When you think of cancer screenings, uncomfortable is probably the first word that comes to mind. Whether it’s a Pap smear, mammogram, or just stripping down for a skin inspection at the dermatologist—none of the tests are particularly pleasant. But they are crucial for protecting your health, especially as you get older.
“Cancer screenings are important because they can detect cancer before you notice symptoms,” says Rebecca Berens, MD, a family physician and owner of Vida Family Medicine in Houston, Texas. “The earlier cancer is detected, the less chance of the cancer growing and spreading (metastasizing). Larger cancers and cancers that have metastasized are more difficult to treat and achieve a cure, and are more likely to have long-term complications or lead to death.”
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Who needs a cancer screening?
“All women should be screened for breast cancer, cervical cancer, and colon cancer,” says Anjali Malik, MD, a board-certified radiologist in Washington, D.C. “If they are high risk, for example, smokers or people with a family history, women should also be screened for lung cancer. And women with genetic syndrome, taking certain medications, or with family history, should be screened for uterine and pancreatic cancer as well.”
But what if you are otherwise healthy and you have no cancer risk factors?
“Even people who are in great physical health can develop cancers due to a variety of factors,” says Jeff Fortner, Pharm.D., associate professor at Pacific University School of Pharmacy in Hillsboro, Oregon, and a member of the SingleCare Medical Review Board. “Some of these are outside of their control, such as family history, exposure to cancer causing substances, and aging. While other factors are controllable such as diet, alcohol, and tobacco consumption.”
When should women get screened for cancer?
Each type of cancer comes with its own age-related risk factors. Use this guide to cancer screening for women by age and cancer type.
Cervical cancer screening age: “Cervical cancer screening should begin at age 21 regardless of age of onset of sexual activity,” says Dr. Berens. According to the CDC, as long as pap smear results are normal, screens should take place every three years from age 21 to 29. From age 30 to 65, screens may be done every three to five years if your results continue to be normal.
Risk factors: Almost all cervical cancers are caused by the human papilloma virus (HPV), which is a very common sexually transmitted infection. According to the U.S. Centers for Disease Control and Prevention (CDC), HPV is so common that almost everyone will get it at some point in their lives. But not all strains cause cervical cancer. Some cause genital or skin warts, and others might not lead to any symptoms at all.
How to reduce your risk: There is a safe and effective vaccine available for HPV called Gardasil 9. It is recommended for boys and girls at age 11 or 12, but it can be administered as young as age 9 or as old as age 45. Children need two doses of Gardasil, six months apart. If your child receives their first dose of Gardasil after age 15, they should receive three doses over the course of six months.
Screening test: Your OB-GYN will screen you for abnormal cervical cells using a pap smear. This is done with a cotton swab inserted in your vagina and swabbed across your cervix.
RELATED: Why you should get the HPV vaccine—even in your 30s or 40s
Breast cancer screening age: According to Dr. Malik, “Screening mammography for average risk women is annually starting at 40, earlier if there is high risk.” CDC guidelines recommend that average risk women have a mammogram once every two years from age 50 to 74, and you should discuss your screening schedule with your healthcare provider starting at age 40.
Risk factors: According to the CDC, many of the factors that increase a woman’s risk for developing breast cancer are beyond her control. Genetics, getting older, starting your period before age 12 or menopause after age 55, having dense breasts, and a family history of breast cancer can all contribute to increased risk.
How to reduce your risk: There are some risk factors that are controllable, however. Women can reduce their risk of breast cancer by staying physically active, maintaining a healthy weight, and avoiding hormonal birth control, alcohol, and cigarettes. Research also shows that having a first pregnancy before age 30 and breastfeeding reduces breast cancer risk.
Screening test: Doctors use a mammogram, which is like an X-ray with compression of the breast, to screen for breast cancer.
Colon (or colorectal) cancer
Colon cancer screening age: “For colon cancer, women should begin screenings at 50, or earlier if they are at increased risk due to colon issues or family history,” says Dr. Fortner. Patients should receive the fecal test every year, but a normal colonoscopy only needs to be repeated once every 10 years, or upon receiving abnormal results from the fecal test. The CDC recommends screening starting at 50, with frequency based on healthcare provider recommendations.
Risk factors: “Colon cancer risk is increased with age, genetics, and a personal history of inflammatory bowel disease such as Crohn’s disease and ulcerative colitis,” says Dr. Berens. She notes that, as with other cancers, a poor diet and limited physical activity can also contribute to colon cancer risk. Tobacco use and alcohol consumption also increase risk of colon cancer.
How to reduce your risk: A fiber-rich diet containing lots of fruits and vegetables and very little processed foods will reduce your risk of colon cancer. You can also exercise more and avoid tobacco and alcohol.
Screening test: There are a few options for colon cancer screening. The most common are a colonoscopy or fecal test. For the latter option, the doctor collects a stool sample and looks for tiny streaks of blood in your stool. If any blood is detected, the doctor will order a colonoscopy. During a colonoscopy, you are first sedated, then the doctor inserts a long, flexible instrument into your rectum and threads it up through to the other end of your large intestine. The instrument transmits an image of the inside of your colon so the doctor can examine it for abnormalities. It doesn’t hurt, but it may cause an uncomfortable, gassy feeling.
Most women will only need regular screenings for cervical, breast, and colon cancers. However, you should do annual well visits with your primary care provider and ask if you have any special risk factors that may portend a need to screen for other cancers, such as skin, lung, uterine, or ovarian cancer.
Risk factors for some cancers include:
- Alcohol use
- Family history
- Certain medications
- Poor diet
- Certain genetic diseases
This is not an exhaustive list. Discuss your health needs with your primary care provider.
How much do cancer screenings cost?
Most insurance plans cover cancer screenings that are recommended based on your age and other risk factors. But if you don’t have insurance, there are other options for receiving free cancer screenings.
“Planned Parenthood, federally-qualified health centers, and local health departments offer many women’s preventive health services on a sliding fee scale,” says Dr. Berens. “Direct primary care practices are located throughout the country and provide affordable comprehensive primary care to all patients regardless of insurance status, and they can help connect self-pay patients with affordable resources for screening.”