Early cancer detection is paramount in the relentless battle against cancer

Recent findings from the American Cancer Society’s latest 2024 Cancer Statistics report paint a complex picture: while overall cancer mortality rates are on a promising decline, the landscape is marred by a concerning surge in diagnoses. Surprisingly, cases of four screenable cancers – breast, cervical, colorectal, and prostate cancers – are on the rise, begging the question: Why the uptick in a world of advanced screening tools? At Private Health Management, our team of experts continuously monitor the latest news, research, and developments for new insights on cancer screening.

The data reveal an unexpected challenge: cancer diagnoses are rising in younger individuals. The most striking example of this is the increased rate of colorectal cancer in those under the age of 50.¹ Colorectal cancer, once considered a disease more prevalent in the older population, now claims the top spot as the leading cause of cancer-related deaths in men under 50 and ranks second in women under 50. While diet and lifestyle are being linked to the unprecedented rise, the exact risk factors are unknown. These startling statistics demand urgent attention and action.

In the relentless battle against cancer, early detection is paramount. Existing screening methods have made significant strides in detecting five major cancer types, which can improve treatment outcomes, reduce the number of late-stage cancers, and save thousands of lives each year.^2,3 Although there are reliable screening tools for these five major types of cancer, unfortunately, these tests only account for about 60% of all people diagnosed with cancer. Therefore, this gap highlights the need to implement additional screening tools to detect cancers that make up the other 40% of all cancer diagnoses. Below are the top five recommendations for cancer screening, as well as a review of emerging cancer screening tests to consider for the detection of cancers that do not currently have an established screening tool in practice.

Top 5 recommended cancer screening tests

Standard screening tests are recommended for breast, cervical, colorectal, lung, and prostate cancer. Recommendations are based on risk factors like age and gender and are updated based on the latest research.^4–6 Guidelines from different medical organizations and government agencies vary slightly, so it is important to speak with your healthcare provider about your individual cancer risks to decide which tests are right for you based on your family health history, environmental exposures, sex, race, and other pertinent risk factors.

• Breast cancer
  Mammograms are low-dose X-rays of the breast that take about 30 minutes to complete. Recent advances in mammography include the development of the 3-D mammogram, or digital breast tomosynthesis, which has been shown to decrease the need for being called back for further imaging, but may be more expensive and may not be covered by insurance.⁷ Data has shown that Caucasian women are at higher risk for developing breast cancer, but Black women are more likely to develop more aggressive, more advanced cancer, at a younger age. Breast cancer screening is recommended either annually or biannually for women between the ages 40 and 75 years.^4–6
• Cervical cancer
  There are two tests that are used to screen for cervical cancer, both of which are performed on a sample collected from around the cervix. These include testing for human papillomavirus (HPV), which is known to cause pre-cancerous changes to cervical cells, and the Pap smear, which looks for changes in the cervical cells under a microscope. Cervical cancer screening is recommended for women every 3 years, beginning between ages 21–25 years and continuing until age 65.^4–6
• Colorectal cancer
  There are several tools available for colorectal cancer screening, including imaging-based tests that directly examine the colon and rectum for signs of abnormalities (colonoscopy, CT colonoscopy, flexible sigmoidoscopy) and non-invasive tests that detect signs of colorectal cancer in stool samples.^4–6 Data has shown that Black men and those with a family history of colorectal cancer are at higher risk for developing the disease. Warning signs for colorectal cancer that are particularly important for younger individuals to be aware of, include a history of diarrhea, rectal bleeding, or iron deficiency anemia. Colorectal cancer screening is recommended for individuals from 45–75 years of age.
• Lung cancer
  Lung cancer screening by low dose computed tomography (LDCT) scans involves a special X-ray machine that takes images of the lungs. The scans usually take about 15 minutes. Lung cancer screening is only recommended for individuals who meet the criteria to be considered high risk, which includes individuals who are 50–80 years old, are a current or former smoker, and have a smoking history of 20 or more pack years.^4–6 One pack year is equivalent to smoking one pack of cigarettes per day for one year.
• Prostate cancer
  For many years, the prostate-specific antigen (PSA) blood test (often along with a digital rectal exam) has been used for prostate cancer screening. But experts now recommend that men at average risk discuss the pros and cons of PSA testing with their doctor before proceeding.⁸ Screening is more important for men who are at higher risk, like Black men and men who have a father or brother that has been diagnosed with prostate cancer. If an individual chooses to screen, PSA testing is recommended every 2–4 years from 45–69 years of age.

