A famous musician passed away due to suspected cancer. How to detect these 10 common cancers in advance? Check yourself now!

According to Japanese media reports, the famous Japanese musician Ryuichi Sakamoto died in a hospital in Tokyo on March 28. He suffered from throat cancer and rectal cancer and had been fighting cancer for nearly 10 years.

Although current medicine has not completely conquered cancer, some cancers can be detected early through screening. This article summarizes the screening strategies for 10 types of cancer, which groups of people need screening, and what screening methods to choose. I hope that this will attract enough attention from everyone, and I also hope that everyone will establish the concept of scientific physical examinations and spread it to more people.

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01

Lung cancer

In China, lung cancer is the leading cause of cancer death.

Low-dose chest CT is the only effective screening method for lung cancer. According to the updated lung cancer screening guidelines in 2021, the lung cancer screening conditions are as follows: age 50-80 years; smoking ≥ 20 pack-years, and if you have quit smoking, it has been less than 15 years. Both of these are indispensable.

"Pack-years" refers to the number of packs smoked per day multiplied by the number of years of smoking. For example, if you smoke 1 pack a day for 20 years, then the number of pack-years is 20, and so on.

02

Colorectal cancer

Colorectal cancer, also known as large bowel cancer, is a common cancer. Worldwide, colorectal cancer is the second most common cancer in women and the third most common cancer in men.

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Screening strategy:

People at general risk: Screening starts at age 45, and is recommended to be continued until at least age 75. The decision on age 76-85 should be made based on individual circumstances. People aged >85 may need screening only if they have not been screened before, depending on their underlying diseases.

Screening can be done by choosing one of the following options:

1. Get a colonoscopy every 10 years.

2. Sigmoidoscopy every 10 years plus fecal immunochemical test (FIT) once a year.

3. Get a sigmoidoscopy every 5 years.

4. Have a colon CT scan every 5 years.

5. Fecal DNA testing is performed once every 3 years, using a single stool collection specimen.

6. Perform fecal occult blood test once a year, testing 3 specimens.

7. Perform a fecal immunochemical test (FIT) on one specimen annually.

High-risk groups: Screening strategies for high-risk groups are related to the presence of a high-risk hereditary familial cancer syndrome, the number of first-degree relatives with colorectal cancer, and their age at diagnosis.

If there is a history of colorectal cancer in first-degree relatives, and the high-risk population is identified based on family assessment, we need to know the first-degree relatives’ history of colorectal cancer and conduct screening based on this situation:

1. If there is a first-degree relative who was diagnosed at the age of <60 years: Screening is recommended to start at age 40, or 10 years earlier based on the age of the relative’s diagnosis. Then, screening intervals are 5 years, and colonoscopy is recommended. If the patient refuses colonoscopy, fecal immunochemical testing should be performed annually.

2. With ≥2 first-degree relatives diagnosed at any age: Screening recommendations are the same as above.

3. If there is a first-degree relative who is ≥60 years old at the time of diagnosis: start screening at age 40. Others are the same as the general risk group. If colonoscopy is chosen, the screening interval is 10 years.

The screening interval is 5 years, not 10 years. As for when to stop screening, there is insufficient evidence at present. It can be determined based on the age of first-degree relatives diagnosed with colorectal cancer, and comprehensive considerations can be made. For example, 79 years old, 85 years old, but screening is generally stopped when the life expectancy is less than 10 years.

Screening methods:

Available screening methods include colonoscopy (COL), sigmoidoscopy (SIG), colon CT (CTC), fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and fecal DNA test (DNA).

Except for colonoscopy, any positive result from other screening methods requires subsequent colonoscopy to confirm the diagnosis.

03

Cervical cancer

Regardless of whether you have received the cervical cancer vaccine, you still need to undergo cervical cancer screening.

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Screening strategy:

According to the CDC's cervical cancer screening guidelines, age is defined as follows, which we Chinese can refer to. As for the screening intervals, if the results are abnormal, further evaluation by a gynecologist is required.

Screening age range and method:

21-29 years old, cytology examination every three years.

For those aged 30-65, the intervals between different screening methods are different. You can choose one of the following options: cytology examination every three years; HPV testing every five years; or a combination of cytology examination and HPV testing every five years.

When can screening be stopped?

1. Aged over 65 years, with sufficient negative screening results, and no CIN2 or above lesions in cytology results in the past 20 years.

2. The cervix has been removed due to other non-cancerous lesions.

Screening methods:

There are two methods for cervical cancer screening. One is virological testing, which is HPV testing; the other is cytological testing, which commonly includes Pap smear test and thin layer liquid-based cytology testing (TCT). TCT is currently a common testing method used in domestic hospitals. Of course, you can also use a "combined test" that includes HPV and cytological testing.

Therefore, there are three screening options to choose from: single cytological screening , such as TCT; single virological examination, HPV testing; combined testing, HPV+TCT.

Regarding which one to choose, there is some controversy about the screening method in the age group of 21 to 29 years old. For example, the USPTF recommends a single cytology test, while the American Cancer Society (ACS) recommends a single HPV test starting at the age of 25. For subsequent age groups, the general direction is to conduct HPV-based testing.

