Breast cancer cells (Photo/Wikimedia CC BY-SA 3.0)
Breast cancer cells (Photo/Wikimedia CC BY-SA 3.0)

Early detection of cancer remains a significant hurdle to saving lives

When I was growing up, people did not want to mention the “c” word at all, or they whispered the word “cancer.” There was much fear surrounding cancer probably because there was little one could do about it.

While there is still fear, we now have effective diagnostic tools and cancer treatments, and we have learned how to strategize against cancer’s sneaky behavior.

The first strategy is to be on the lookout. Whenever I see a patient, one of the things I think about is whether they are due for a cancer screening test. Unfortunately, most cancers cannot be detected by screening, and only four types of cancer screening have received a high-level recommendation from the U.S. Preventive Services Task Force: colon, lung, breast and cervix. (Prostate cancer has a screening test, but the task force does not recommend it due to over-diagnosis.)

According to the National Opinion Research Center at the University of Chicago, 14% of all cancers diagnosed in the United States are detected by a recommended screening test. Surprisingly, just 61% of breast cancers are detected by screening, and only 3% of lung cancer cases are detected by screening despite the Preventive Service Task Force recommendations. These low numbers are primarily due to patients not getting tested at all.

Although lung cancer has the highest mortality of all cancers in men and women, the American Lung Association reported that just 5.8% of people eligible for lung cancer screening were screened in 2021. Clearly, there is a problem with preventive health-care delivery.

The second way to beat cancer is to catch symptoms early. By catching cancer early, the survival rates may be four times higher compared with later-stage detection. The challenge for many of my older patients is that common symptoms may not be perceived as serious either by themselves or their physicians, and diagnosis is delayed. Here are some examples where diagnosis of cancer could easily have been missed:

A 75-year-old woman came to see me complaining of a two-week history of lower back pain. This was my first encounter with her so I reviewed her medical record, which revealed that she had breast cancer more than 20 years prior. This raised a red flag in my mind, so I sent her for STAT spine x-rays. She returned to my office within an hour, and I delivered the bad news that there was an abnormality in one of her vertebrae. A needle biopsy of the vertebra subsequently revealed metastatic breast cancer. Fortunately, she responded well to radiation therapy.

Only four types of cancer screening have received a high-level recommendation from the U.S. Preventive Services Task Force: colon, lung, breast and cervix. 

A 68-year-old man presented with nightly fevers for several weeks, mild weight loss and several months of itchy skin, particularly when he took hot showers. This alarming constellation of symptoms suggested that he could have lymphoma, or cancer of the lymph glands. He had no enlarged lymph nodes upon physical exam so I ordered CT scans of his chest and abdomen, which revealed enlarged lymph nodes near his abdominal aorta. I referred him to oncology for further evaluation and chemotherapy.

An 85-year-old woman came to see me because of mid-back aches for several weeks. Her physical exam was normal, and I showed her some back stretches. When she returned two weeks later complaining of loss of appetite and newly onset depression, I was concerned that she had cancer of the pancreas. (More than 75% of patients with pancreatic cancer have depression and anxiety.) A CT scan of her abdomen confirmed my suspicion. She ultimately decided to forgo treatment for it and moved to Alaska to live with her daughter.

The third way to beat cancer is to pay attention to any risky behavioral factors. The American Cancer Society’s prevention studies have been critical in identifying risk factors. It was the Cancer Prevention Study-1 (CPS-1), which enrolled over a million participants in the 1950s, that first identified smoking as a major risk factor for cancer.

CPS-3 was launched in 2006, and I volunteered to be one of the 400,000 national participants. Over the course of the study, I have submitted blood and urine samples and completed numerous telephone and online surveys. Combining data from CPS-2 and CPS-3, this ongoing research has found that older age and smoking have the highest relative risk for developing any cancer for both men and women.

Additional risks for men are family history of cancer, red meat consumption, alcohol intake and physical inactivity. Additional risks for women are family history of cancer, obesity, type 2 diabetes, and physical inactivity. It will be interesting to see if other cancer risk factors emerge over the expected 40-year duration of this study.

In summary, to maximize your chances of beating cancer, get your recommended screening tests, see your doctor promptly if you have symptoms that don’t resolve as expected and pay attention to your personal risk factors. As cancer research continues to advance, I hope the “c” word will someday mean “cured.”

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.