Cancer Screening & Early Detection Toolkit

The USPSTF’s new pending recommendation is that all people with breasts* get screened every other year (every two years), from ages 40 to 74. This can include: 

• cisgender women
• trans women and non-binary people assigned male at birth who have taken hormones 
• trans men and non-binary people assigned female at birth
  • Although top surgery significantly decreases breast cancer risk, screenings are necessary to check tissue and lymph nodes that are still there.
• intersex individuals

*Most breast cancer information is written for women, but the Iowa Cancer Consortium understands that not everyone with breasts identifies as woman or female. Cancer Research UK and Susan G. Komen have more details on breast/chest screening for LGBTQ+ patients. Surgery history, hormone usage, and sex assigned at birth can determine risk level and if/when screening is necessary (source).

Common tests to detect breast/chest cancer are mammograms and clinical breast exams. 

• A mammogram uses X-rays to take pictures of the breast. You stand in front of a special X-ray machine where a technologist will place your breast on a plastic plate. Another plate firmly presses down and flattens the breast while the X-ray is being taken. The steps are repeated for the other breast. It can be uncomfortable, but it only takes about 15 minutes (source). (Healthy Women Step by Step Guide)
  • Tips: You will need to undress from your waist up, so some people prefer wearing two-piece outfits. Do not wear deodorant, perfume, or powder on the day of your appointment. Try not to have your mammogram the week before or during your period to avoid more discomfort.
• A clinical breast exam (CBE) is a physical exam of your breasts done by a healthcare provider to check for anything unusual like a lump. They will visually check your breasts while you are sitting up, and also carefully feel them, your underarms, and the area below your collarbone while you are lying down. You can ask your provider to perform one during your regular gynecological or annual physical check-ups.

You can also do breast self-exams to supplement, but not replace, the above screening methods. 

If you need accommodations to access screening, talk to your health care provider.

• Mammogram results are usually available two weeks after your appointment, and most have negative results showing no sign of cancer.
• If your mammogram does show something abnormal, you will need follow-up tests like a diagnostic mammogram, breast ultrasound, breast MRI, or biopsy–all ways of getting more detailed images of the breast–to confirm if cancer is present. 

If you are considered at higher-risk of developing breast/chest cancer, you may need more personalized guidelines where you are screened earlier or more often. Things that could increase your risk of developing breast cancer could include having (source): 

• A BRCA1 or BRCA2 inherited gene mutation
• Li-Fraumeni syndrome, Cowden/PTEN syndrome, or Bannayan-Riley-Ruvalcaba syndrome
• A parent, sibling, or child with BRCA1/2 gene mutations or who has one of the above syndromes, who has not had genetic testing themselves
• A personal history of invasive breast cancer or ductal carcinoma in situ (DCIS)
• A personal history of lobular carcinoma in situ (LCIS) or atypical hyperplasia
• Radiation treatment to the chest at the ages of 10-30
• A greater than 20 percent lifetime risk of invasive breast cancer based on family history 

To find out if you are high risk, it is best to have a breast cancer risk assessment done. Talk to your healthcare provider for more information about this tool and other risk factors.

• Team Breast Friends (Benton, Cedar, Iowa, Johnson, Jones, Linn, and Washington counties)
• Especially for You Fund (Linn, Benton, Buchanan, Delaware, and Jones counties)
• Care for Yourself (Statewide) This program provides breast and cervical screening and diagnostic services, including clinical breast exam (CBE), mammograms, pap tests, human papillomavirus (HPV) tests, diagnostic testing for abnormal screening results, and referrals to treatment. Women and individuals assigned female at birth are eligible for screening. There is no cost to enroll in Care for Yourself, and participants will receive no bill for their screenings. You may be eligible, if you:
  • Have no insurance or are under insured
  • Experience barriers in receiving breast and cervical screening
  • Have a household income at or below 250% of the federal poverty level
  • Are between 40 and 64 years of age, or under age 40 with breast cancer symptoms for breast cancer screening
  • Are between 21 and 64 years of age for cervical cancer screening
  • Are over 64 and do not have Medicare Part B and meet income guidelines

The USPSTF recommends screening for colorectal cancer in all adults ages 45-75 years old.

