Transcription:
The Importance of Cancer Screening

Melanie Cole (Host):  Sometimes hereditary or genetic factors can increase your risk for cancer. City of Hope’s cancer screening and prevention program is designed to help you understand more about your personal cancer risks. Armed with this knowledge, you can learn how to minimize your risk and stop cancer from developing. We’re here to show you how you can do your part to outsmart cancer. My guest today is Dr. Cary Presant. He’s a system professor and past director of medical oncology at City of Hope and author of Surviving American Medicine. Welcome to the show, Dr. Presant. Tell us a little bit about cancer screening—why is it important and what cancers can be screened for. 

Dr. Cary Presant (Guest):  Well, early detection is the key to surviving cancer. There’s a saying, stage I is the cure. The earlier stage you find cancer, the better your cure rate and the less treatment you need. You might not need a big expensive, operation. You just need a small resection or a small biopsy and that can take care of the cancer. Trying to get it early is the key. So, screening is the secret to getting the earliest stage cancers diagnosed and taken care of. All the common cancers that we have throughout all of men, women, all of these can be screened, of course. You think about the commonest cancer in women, breast cancer. Breast cancer screening is very straightforward mammography. If necessary, breast ultrasound, MRI. These are very straightforward at finding the smallest cancers so that they can be taken care of very, very easily. Prostate cancer, most common in men. This can be screened for by the use of the PSA test and sometimes rectal examination. And this can pick up cancers very, very early, sometimes so early that they don’t even need treatment. They just need to be watched. We now know that there is a new treatment, a new screening program for lung cancer, which is the commonest fatal cancer that we have. Lung cancers can be found by a very fast CT scan using very low x-ray doses and the screening CT scan of the chest takes only about five minutes. It’s as fast as doing a chest x-ray but much, much better because it can pick up very early lung cancers that have a very, very high cure rate. Those are the commonest types of cancers that we have, and they have been very easy to screen for. But we can also screen for cancers of the tongue and mouth when you go to see the dentist. We also have the ability to screen for cervical cancer, which starts as soon as the woman becomes sexually active so that we can find the precursors of cancer of the cervix that can be diagnosed and treated before it ever turns into frank cancer. We know that skin cancers can be diagnosed when you go to see your doctor very early before they need very expensive treatment. Of course, colon cancer, one of the common cancers. We note this can even be prevented by a screening colonoscopy, where polyps, before they’re ever cancer, can be taken off so they never turn into cancer. These are very, very important types of screening tests that everyone should be thinking about. The first step is talk it over with your doctor. If he has the ability to come to City of Hope and get screening there in our multidisciplinary teams we’re happy to do that. But the most important thing, talk to your doctor and say, “Here I am. I’m”—however old you are—“I want to know what kinds of screening tests are going to be the very best for me. I don’t want to get a cancer when it’s far advanced that there’s not much we can do. I want to make certain we pick up something really early, even before it gets to be cancer, so that I stay healthy forever.” 

Melanie:  Dr. Presant, some screening like the lung cancer screening, which is relatively new, does that carry a stigma? Are people afraid to ask for lung cancer screening? And when would you know that it’s time to get screened? 

Dr. Presant:  The most important thing with lung cancer screening is that if you’ve never been a smoker, if you don’t have any lung symptoms, then it’s not necessary to get screening. If you’ve been a smoker, as many, many people have, when they’re younger, maybe even currently, then when you have about 20-pack years—that is, one pack a day for 20 years or half a pack at 40 years—when you have 20-pack years behind you, it’s time for you to get screened. Is there a stigma associated with this? No. Sometimes people say, “Oh, there’s a stigma associated. I don’t want to find out that I have cancer.” What you really want to do is you want to find out when you have an early cancer or even a predictor of cancer that you can take out some things that is not yet cancer. You can take it out, you never get cancer. There is no stigma associated with that. Also, the treatments for early stage cancers are so very, very straightforward and easy today that the cure rate is going to be very, very high. We shouldn’t be afraid of the stigma of having cancer. We should be afraid of the stigma of having advanced cancer that is so very difficult to treat and frequently unsuccessful, because higher stage cancers—stage II, III, IV—that gets to be much more serious and you need a lot more treatment for it. 

Melanie:  Tell us a little bit about genetic testing—we hear a lot about that today—and how can that be used to prevent cancer or find out if you are somebody who is at high risk? 

Dr. Presant:  When you’re going to see your doctor, you have to say to your doctor, “Doctor, look at my family history. Here’s what the people in my family have had.” If you have lots of cancers in your family, we can do gene testing. Gene testing is very easy. It only requires a little swab at the mouth with a little Q-tip or a blood test, and we can find out if there are genes that have changes, mutations that can increase your chance and your risk of having cancer. If so, there are treatments that can prevent cancer, and there is a screening program for each type of gene mutation that allows you to pick up cancers at the very earliest stage. So instead of waiting until you are 40 or 50 to have mammography, you may start earlier if you have a gene mutation in the genes, like BRCA-1, BRCA-2. If you have a gene mutation that might cause colon cancer, you might have stool checked for blood or a stool checked for DNA or even colonoscopy starting earlier than our usual recommendation with colon, which is about age 50. You might start at age 35 or 40. Knowing what the diseases are in your family is really important. Talk to your parents. Talk to your grandparents. Make certain you have written down what all the people in your family, each person, has had in the past. These include your kids, your brothers, sisters, your parents, your grandparents, your cousin. Make certain you know your aunts and uncles, what everybody has had, so you can discuss it with your doctor. If your doctor is not familiar and says, “Well, you know, I see there’s some cancer there, but I don’t really know if this is a really strong inherited risk,” ask for a second opinion. You can come to City of Hope. We have a very strong program in genetics and counseling and prevention. You can go to other doctors around the country as well. But make sure that you start with your doctor and get your family history checked so you know your risk of all the important diseases and especially your risk of cancer, because it’s highly preventable. 

Melanie:  Dr. Presant, in just the last few minutes, tell the listeners why they should come to City of Hope and why cancer screening and prevention is so important, why they should get screened for these cancers we’ve been discussing. 

Dr. Presant:  Well, we know that getting screened and getting preventive treatment can reduce your risk of dying from cancer. It can extend your life so you see a lot more birthdays, celebrate a lot more anniversaries, have a lot more fun, and live a lot longer and enjoy. But City of Hope is really terrific because we have a multidisciplinary team that is able to take care of all the different aspects of every different cancer. This multidisciplinary team starts with people who focus on prevention and physicians who focus on genetic testing and genetic counselors, and this becomes very, very important, very supportive to a patients so that they know that they have the right advice, they can reduce their risk of cancer, and can live a longer, more satisfying kind of life. Plus we have people in multidiscipline including radiation surgery, medical oncology. Immunotherapy is a very new program that can treat a cancer so very effectively. You can get everything you need at City of Hope. But start with your physician and make certain you get screened. Make certain that you talk about prevention. 

Melanie:  Thank you so much. It is really great information. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.