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Knowing your risk factors for disease is one of the first steps toward prevention and treatment. At Northwell Health, we recommend regular health screening tests so that you truly understand your risk factors. Then you and your primary care physician can work together to address health problems before they start.
What are health screenings?
Health screenings are tests that find serious conditions before they cause symptoms, during the early stages when they can be cured. This is important for certain malignancies that occur commonly and cannot be as easily treated once they cause symptoms. The tests should be relatively specific, meaning they don’t produce many false-positive tests that can lead to further (unnecessary and sometimes potentially dangerous) testing. Screening tests meeting these criteria don’t exist for all malignancies, but they do for breast cancer, colorectal cancer, and prostate cancer.
Breast cancer screening:
Mammography remains the best screening test for breast cancer, but the evidence about the frequency of testing and the age at which to begin testing is not so clear cut. Most experts agree, however, that for a person without risk factors (e.g. family history of breast cancer) the minimum testing suggested is to have a mammogram every other year starting at age 50. The best advice about when to start and how often to be tested is to discuss your particular situation with your primary care provider (which may be your gynecologist).
Colorectal cancer (CRC) screening:
Colon cancer occurs in both males and females, and mortality from this disease can be dramatically reduced with appropriate screening. There are two approaches to CRC screening. The first, and most well-known, is to have a colonoscopy starting at age 50 (earlier if there is a family history or other risk factors). The advice about when to repeat this test depends upon the findings at the first colonoscopy and can range from 6 months to 10 years. The other approach, applicable only to patients with no family history or other risk factors, is to have a special immunologic stool test every year. The patient simply uses a special kit to mail a small sample of stool to the lab for testing. As long as the test is negative and no other risk factors develop, performing this test every year is sufficient.
Prostate cancer screening:
Prostate cancer screening is not as clear cut as the other two conditions mentioned above. First, prostate cancer is generally more treatable, even at its later stages. Also, the blood test used for prostate cancer screening (the PSA or Prostate Specific Antigen test) is extremely sensitive, meaning there are a significant number of false-positive tests (positive tests in men without prostate cancer). The problem with false-positive tests is that they often lead to further testing, some of which are invasive (biopsies) and have some risk (e.g. possible infections or bleeding). Most physicians do recommend a PSA test for patients with a family history (father or brother) of prostate cancer. For patients without a family history or other risk factors, most recommend a process called shared decision making. That is where the physician explains the pros and cons of the test to the patient and allows the patient to decide whether or not to have the test. Regardless of whether a patient decides to have the PSA test, all men over the age of 50 (earlier if there are risk factors) should have a digital rectal examination (DRE) annually. This involves the physician inserting a gloved, lubricated finger into the rectum to evaluate how the prostate feels and assess for changes such as hardness, nodularity, or other irregularities that might suggest the need for further testing.
Talk with your doctor about when and how often you should be screened. Depending on your personal health history, family health history, or screening results, your doctor may recommend a different screening schedule.
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