Colorectal cancer screening can be done either with a self-test that looks for signs of cancer in a person’s poop (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). Details on preparation and instructions for each option can be found here. 

• Stool-based tests include a multi-targeted stool DNA test (mt-sDNA), Guaiac-based fecal occult blood test (gFOBT), or Fecal immunochemical test (FIT). Your colon sheds cells that are released in your stool, so these tests can detect any cancerous changes. You collect a sample after a bowel movement with the kit, then mail it off to your doctor or a lab. Some stool-based tests require a prescription. Ask your health care provider or pharmacist for information about which tests are available for you.
• Visual structural exams include a colonoscopy, CT colonography (virtual colonoscopy), or flexible sigmoidoscopy. A colonoscopy is most commonly used because it is widely known and covered by insurance and can allow for a full view of the colon with the option to biopsy and remove polyps at the same time. 
  • Many people dread preparing for a colonoscopy, but your colon needs to be cleared out for the procedure to be effective. Colorectal cancer survivors and caregivers have shared their tips for prepping here. Because you will be sedated for the procedure, you will not be able to drive or work that day and are encouraged to bring someone with you. 

If you need accommodations to access screening, talk to your health care provider.

• Typically, if no polyps are found during your first colonoscopy, you do not need one for another 10 years. 
• If polyps are found, the next step will be to surgically remove them through a polypectomy. Sometimes this is done at the same time as your colonoscopy – ask your doctor ahead of time what they will do if polyps are found during the procedure. Depending on the type, size, and number of polyps found, a colonoscopy may be repeated in 3-10 years. (source)
• Stool-based exams need to be repeated every 1 to 3 years. A follow-up colonoscopy is scheduled if there is a positive result.

While people at average risk of colorectal cancer should get their first colonoscopy at 45, high-risk groups should start earlier. This could include people who have had:

• A parent, sibling, or child with a history of colorectal cancer or certain types of polyps (starting at age 40 or 10 years before the age that family member was diagnosed)
• A personal history of colorectal cancer or certain polyps 
• Inflammatory bowel diseases like ulcerative colitis or Crohn’s disease
• Family or personal history of hereditary colorectal cancer syndromes like familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
• Radiation to the abdomen (belly) or pelvic area 

Not sure if you should get screened or what screening method you should use? Know your options and take the quiz from the Colorectal Cancer Alliance. The quiz is available online or over the phone, with assistance in Spanish available.

• Iowa Gets Screened (Black Hawk and Polk counties)
  • Eligibility Requirements include: Iowans age 45-75 who are at or below 300% Federal Poverty Level and are uninsured or under-insured
  • Educational Videos- Part 1: Your Colon, Part 2: Colon Cancer, Part 3: Screening Tests 
• Free Colon Cancer Screenings and Educational Workshops (Scott, Louisa, and Muscatine counties)
• Colon Cancer Foundation of Iowa
• Colon Cancer Coalition Educational Materials

The USPSTF recommends yearly screening for patients 50-80 years old who: 

• Have no signs or symptoms of lung cancer
• Currently smoke or have quit within the past 15 years*
• Have a 20 pack-year smoking history (one pack per day for 20 years or two packs per day for 10 years, etc.)
• Receive a written order for a low-dose CT scan from your physician

*The American Cancer Society recommends lung cancer screening for anyone who meets the eligibility guidelines above, regardless of years since quitting. Visit the American Cancer Society for more information.

There are quizzes available through the American Lung Association and Screen Your Lungs to help you determine if you qualify for a lung screening. 

A low-dose CT scan is used to screen high-risk patients and involves no needles, medications, or pain. You lie very still on your back for about 30 seconds on a table that moves through a donut-shaped machine that takes pictures of your lungs. The entire process takes a few minutes, and you may be asked to hold your breath for certain images. A technologist will be with you and talking to you the whole time. (What to Expect– also available in Spanish and Simplified Chinese)

If you need accommodations to access screening, talk to your health care provider.

• If there is a nodule (a small abnormal area) seen on your scan, your physician will contact you for follow-up. It is important to know that not all nodules are cancerous, but should be watched closely by your physician.
• If you are requested to return within a year, there is the possibility of an out-of-pocket expense, especially if your deductible has not been met yet. Talk to the billing office and your health insurance provider to understand what costs you might be responsible for and if the office has financial assistance programs available.

