December 2, 2020
Members of the Tuscaloosa community have the opportunity to learn about trends and advances in health and medicine as part of the Mini Medical School program. Mini Medical School is a collaborative effort of the College of Community Health Sciences and The University of Alabama OLLI program and features a series of lectures provided by CCHS faculty and physicians from University Medical Center, which is operated by the College. Eight lectures are presented each fall and spring semesters. OLLI, short for Osher Lifelong Learning Institute is a member-led program catering to those age 50 and older. Mini Medical School is open to OLLI registrants and the public.
Screening can help doctors find and treat cancer early, before signs or symptoms appear. Early detection is important because when cancer is found early, it may be easier to treat.
Dr. Catherine Skinner, assistant professor of family, internal and rural medicine at The University of Alabama College of Community Health Sciences, said the ultimate goal of cancer screening is to reduce the number of people who develop cancer, and the number of people who die from the disease.
Skinner, who also practices family medicine and obstetrics at University Medical Center, which the College operates, provided a presentation about women’s health and cancer screenings November 3 as part of this semester’s Mini Medical School program. Mini Medical School is a joint program of UA’s OLLI program and CCHS and provides an opportunity for OLLI and community members to receive updates and learn about trends in medicine and health.
Skinner provided an overview of screening for various types of cancer that affect both women and men.
Most cervical cancers are linked to the human papillomavirus (HPV), a common sexually transmitted infection. A pap smear is the most effective screening tool; there’s not much evidence that pelvic exams reduce cervical cancer, Skinner said.
She said pap smears are no longer recommended annually for women. Women aged 21-29 are encouraged to get a pap smear every couple of years. For women age 30-65 who are asymptomatic and have no family history of cervical cancer, screening is recommended every three years. Skinner said pap smears are not recommended for women over the age of 65 if they have had adequate screening and no lesions in the previous 20 years. “That’s because the main cause of cervical cancer is HPV, a sexually transmitted infection,” she said. “After age 65, cells don’t divide as much and sexual habits change.”
Ovarian cancer is hard to detect and often diagnosed in late stages because its symptoms are nondescript – primarily bloating of the abdomen, Skinner said. The screening tools used most often for ovarian cancer, in addition to a pelvic exam, are transvaginal ultrasound and the CA-125 blood test.
Breast cancer is a common cancer among women, with a number of screening tests. Mammograms are widely used and include digital mammograms, which might be better for dense breasts, and 3D mammograms, which can find small tumors, Skinner said. But with 3D mammography, “there can be overdiagnosis and overtreatment,” she said. “While 3D mammography has been approved by the FDA, it’s not clear where it fits into breast cancer screening.”
Ultrasound, another screening tool, is often used if a mammogram shows something suspicious. There are also MRIs, clinical breast exams and breast self-exams.
There are differences in breast cancer screening recommendations, Skinner said. The U.S. Preventive Services Task Force recommends breast screening every two years for those age 50-74 and that women age 40-49 should consider a mammogram after consulting with their doctor about the risks and benefits. The American Cancer Society recommends the following: women age 40-45 should choose if they want a mammogram; those age 45-54 should have yearly mammograms; and women 55 years and older should have a mammogram every one-to-two years.
The American Cancer Society does not recommend clinical breast exams, those performed by a physician, and the USPSTF states that there is insufficient evidence to recommend for or against the exams. The American College of Obstetricians and Gynecologists, however, recommends clinical breast exams every one-to-three years for women age 20-39 and annually for those 40 and older.
Skinner said breast self-exams are important because they allow women to become familiar with their breast so that they can detect changes more easily.
Colon cancer affects both women and men, and there are a number of screening tests that can be used to detect this type of cancer. A colonoscopy is the most sensitive test and is conducted by inserting a lighted tube into the rectum and through the entire colon. It requires the patient to prep and anesthesia is used. A sigmoidoscopy checks the lower colon but can be performed in a doctor’s office with minimal anesthesia. A fecal occult blood test looks for blood in stool, which can indicate the presence of polyps. A double contrast barium enema can also show if there are polyps in the colon. And a stool DNA test analyzes DNA from stool to look for polyps. Polyps are small clumps of cells that form on the lining of the colon. Most colon polyps are harmless, but over time, some can develop into colon cancer.
Colon cancer screening is recommended to start at age 50 and continue every 10 years for asymptomatic individuals. Those with a family history of colon cancer should begin screening 10 years earlier than the age of the family member diagnosed. “We want to find polyps, remove them and prevent them from becoming cancer,” Skinner said.
Skin cancer, when caught early and treated, is highly curable, but there currently are no recommendations for skin cancer screening.
There are three types of skin cancers. Melanoma is the most serious form and have symptoms that follow what’s known as ABCDE criteria – asymmetry, border irregularities, color variation, diameter greater than six millimeters (the size of a pencil eraser) and enlargement or changes in color or shape.
Basal cell carcinoma can resemble the following: an open sore that doesn’t heal; a shiny bump or nodule; a reddish patch or irritated area; a scar-like area that is flat white, yellow or waxy in color; and a small pink growth with slightly raised edges and a crusted indentation in the center.
Squamous cell carcinomas may appear as flat reddish or brown patches in the skin, often with a rough, scaly or crusted surface. They tend to grow slowly and usually occur on sun-exposed areas of the body, such as the face, ears, neck, lips and backs of the hands.