Guest Author - Denise Howard, M.D., M.P.H.

The survival rates for Breast, Cervical, and Colorectal cancers have dramatically improved over the past decade. This is primarily due to the availability and effectiveness of screening test that allow early detection and in some cases prevention of these previously deadly cancers. The lifetime risk of developing Breast cancer is 1/8. It is 1/17 for lung cancer, 1/18 for colorectal cancer, 1/38 for endometrial cancer, 1/68 for ovarian cancer and 1/135 for cervical cancer. Given this, every woman should utilize these recommended tests, but what are they and what are the recommendations?

Cervical cancer screening involves an annual pap smear for sexually active women who haven’t had a hysterectomy. This involves a vaginal speculum exam where a scraping of the cervix is taken. The sample is sent to a lab and the cells from the scraping can be examined for abnormalities such as precancerous changes or cancer itself. The addition of Human Papilloma Virus (HPV) testing has made this screening even more precise. Further testing in the form of a colposcopy is recommended in the setting of precancerous changes or certain types of HPV. A colposcopic guided biopsy of the cervix can be taken if abnormalities are noted. This biopsy will typically provide the definitive diagnosis and thereby directing further management. Precancerous changes, also called dysplasia can be treated early thereby preventing the development of cervical cancer. Detection of precancerous changes allowing for effective treatment is the key to preventing cervical cancer.

A mammogram is a radiologic test of the breast that can detect small cancers many years before they can be detected by breast examination. Annual mammograms are recommended in all women over the age of 40. In women with a strong family history of breast cancer earlier screening maybe required. Preventative therapy in the form of selective oral medication is an option for high risk women. Mammographic abnormalities can be biopsied either with a needle or surgically by excising the area of involvement. This tissue sample can be evaluated by the pathologist and a definite diagnosis made. Early detection is the key to breast cancer survival.

Colonoscopy is the gold standard for colorectal cancer screening. Other screening tests include a barium enema, annual fecal blood test and a sigmoidoscopy. If any of these tests are abnormal a colonoscopy would be indicated. A routine colonoscopy is recommended at age 50 (age 45 for African Americans) and the frequency is every 10 years if the test is completely normal. It is a procedure by which a lighted scope is passed through the entire colon. Polyps or other abnormalities can be visualized, biopsied and in some cases removed. The removal of precancerous polyps can prevent the development of colorectal cancer.


Other common malignancies in women include Ovarian, Uterine and Lung cancer. There aren’t any recommended screening tests for these cancers. Uterine cancer typically presents with earlier abnormal bleeding. Early diagnosis is possible and the survival rate is good. Lung and Ovarian, unfortunately, typically presents late and the chance of survival is low compared with the other cancers mentioned above. The lifetime risk of dying from lung cancer is the highest of all malignancies.

Cancer screening test for selective malignancies are available. They are effective, safe, inexpensive and well tolerated. Every woman should undergo these tests as recommended and encourage their friends and family to also comply. This is a matter of life and death.