Screening programs are methods of scanning the patient for the purpose of early diagnosis for a malignant disease with no symptoms like cancer. For breast cancer, mammography and for cervical cancer, pap smear tests are applied.
How should the screening tests be?
The course of the disease should be such that it allows an appropriate time frame for early diagnosis. When diagnosed early, there should be treatment options that will cure. It should be more effective when treatment is started early (before symptoms begin). It should be a reliable, easy, inexpensive and community-wide screening test. The age of screening initiation, and screening interval should be determined according to target population.
What are the features of screening tests?
Due to its frequency, and severity such diseases are considered as public health problem. Screening tests do not diagnose. In case of screening positive results, additional imaging examinations such as biopsy should be performed for further investigation.
What are the malignant diseases for which screening is recommended?
The Lung cancer
Breast cancer screening tests:
In terms of Breast cancer, an annual mammography screening is recommended for the patients with 40 years old. For patient in between 20-40 years old, one time in 3 years. An annual breast examination for patients over 40 years old, and a self-breast examination for those with over 20 years old. Patients should be informed and should be allowed to take his/her self-decision. In case of detection of mass palpable, and if regular mammography could be applied, evaluation should be done by USG, and solid lesions or cystic lesions with solid component should be performed by a biopsy exam.
What are the risk groups in colon cancer?
In terms of colon cancer, the risk groups are asymptomatic for the population over 50 years old, IBD (Inflammatory Bowel Disease) Adenomatous polyposis, Turcot syndrome, Juvenile polyposis, history of Sporadic adenoma, colorectal cancer IBD, breast, ovarian or endometrial cancer, family history of FAP (Familial Adenomatous Polyposis), HNPKK (Hereditary Non-Polyp Colorectal Cancer), First degree relatives are patients with colorectal cancer before the age of 60.
Colorectal cancer screening tests:
Colorectal cancer screening techniques are tests like fecal occult blood determination, flexible sigmoidoscopy, colonoscopy, and CEA determination. Colonoscopy scans are started 8-10 years after the onset of symptoms in inflammatory bowel patients and is repeated every 1-2 years. Screening is done more frequently in people with a history of adenoma/ polyp (10 years ago). People with a history of colon cancer should have a colonoscopy again within 1 year, then a colonoscopy every 2-3 years.
Cervical cancer screening tests:
Screening for cervical cancer should start at the age of 21 (whether vaccinated or not), then it should be screened every 3 years, 3 consecutive pap tests are negative or if there is no positive test in the past 10 years, it can be stopped at the age of 65.
High risk HPV-DNA test:
The high-risk HPV-DNA test has also recently been approved for screening in patients over the age of 30. It is recommended that individuals with HPV vaccine continue screening according to the same criteria.
Prostate cancer screening tests:
Prostate cancer in men over the age of 50, regular annual PSA and prostate examinations should be performed from the age of 50.
Lung cancer screening tests:
Lung cancer screening criteria should be applied to people between the age range of 55-74, with a history of smoking of at least 30 PY, and should be for patients who had stopped for 15 years back. For those patients, with an interval of one year, examinations such 3 spiral CT as PAAC (Chest X-ray) should be investigated.
Skin cancer screening tests:
In terms of skin cancer, skin examination and self-skin examination of the people to be screened are important to be performed in the clinic. ABCD criteria are important in skin cancer. ABCDE criteria include asymmetry, irregularity, discoloration, diameter over 6 mm, and progression of lesions. These people should be examined every 3 years between the age of 20 – 40 years, and once a year over the age of 40 years old. In addition to the general examination, testicle, skin, lymph node, thyroid, and oral cavity examinations should also be performed.