Other cancer screening tests

In some cases, cancer signs can be identified by visual examination or by feeling the area to check for abnormalities. These exams may find cancer, but due to a lack of evidence showing a clear benefit, medical and government agencies have not recommended these as standard screening tests. These tests include oral/head and neck cancer screening during a dental exam, skin cancer screening, and clinical breast exams. Ask your healthcare provider if these tests may be beneficial for you.

Cancers with no recommended screening tool

For many other cancers, like pancreatic, kidney, uterine, bladder, and certain blood cancers, there are no standard screening tests. These make up about 40% of cancer diagnoses in the U.S. and can be difficult to detect until the person starts having symptoms, which may correspond with a later, more difficult to treat, stage of disease.⁹ However, there are some emerging technologies that can detect signs of these cancers in earlier stages, prior to the appearance of symptoms. These tests are not yet approved by the FDA but are designated as “laboratory-developed tests” and are available for doctors to utilize, however they are often not covered by insurance.

Emerging screening tests include those that use a non-invasive blood sample to analyze “cell-free DNA” (cfDNA), which is shed into the bloodstream by all cells in the body, including cancer cells. Single cancer tests detect signatures of a specific cancer, like Shield® by Guardant Health for colorectal cancer, FirstLook® by Delfi Diagnostics for those at high risk of lung cancer. Multi-cancer early detection tests (MCED), like Galleri® by Grail, can detect over 50 types of cancer in the bloodstream.

Another approach to early detection is integrating annual whole body MRI scans into a monitoring strategy. While these imaging scans can identify evidence of cancer, one must also be cognizant of the risks of falsely assigning cancer to these findings and the associated anxiety this can inflict upon an individual. Therefore, identifying the appropriate testing population is an important factor to consider when utilizing this type of screening method.

As you decide which cancer screening options are right for you, there are many factors to consider, such as your family history, lifestyle and environmental risk factors, age, and more. While deciding on the appropriate screening approach is an individual decision, the undeniable truth is cancer screening saves lives. If more men and women followed the cancer screening guidelines, thousands more could be saved. Your primary healthcare provider can help advise you on when to screen and what type of test is best to proceed.

References

1. 2024 Cancer Facts & Figures Cancer | 2024–First Year the US Expects More than 2M New Cases of Cancer. https://www.cancer.org/research/acs-research-news/facts-and-figures-2024.html.
2. Crosby, D. et al. A roadmap for the early detection and diagnosis of cancer. The Lancet Oncology 21, 1397–1399 (2020).
3. Henley, S. J. et al. Annual report to the nation on the status of cancer, part I: National cancer statistics. Cancer 126, 2225–2249 (2020).
4. Cancer Screening Guidelines | Detecting Cancer Early. https://www.cancer.org/cancer/screening/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html.
5. Detection, Prevention, and Risk Reduction. NCCN https://www.nccn.org/guidelines/category_2.
6. A and B Recommendations | United States Preventive Services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations.
7. Sumkin, J. H. et al. Recall rate reduction with tomosynthesis during baseline screening examinations – an assessment from a prospective trial. Acad Radiol 22, 1477–1482 (2015).
8. Grubb, R. L. Prostate Cancer: Update on Early Detection and New Biomarkers. Mo Med 115, 132–134 (2018).
9. Multi-cancer Early Detection Tests | MCED | GRAIL Galleri Test. https://www.cancer.org/cancer/screening/multi-cancer-early-detection-tests.html.