a doctor taking patient s blood pressure
Community health experts say newer guidelines for cancer screenings aren't on many New Yorkers' radar. Photo by Thirdman on Pexels.com

The cancer screening guidelines you follow are likely outdated, according to health workers serving communities in the Bronx and Queens.

Growing research has led to recommendations to screen earlier for certain cancers. But people might be following the old guidelines—or worse, not even thinking about screening because they’re so young. For example, colorectal cancer rates are rising among young people, with early-onset cases happening before the age of 50

The need for earlier screenings came up during a Queens Community Board 13 health committee meeting on preventative medicine this past March. 

The health committee members, some of whom are public health workers, warned that many in the community don’t know about new guidelines for cancers like breast and prostate.  

Experts at Montefiore Health System see this as well, saying patients tell them they don’t think they need to get prostate screening until 50 and are shocked that Black men, for instance, should get screened at 45. “All the changes get confusing and scary,” said Alyson Moadel-Robblee, deputy director of community engagement and cancer health equity at the Montefiore Einstein Comprehensive Cancer Center.

Why cancer screening recommendations are confusing 

doctor talking to a patient sitting on bed
Researchers say if Black women started breast cancer screenings at 42, that could help lower racial disparities in deaths. Photo by RDNE Stock project on Pexels.com.

There isn’t a universal recommendation for when to get screened for many cancers. Most guidelines either come from a federal task force (the United States Preventive Services Task Force or USPSTF) or from medical groups like the American Cancer Society (ACS). 

Let’s look at breast cancer, for example. The recommendations from the ACS are different from the USPSTF. That’s partly due to the USPSTF’s lag in updating some guidelines, despite new research. This is according to medical groups that have updated their guidance to reflect racial disparities and other trends in research.

Things can get even more confusing when you account for race, risk factors like a family history of cancer, income, insurance access, and lifestyle factors — all of which can put you at a higher risk of getting or dying from cancer. Things get more convoluted when you add insurance to the mix. State law mandates insurance companies must cover recommended screenings. But each provider bills differently and follows different guidelines, especially when it comes to patients who need early screenings.

Cancer screenings: the old vs. new guidance

The following section features five of the most common cancers affecting New Yorkers — including old and new guidelines. Researchers say race also plays a role in screening recommendations. Note: the guidelines are both from the ACS and the USPSTF.

Breast cancer

  • Old guidelines:
    • Every 2 years: women aged 50 – 74. 2016, USPSTF
  • New guidelines:
    • Every 2 years: women starting at age 40. 2023, USPSTF, draft guidance
    • Or every year: women starting at age 45. 2023, ACS
  • Most affected: Black women have a 40% higher risk of dying due to early-onset breast cancer when compared to white women.

Colon/colorectal cancer:

  • Old guidelines:
    • Every 10 years: People aged 50-75. 2008, ACS
  • New guidelines:
    • Every 10 years:
      • Start: Average-risk people, aged 45. If healthy: continue to age 75. Discuss with doctor: 76-85. Stop: 86+. 2018, ACS
  • Black people are about 20% more likely to get colorectal cancer and about 40% more likely to die from it compared to other racial groups.

Cervical cancer

  • Old guidelines:
    • Women aged 21-65:  Pap smear every 3 years.
    • Aged 30-65:  Pap smear and HPV testing every 3 years. 2012, USPSTF
  • New guidelines:
    • Women aged 21-29: Pap smear every 3 years.
    • Aged 30-65: Pap smear only every 3 years.
    • Or primary HPV only every 5 years. 2018, USPSTF; Update in progress
  • Black women have the highest rate of cervical cancer deaths, followed by Hispanic women.

Lung cancer

  • Old guidelines:
    • Yearly: People ages 55 – 80 if they have smoked 1 pack per day for 30 years (or 2 packs a day for 15 years) and currently smoke or have quit smoking in the past 15 years. 2013, USPSTF
  • New guidelines:
    • Yearly: People ages 50 – 80 if they have smoked 1 pack per day for 20 years (or 2 packs a day for 10 years) and currently smoke or have quit in the past 15 years. 2021, USPSTF and ACS
  • Black men have the highest rates of developing and dying from lung cancer.

Prostate cancer

  • Old guidelines:
  • New guidelines:
    • Men should discuss with their doctor at:
      • Age 40 if you have more than one close family member who had prostate cancer before age 65.
      • Age 45 if you are Black or have one close family member who had prostate cancer before age 65.
      • Age 50 if you do not have specific risk factors. 2023, ACS
  • Most affected: Non-Hispanic Black men have the highest rates of getting and dying from prostate cancer.

What’s the harm in screening earlier or later than recommended?

doctors discussing a diagnosis
Colorectal cancer is the second-leading cause of cancer death in New York City. Photo by RDNE Stock project on Pexels.com

Experts say screening earlier or later than recommended can bring possible harm. This includes unnecessary exposure to radiation, overtreatment from false-positive results, or the risk that comes with biopsies. 

“When I screen people, I want to make sure that if there’s any harm associated with screening it is outweighed by the benefit that we might get from saving lives from cancer or preventing people from dealing with cancer,” said Beth Seltzer, executive director of the Clinical and Scientific Affairs Unit at the NYC Health Department. “There’s always that balance.”

With breast cancer, for instance, there’s a small amount of radiation exposure in mammograms. With colonoscopies and other invasive procedures, there’s a small chance that something could go wrong, Seltzer says. There’s also the stress of false positives overall.

But experts at Montefiore and the city health department say the issue they see isn’t overscreening — it’s generally that communities they serve don’t get adequately screened. 

How to be your best cancer screening advocate

three person looking at x ray result
Lung cancer is the leading cause of cancer death in New York City overall, found most often in people aged 45 and older. Photo by EVG Kowalievska on Pexels.com

When talking to your medical providers and trying to get screened earlier than they recommend, you might come across challenges, such as bias. A study found that oncologists may recommend different treatments to Black and Latino patients compared to white patients.

This might be due to assumptions about what patients want or due to cancer doctors historically taking less time to educate or build relationships with non-white patients. 

Moadel-Robblee shared some tips on how to prepare for a “shared decision-making” discussion with your doctor:

  • Prepare suggested questions like:
    • I’d like to learn about which cancer screenings I may be due for and what recommendations you have.
    • Could you share which guidelines you follow, since there are so many, and why?
    • Could you share the risks and benefits of each screening?
    • How could I find out if my insurance covers these? 
    • Could you assess my risk for cancer and how that might affect your screening recommendations for me?
  • Bring an advocate: a family member or friend who can take notes.
  • Take advantage of patient advocate programs that most health systems have available.
  • Record conversations to relieve the pressure of remembering important information.

How to access cancer screenings

The NYC Health Department provides these tips on how to get screened: 

  • Your screening will likely be covered if insured. 
  • If you’re uninsured, the New York State Cancer Services Program offers free breast, cervical and colorectal cancer screenings.
  • NYC Health has a mammography van program where you can get free mammograms.
  • New York City Health + Hospitals has a sliding scale and offers low-cost screenings.

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