04

Liver cancer

There are two main types of liver cancer, one is called hepatocellular carcinoma and the other is called cholangiocarcinoma. The former is common and the latter is less common. Hepatitis B virus and hepatitis C virus infection are the main causes of liver cancer. Early liver cancer generally has no specific symptoms.

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Screening strategy:

The American Association for Liver Diseases (AASLD) guidelines recommend liver cancer screening for people with chronic hepatitis B infection and increased risk of liver cancer.

The so-called increased risk of liver cancer refers to men over 40 years old, women over 50 years old, a family history of liver cancer, and hepatitis B cirrhosis.

In addition to hepatitis virus infection, metabolic syndrome (three highs: high blood lipids, high blood sugar, and high blood pressure), food contamination (aflatoxin), pigmentation, long-term liver damage, and especially factors that can cause cirrhosis, such as long-term drinking of large amounts of alcohol, can also increase the risk of liver cancer.

Screening methods:

For liver cancer screening in people with hepatitis B who meet the increased risk of liver cancer, AASLD recommends performing liver ultrasound examination every 6 months.

05

Gastric cancer

Gastric cancer is one of the common digestive tract tumors. Globally, the incidence of gastric cancer in men ranks fourth among male cancers and the mortality rate ranks third. The incidence rate in men is twice that in women. China is a country with a high incidence of gastric cancer.

The specific pathogenic factors of gastric cancer are not yet very clear, but according to research, the following factors are closely related to the occurrence of gastric cancer: diet, smoking, Helicobacter pylori infection, existing gastric diseases (gastric polyps, chronic atrophic gastritis, residual stomach after partial gastrectomy), genetic and genetic factors, etc.

Screening strategy:

At present, there is still some controversy about gastric cancer screening. Different screening methods are recommended according to the different incidence rates of gastric cancer. my country has not yet implemented a gastric cancer screening, but according to the article "Expert Consensus on Early Gastric Cancer Screening Process in China", it is recommended to screen for gastric cancer in people at high risk of gastric cancer. The high-risk group is over 40 years old and meets any of the following conditions:

1. People living in areas with high incidence of gastric cancer.

2. People infected with Helicobacter pylori.

3. Patients with a history of precancerous diseases of the stomach, such as chronic atrophic gastritis, gastric ulcer, gastric polyps, residual stomach after surgery, hypertrophic gastritis, pernicious anemia, etc.

4. First-degree relatives of gastric cancer patients.

5. The presence of other risk factors for gastric cancer (such as high salt intake, pickled diet, smoking, heavy drinking, etc.).

Screening methods:

1. Upper gastrointestinal endoscopy: Upper gastrointestinal endoscopy can be used to directly observe the gastric mucosa and obtain biopsies for the diagnosis of gastric cancer and precancerous lesions.

2. Barium meal X-ray (barium swallow): Before the test, the patient drinks a liquid containing barium, which coats the esophagus and stomach. The test takes X-ray images.

06

Pancreatic cancer

Most patients with pancreatic cancer have atypical early symptoms, including upper abdominal discomfort, dull pain, indigestion or diarrhea, which can easily be confused with other digestive system diseases; in addition, there are also symptoms such as jaundice, weight loss and anorexia.

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Screening strategy:

The U.S. Centers for Disease Control and Prevention recommends that pancreatic cancer screening is not recommended for the general population. In layman's terms, if your family members, especially first-degree relatives (parents, children, siblings) do not have pancreatic cancer, you do not need to check your pancreas.

So what should we do for high-risk groups? In fact, there is no consensus in the academic community about high-risk groups, but it is generally believed that if a first-degree relative has pancreatic cancer, or if multiple second-degree relatives have pancreatic cancer, then pancreatic cancer screening is recommended.

Screening methods:

The current recommendation is magnetic resonance pancreatic cholangiopancreatography or endoscopic ultrasound, which are very complicated, and B-ultrasound or CT examinations are not recommended. In addition, there are currently no accurate and effective biochemical markers for screening pancreatic cancer.

07

Prostate cancer

Prostate cancer is a common cause of cancer death in men. Early prostate cancer** is hidden and there are effective treatment measures for early prostate cancer.** Therefore, screening for prostate cancer in specific populations and early diagnosis and treatment can improve the prognosis of prostate cancer patients and ensure their quality of life.

Screening strategy:

The definition of high-risk population in my country's "Prostate Cancer Screening Expert Consensus" includes age, as follows:

1. Males aged ≥ 50 years.

2. Men aged ＞45 years with a family history of prostate cancer.

3. Men aged ＞ 40 years with baseline prostate-specific antigen (PSA) ＞ 1μg/L.

Because prostate cancer progresses slowly, it is generally accepted that screening should be terminated when other major comorbidities are present and life expectancy is less than ten years.

Screening methods:

Currently, there is no fixed standard program for prostate cancer screening, and the optimal detection interval and combination remain uncertain, but based on current research data, we recommend PSA screening alone every 2 to 4 years.

