Mark Your Calendar: When Should You Begin Cancer Screening?

Getting preventive care is one of the most important steps you can take to manage your health. Screening can detect early cancers when the diseases are potentially more treatable and curable. Though some organizations, like the U.S. Preventative Screening Taskforce, have been vocal about recommendations of fewer screenings, the UCSF Department of Radiology and Biomedical Imaging stands with the American Cancer Society and other reputable health organizations that encourage regular screening for the early detection of cancer.

So when should you make an appointment for your next preventative screening imaging exam?

Age 40: Breast Cancer Screening
Despite highly controversial opposition from the U.S. Preventative Task Force, breast cancer screening should begin for all women at 40 years of age. The UCSF Department of Radiology, in accordance with guidelines from the American College of Radiology, the National Comprehensive Cancer Network and additional health organizations, continues to recommend annual screening mammography in women beginning at age 40 to maximize the survival benefits of early detection of breast cancer.

Some groups have proposed using mammography to screen high-risk women only. Studies have shown, however, that using this type of risk-based approach to screening misses the vast majority of breast cancers.  This is because most women aged 40 to 49 who develop breast cancer do not have any known risk factors. Therefore, we do not support limiting annual screening to high-risk women only – we recommend all women, from age 40 and up, undergo annual screening mammography as long as they remain healthy.

Age 50: Colorectal Cancer Screening
Regular screening, beginning at age 50, is the key to preventing colorectal cancer, the third most common type of cancer in both men and women. There are a number of options for colorectal cancer screening, but a kinder, gentler test is low-dose CT colonography (also known as CTC or virtual colonoscopy.) No sedation is needed so you can return to normal activities immediately after this test. CT colonography is equally as effective as a colonoscopy for large polyps which are the precursor lesions leading to colorectal cancer.

CTC is endorsed by the American Cancer Society, The US Multi-Society Task Force on Colorectal Cancer and the American College of Radiology as an acceptable and valid method to screen the colon for polyps and masses.

Age 55 – 77: Lung Cancer Screening
Lung cancer screening can detect early lung cancer in at-risk patients, when the disease is potentially more treatable and curable. Sufficient evidence supporting the value of lung cancer screening has lead the UCSF Department of Radiology to recommend regular low-dose CT screening for certain candidates – smokers, or those who have quit in the last 15 years, aged 55 to 77 with at least 30 pack-years of smoking history.

CT lung screening has been shown to reduce lung cancer deaths by as much as 20 percent. The National Lung Screening Trial (NLST), a long-term lung cancer screening trial sponsored by the National Cancer Institute (NCI) and conducted by the American College of Radiology Imaging Network (ACRIN) and the Lung Screening Study group, was launched in 2002 and followed 53,454 current or former heavy smokers ages 55 to 74. The results of the trial showed that lung screening reduced lung cancer deaths by as much as 20 percent in those participating.

 UCSF is in good company in following the USPSTF recommendations to use low-dose CT scan (LDCT) of the chest for eligible candidates. The American Cancer Society, the National Comprehensive Cancer Network, the American College of Chest Physicians, and the American Society of Clinical Oncology are among the organizations that also support this screening exam. The UCSF CT Lung Cancer Screening Program, covered by most insurance providers, offers the earliest detection options with a low-dose chest CT scan.

Age 65 (for women) & 70 (for men): Bone Density Screening for Osteoporosis
UCSF and the National Osteoporosis Foundation recommend women aged 65 and older and men aged 70 and older undergo regular bone density screening tests. Additionally, men or women who have broken a bone after age 50, women of menopausal age with risk factors, postmenopausal women under age 65 with risk factors and men aged 50 to 69 with risk factors are good candidates for DXA. Those who test positively for low bone density should be screened every one to two years to ensure osteoporosis medication is working properly.

A dual-energy X-ray absorptiometry (DXA) bone density scan is an examination that uses an enhanced form of X-ray technology to measure bone mineral density commonly in the spine or hip. This type of imaging exam can tell if a patient has normal bone density, low bone density (osteopenia) or osteoporosis, which leads to 1.5 million fractures annually in the United States. The lower a patient’s bone density, the greater the risk of breaking a bone.

An alternative to DXA is the Quantitative Computed Tomography (QCT), which was invented at UCSF. The QCT has advantages over DXA, as it can measure bone density in patients who are very small or large, patients with degenerative disease of the back, and patients with prostate cancer who are being treated with Androgen deprivation therapy.

Unlike DXA, which provides measurements in terms of area, QCT provides measurements in terms of volume.  A standard CT scanner equipped with special hardware and software, QCT uses cross-sectional CT images of the spine and hip to measure bone density.  The low-dose scan takes approximately 10 minutes.