You might need to get screened for cancer earlier than you think

The cancer screening guidelines you follow are likely outdated, according to health workers serving communities in the Bronx and Queens.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

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.

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

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

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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