08

Thyroid cancer

Thyroid cancer is the most common malignant tumor of the endocrine system and head and neck tumors, with a good prognosis. Data from the U.S. Centers for Disease Control and Prevention Task Force show that the 5-year survival rate of thyroid cancer is 98.1%.

Screening strategy:

According to the National Cancer Institute (NCI) and the U.S. Centers for Disease Control and Prevention Task Force (USPSTF), routine thyroid cancer screening is not currently recommended for healthy people without symptoms.

According to the Clinical Practice of Diagnosis and Treatment of Thyroid Nodules formulated by the American Society of Clinical Endocrinology in 2016 and the NCI guidelines, the following groups are recommended to be screened for thyroid cancer:

1. The doctor palpated an enlarged thyroid nodule.

2. There are direct relatives with medullary thyroid cancer, papillary thyroid cancer, or multiple endocrine neoplasia type 2.

3. Have a history of head and neck radiotherapy, such as nasopharyngeal carcinoma patients who have received radiotherapy.

4. The lymph nodes in the neck are swollen and highly suspected to be cancerous.

5. Persistent dysphagia, dysphonia, or dyspnea.

Screening methods:

There is currently no standardized examination program for thyroid cancer screening. Thyroid B-ultrasound is currently the most commonly used test in hospitals in my country.

09

Breast cancer

The incidence of breast cancer ranks first among female malignant tumors. The symptoms of breast cancer are also quite diverse. If you have the following symptoms, remember to see a doctor:

1. A lump appears in the breast, near the breast, or under the arm.

2. The breast morphology changes, that is, the appearance of the breast changes, and you need to observe it regularly.

3. Dimpling or wrinkling of the breast skin; some breast cancers manifest as "orange peel"-like skin changes.

4. Breast discharge, especially bloody.

Screening strategy:

There are different screening strategies for breast cancer for different risk groups.

General risk groups:

1. Under 40 years old: generally no screening is required;

2. 40-49 years old: Individualized customization is required, and screening is not strongly recommended;

3. 50-74 years old: screening is recommended;

4. Over 75 years old: If life expectancy is more than 10 years, screening is recommended.

The above screenings recommend mammography, which can be performed every 1-2 years if desired.

Moderate risk group:

The so-called moderate risk group, generally speaking, is a woman who has a first-degree relative with a history of breast cancer but does not have a clear genetic syndrome. However, it should be noted that if a first-degree relative has breast cancer before menopause, then the screening age may need to be advanced, but the evidence is not sufficient, so sometimes it is necessary to carefully discuss the benefits and risks with the screening subjects.

Generally speaking, people at moderate risk can adopt the same screening strategy as people at general risk.

High-risk groups: If you have these conditions, we consider you to be a high-risk group.

1. Personal history of ovarian, peritoneal, fallopian tube, or breast cancer;

2. Family history of ovarian cancer, peritoneal cancer, or fallopian tube cancer, or a significant family history of breast cancer;

3. Ancestry associated with BRCA1 or BRCA2 mutations (e.g., Ashkenazi Jewish ancestry);

4. Genetic susceptibility (eg, known BRCA or other susceptibility genes);

5. Previous chest radiotherapy;

6. Other breast cancer risk factors resulting in an estimated lifetime risk of breast cancer greater than 20%.

For high-risk groups, it is recommended to see a specialist to discuss screening plans. Generally, screening needs to be strengthened, such as annual breast MRI examinations, and other preventive measures may be needed, such as surgery or drug prevention.

10

Nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is an epithelial tumor that originates in the nasopharynx. Although rare in most of the world, NPC is prevalent in southern China, Southeast Asia, North Africa, and the Arctic.

Nasopharyngeal carcinoma often originates from the relatively hidden pharyngeal recesses, so patients may be asymptomatic for a long time. As a result, most patients are already in the advanced stage of the disease when they develop symptoms and seek medical treatment.

Possible pathogenic factors of nasopharyngeal carcinoma include: Epstein-Barr virus infection, diet, genetics, HPV infection, molecular pathogenesis, etc.

Screening strategy:

Because nasopharyngeal carcinoma may be familial and has a high cure rate in the early stages, screening of first-degree relatives of nasopharyngeal carcinoma patients may be considered in certain high-risk areas to detect the disease early and provide early treatment.

Screening methods:

In high-risk areas, checking for EBV antibodies is not very meaningful. EBV DNA should be checked directly in the peripheral blood. If positive, it is recommended to recheck after one month. If it is still positive, it means that active EBV infection has persisted. In this case, electronic nasopharyngeal endoscopy + nasopharyngeal enhanced magnetic resonance imaging screening is recommended to rule out the risk of nasopharyngeal cancer.

Finally, I would like to remind everyone to have a valuable physical examination. Before taking a physical examination, you must consult a doctor first. The doctor will tailor an overall physical examination plan based on your specific situation. The more physical examination items, the better, and the more expensive, the better. Don't miss out on the items that should be checked.

Source: Keyou Health

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