal after a few weeks.
Different kinds of cancer screening are available.
Screening tests are used to detect certain kinds of cancers when they’re small and easier to treat successfully. In some cases, screening tests can detect abnormal growths before they become cancerous. Removing such growths can help prevent cancer.
The American Cancer Society and U.S. Preventive Services Task Force set screening guidelines for a variety of common cancers, specifying the age at which screening should begin and the frequency with which it should be done.
Screening procedures include:
- Mammography for breast cancer.
- Colonoscopy for colorectal cancer.
- Pap tests (also known as pap smears) for cervical cancer. People whose Pap tests show abnormal cells may have a follow-up DNA test to detect the human papillomavirus (HPV), a virus that can contribute to the development of cervical cancer.
- Digital rectal exams and PSA tests for prostate cancer.
Create a screening plan with your physician based on risk.
Additional or more frequent screenings may be recommended for people who have had cancer or have a strong family history of cancer.
“While most cancers are sporadic — meaning they arise from factors that aren’t inherited — about 15% of cancers do have an underlying inherited component,” Rana explains.
“People with a first- or second-degree relative — a parent, sibling, child, grandparent, aunt, uncle, nephew, or niece — who had cancer, especially at a young age, should consider being tested for inherited genetic mutations that raise their risk for specific types of cancer.”
Rana says that even when people with a family cluster of cancer don’t test positive for a cancer-related mutation, they may share other genetic factors that put them at heightened risk for the disease. Anyone with a strong family history of cancer should talk with their physician about a screening plan tailored to their needs.
Such a plan might include beginning screening at an earlier age than people in the general population, being screened more often, or screening with additional technologies. People with an increased risk of breast cancer, for example, might be advised to have breast MRI scans and mammography. People from families with a high risk of pancreatic cancer are also increasingly counseled about the risks and benefits of being tested for the disease using endoscopic ultrasound or MRI.
Dana-Farber’s Centers for Early Detection and Interception is a multidisciplinary clinical and research program for individuals who are at increased risk of developing cancer.
Recent research is giving more insight into the best screening recommendations.
As scientists learn more about the inherited roots of some cancers, screening recommendations are adjusted to reflect the new findings.
“It’s increasingly recognized that some gene mutations associated with increased breast and ovarian cancer risk can also lead to aggressive prostate cancer and, potentially, prostate cancer at an earlier age,” Rana relates. “In some populations, earlier prostate cancer surveillance is recommended, beginning, for some, at age 40.”
Research is also beginning to show that in families where increased cancer risk isn’t linked to an abnormality in a single gene, it may result from variations in several genes that cumulatively put someone in a higher risk category, Rana continues. Studies have validated these “polygenic risk scores” in certain cancer types including breast and prostate cancer, but their use in clinical care continues to be evaluated. Investigators are exploring whether polygenic risk factors can be used to personalize breast imaging modalities and schedules.
Early detection could reduce disparities.
It is thought that some disparities in mortality between socioeconomic groups could be minimized by increasing awareness of, and improved access to, early detection efforts. There are many reasons for this.
One area where awareness could make a major impact is skin cancer. Even though prevalence is highest among white people, mortality rates are higher among people of color. This is likely because a common misconception among physicians is that people of color are not at high risk for skin cancer. Potential early signs of skin cancer can be ignored or missed, leading to a delay in the cancer diagnosis until it is in an advanced and more deadly stage.
People of color and their physicians should engage in regular skin checks, paying especially close attention to the nails, palms of the hands, and the soles of the feet.
Socioeconomic class can also make it difficult to access early detection efforts. Challenges caused by poverty, including lack of insurance and housing insecurity, can also impede early detection efforts. One 2022 study from Florida concluded that cancer mortality was 22% higher in high poverty areas.
For some members of the LGBTQ+ community, screening can also be emotionally, mentally, and physically distressing in a medical system largely designed for and by cisgender heterosexual males.
As part of its mission to ease the burden of cancer for everyone, Dana-Farber is dedicated to minimizing these disparities through research and improved access to community resources. Among many efforts, this approach includes initiatives like the Cancer Care Equity Program, our mammography van, and a continuous commitment to inclusivity.
About the Medical Reviewer
Dr. Rana received her MD from the Robert Wood Johnson Medical School at the University of Medicine and Dentistry of New Jersey in 2007. She completed her residency in internal medicine and her fellowship in genetics and genomic sciences at the Mount Sinai School of Medicine. She received her MPH from Harvard T.H. Chan School of Public Health in 2020. Dr. Rana joined the Dana-Farber Cancer Institute in 2012.