• Radon (Clinical Assessment, Radon Exposure History) 
  • While long-term radon exposure does not qualify a person for a lung cancer screening, radon is the second leading cause of lung cancer behind tobacco. It is important to check radon levels in homes, schools, workplaces, and other areas people gather. Learn more about radon and resources here.
• Tobacco Use Disparities
  • Indigenous communities have used tobacco for religious and ceremonial purposes for centuries. However, they, along with other marginalized population groups, face greater health issues and increased lung cancer risk due to the use of commercial tobacco made and sold by tobacco companies. The tobacco industry uses marketing, flavored products, and neighborhood data to target these communities in their sales. Learn more about health disparities related to commercial tobacco here.
• Occupational Hazards
  • People who work in certain environments can breathe in substances like asbestos or that cause cancer while on the job, putting them at higher risk of developing lung or other cancers. Working in industries like farming, livestock, mining, construction, first response, and the military may place you at a higher risk of work-related lung diseases like cancer. Learn more about occupational cancer risks here.

• Quitline Iowa
• LUNGevity Foundation
• Request a low-cost radon testing kit
• GO2 Foundation
• American Cancer Society Lung Cancer Guide

The prostate is a small gland in the male reproductive system located just below the bladder and in front of the rectum. It is about the size of a ping-pong ball and surrounds the tube that empties urine from the bladder (urethra). Learn more about the prostate gland here.

• The USPSTF recommends that for people with a prostate aged 55 to 69 years old, the decision to undergo prostate-specific antigen (PSA)-based screening should be an individual one based on its potential benefits and harms after a discussion with their health care provider.
  • Trans women, non-binary individuals assigned male at birth, and intersex individuals can still get prostate cancer and should talk to their health care provider about screening options when they turn 55. 
• For people with a prostate 70 years or older, the USPSTF does not recommend PSA-based screening.
• The American Cancer Society recommends starting the discussion about screening at age 50 for men at average risk and expected to live at least 10 more years.

Two tests commonly used in prostate cancer screening are the prostate-specific antigen (PSA) blood test and a digital rectal examination (DRE). 

• A PSA blood test measures the level of the prostate-specific antigen protein in the blood. This protein is part of the semen fluid that the prostate makes. There is little risk to having the blood test, and you may have pain or bruising at the spot the needle was put in your arm. You need to avoid ejaculation for 24 hours before the PSA test because PSA levels increase when semen is released. 
• A digital rectal exam (DRE) is a test in which a health care provider inserts a gloved, lubricated finger into the rectum as you are standing and bending forward at the waist or lying on your side on an exam table with knees pulled up to your chest. They are checking the size of the prostate gland and feeling the surface through your bowel wall for any abnormalities. The exam only lasts a few minutes. 

If you need accommodations to access screening, talk to your health care provider.

• Generally, the higher the PSA level, the more likely prostate cancer is present, but there is no specific normal or abnormal level of PSA in the blood. 
  • PSA levels fluctuate, but a level of 4.0 ng/ml (nanograms per milliliter) and lower is considered normal. However, there are individuals with lower levels who do have prostate cancer, as well as individuals with higher levels who do not.
• The time between future screenings depends on the result of the PSA test. 
  • If the result is a PSA of less than 2.5 ng/mL, you may only need to be retested every 2 years.
  • Screening should be done yearly for patients whose PSA level is 2.5 ng/mL or higher.
• Higher PSA levels (between 4.0 and 10 ng/ml and greater than 10 ng/ml) can be from older age, enlarged prostates (BPH-benign prostatic hyperplasia), riding a bicycle, certain medicines and procedures, or ejaculation within one to two days of the test. 
  • To determine if prostate cancer is present, the doctor may recommend a second PSA blood test, a series of PSA tests and physical exams to monitor any changes, or a prostate biopsy to test a tissue sample for cancer. 

