CANCER SCREENING: WHY, WHO AND WHEN?

Cancer is the second leading cause of deaths in the Bahamas after Heart disease. One of the
effective ways of controlling this disease is by screening. Screening for Cancer involves testing
your body to pick up Cancer in its early stage when you do not experience any symptoms.
Screening tests when done at regular intervals may detect breast, cervical, and colon cancers
early, where treatment is likely to work best. Lung cancer screening is sometimes
recommended for people who are at high risk.

The main goals of cancer screening are to bring down the number of people who die from the
disease, prevent deaths from cancer altogether and to reduce the number of people who
develop the disease.

Breast Cancer:

Breast cancer is the most common cause of cancer death in women in the Bahamas.
Mammograms are the mainstay for screening of Breast Cancer. The American College of
Radiology recommends annual screening mammography for women starting at age 40. In cases
with high risk (family history, exposure to radiation), you may start screening from age 30
onwards, every year.

This affords the maximum benefits of reduced breast cancer deaths, less extensive treatments
for cancers detected, decreased chance of advanced disease, and early treatment of high risk
lesions. Having regular mammograms can lower the risk of dying from breast cancer, thus
saving lives!

Colon Cancer:

In both men and women, Colon Cancer is the second leading cause of cancer death in the
Bahamas. The goal of screening for colon cancer is to find the polyps or growths in their early
stages, so that they can be removed before cancer has had a chance to develop. Colon cancer
almost always develops from precancerous polyps.

Colonoscopy is the most common screening test where a flexible tube is inserted into the
rectum and beyond to visualize the insides of colon. Virtual colonoscopy (CT Colonography) is a
non-invasive alternative imaging test which uses CT scanner to produce 3D images of the large
intestine simulating the colonoscopy. The American Cancer Society (ACS) recommends that
men and women undergo screening for colon cancer beginning at age 50. ACS suggests a
regular colonoscopy once every 10 years or a Virtual colonoscopy once every 5 years.
Individuals at increased risk or with a family history of colon cancer may start screening earlier
at age 40.

Cervical Cancer:
Cervical cancer is the third most common cause of cancer death in women in the Bahamas.
Two screening tests can help prevent cervical cancer or diagnose it early. The ‘Pap smear’ looks
for pre-cancers, the cell changes on the cervix that might become cervical cancer if they are
not treated on time. The HPV test looks for the human papilloma virus that can cause these cell
changes. Although most women with cervical cancer have the HPV infection, not all women
with it will develop cervical cancer.

It is recommended by the Centers for Disease Control and Prevention (CDC) that for women
from ages 21 through 29 be screened with a Pap smear every 3 years. Women with ages 30
through 65 should be preferably screened every 5 years with Pap and HPV co-testing or
continue Pap smear test every 3 years. Screening with both the Pap smear and the HPV test
lowers the number of cases of cervical cancer.

Prostate Cancer:

Prostate cancer is the leading cause of cancer death in Bahamian men. Digital rectal exam and
Prostate-specific antigen (PSA) test are the two methods available for screening. However,
screening offers only a small potential benefit of reducing the chance of death from prostate
cancer in some men.

For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)
based screening should be an individual one. Before deciding whether to be screened, men
should have an opportunity to discuss the potential benefits and harms with their doctor.

Lung Cancer:

The US Preventive Services Task Force recommends yearly lung cancer screening with low-dose
computed tomography (CT scan) for people between 50 and 80 years who have a history of
heavy smoking (20 pack-year or more) and still smoke presently or have quit within the past 15
years. A pack-year is smoking an average of one pack of cigarettes per day for one year.

To conclude, screening tests can save lives! Talk to your doctor about your personal risk of
developing any of these cancers and the screening plan. Together you can decide on an
appropriate screening test and schedule based on your age, your medical history and your
family history.
Dr Amaresh Hombal, MBBS, MD.
Consultant Radiologist
The Imaging and Breast Centres
at the Medical Pavilion Bahamas