Because there is a risk of overdiagnosing and overtreating prostate cancer that would otherwise grow slowly and never threaten someone’s life, it is important to note risk factors that could encourage earlier screening discussion at age 45 or even 40. You may be at higher risk of developing prostate cancer if you: 

• Are 65 years or older 
• Are African American or Caribbean with African ancestry 
• Have a first-degree relative (parent, child, or sibling) who had prostate cancer, including relatives in three generations on your mother’s or father’s side of the family
• Were diagnosed with prostate cancer when you were 55 years old or younger
• Have other members of your family that have been diagnosed with breast, ovarian, or pancreatic cancer (BRCA1 or BRCA2 gene mutation may be present in family)
• Have Lynch syndrome (also known as hereditary non-polposis colorectal cancer or HNPCC), or other inherited gene changes
• Have been exposed to large amounts of Agent Orange, cadmium, or other cancer-causing chemicals, for example, from working in the military, farming, manufacturing, or as a first responder

Take the “Am I at Risk?” Quiz from Zero Prostate Cancer.

• Prostate Cancer Screening Interactive Decision Aid
• CDC’s Talk to Nathan about Prostate Cancer Screening
• ZERO Prostate Cancer Educational Materials
• Prostate Health Education Network

The USPSTF has no guidance for anal cancer screening at this time. However, the American Society of Clinical Oncology recommends that people with a higher risk of developing anal cancer should talk with their primary care doctor about anal cancer screening. Those at higher risk who may benefit from screening include:

• People who have HIV
• People who regularly have anal sex
• People who have a history of anal warts or precancerous cell growth on the anus
• People who have a history of abnormal cell growth caused by HPV on another part of the body
• People who have had another HPV-related cancer, like cervical cancer, vulvar cancer, or vaginal cancer
• People with a suppressed immune system from an autoimmune disorder, being a transplant recipient, or long-term use of medication that weakens the immune system

Source: OncoLink

• Digital Anal Rectal Exam
  • A healthcare provider inserts their gloved finger into the anus. This is done to feel the wall of the anus to detect any lumps, warts or ulcerations.
• Anal Cytology
• • • Also known as an anal Pap smear, this test collects cells from the anus to be looked at in a lab. The test is done by:
      • Lying on your side with your legs bent. 
      • A swab (similar to a Q-Tip) is inserted a few inches into the anus. It is rubbed against the side of the bowel where the anus and rectum meet. This gathers cells from that area. 
      • The swab is either used to make a slide or it is put into a liquid preservative and sent to the lab. 
      • The pathologist looks at the cells under a microscope, looking for any abnormalities in the cells.
    • Do not use an enema or insert anything in the rectum for 24 hours before the exam. Lubricants should not be used before the test because they can interfere with the results. The swab must be done before a digital rectal exam.

• High Resolution Anoscopy
  • In anoscopy, a small plastic tube is inserted into the anus. The inside of the anus can be better seen this way. In high resolution anoscopy, a special microscope called a colposcope is used to view the anus through the plastic tube. If an abnormal area is seen, a biopsy (tissue sample) can be taken with these tools.

If you need accommodations to access screening, talk to your health care provider.

Source: OncoLink

• Follow-up care depends on the result of the tests and the person’s HIV status.
• For some abnormalities, follow up will be repeat anal cytology testing a few months later. 
• Some people whose results showed moderate to severe abnormalities will need treatment of the abnormal areas. Treatments can include topical medications, cryotherapy (freezing the area), laser therapy, and surgery.
• While only a very small number of people with abnormal screening results will develop anal cancer, providers have no way of knowing who will progress to cancer. Close monitoring helps to detect any cancers early when it is most treatable.

Source: OncoLink

• Anal cancer is often, but not always, caused by the human papillomavirus (HPV). In particular, HPV-16, HPV-6, and HPV-11 are thought to be most related to developing anal cancer. 
• The HPV vaccine protects against many types of HPV, including HPV-16, HPV-6, and HPV-11. Learn more about the HPV vaccine.
• While using condoms during anal intercourse does not completely protect against getting HPV (it is possible to get HPV with any genital-to-genital contact), condoms do reduce the genital area exposed. This can reduce the risk of HPV transmission.
• Smoking can also increase a person’s risk for developing anal cancer.

• American Cancer Society
• American Society for Clinical Oncology
• Iowa HHS | HPV Vaccine
• OncoLink