From Butt to Boobies, Recommendations on Cancer Screenings

Cover Image by Vlad Deep via Unsplash

I recently had my first appointment with an amazing, new (to me) gynecologist. Being that I’m 47, she asked if I’d had a colonoscopy yet. I have not, but she strongly encouraged me to do so as it is recommended that people of average risk start screening for colorectal cancer at the age of 45. 

I assume I’m at average risk, but here’s how the American Cancer Society defines people at average risk for colorectal cancer (1):

For screening, people are considered to be at average risk if they do not have:

A personal history of colorectal cancer or certain types of polyps

A family history of colorectal cancer

A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)

A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer

But wait, let’s back that butt up a bit. . . some of you may be thinking, “Did I read that right? Doesn’t she mean the recommendation is to start colorectal cancer screening at the age of 50?” Nope. The recommended age to start screening for colorectal cancer was reduced from 50 years of age to 45 years of age in 2018 by the American Cancer Society, and the US Preventive Services Task Force followed suit in 2021.

The recommendations changed because 1) of a recent and alarming rise in colorectal cancer in people younger than 50 and 2) colorectal cancer is one of the most preventable cancers with its long progression and available screening tests. 

And while there are screenings available that are less invasive than colonoscopies, my doctor said that a colonoscopy is basically the gold standard for screening. Initially, I really wanted to just go the whole “poop in a box” route, because I figure my diet and my abstinence from smoking and alcohol for the past two decades would mean it would be okay to start with the less invasive route. However, I’ve heard from other providers that those stool-based tests may cause a headache with insurance. There’s no way I’m burrowing into the rabbit warren of insurance, but I will say check with your health and insurance providers before pooping-in-a-box instead of scheduling a colonoscopy. 

I plan to talk to my primary care provider and schedule a colonoscopy around the first of the year.

Onto the Boobies. . .

Then my gynecologist said “I see you just had a mammogram last year. That’s great!” She asked if I wanted to schedule another. I paused and asked “Well, what’s the recommended guidelines for mammograms these days?”

One of the reasons I asked this before jumping in and scheduling one is that 1) my mammogram gave me intense anxiety (likely due to some latent emotions I haven’t yet dealt with over the death of a friend from breast cancer), and 2) I am worried about false positives.

Here’s the thing, where the recommended guidance for colorectal screening is agreed upon (start at age 45 for people of average risk), the same is not true of breast cancer screening. 

Breast cancer screening recommendations are all over the board, and I believe this is a HUGE DISSERVICE to women. 

See this table of recommendations compiled by the CDC:

There are seven different organizations weighing in with recommendations for breast cancer screening. The organizations are the US Preventive Services Task Force, American Cancer Society, American College of Obstetricians and Gynecologists, International Agency for Research on Cancer, American College of Radiology, American College of Physicians, American Academy of Family Physicians. While the recommendations aren’t wildly different, the biggest discrepancies are about whether or not to start at age 40, 45, or 50, and when to finally stop screening. 

Like with colorectal screening, we are focusing on screening recommendations for women of average risk. The American Cancer Society defines average risk for breast cancer as “For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and has not had chest radiation therapy before the age of 30.” (2)

At this point, I plan to follow the recommendations of the US Preventive Task Force which says that women at average risk for breast cancer should begin biennial screening mammography at age 50 and stop at age 74.

The USPTF was created in 1984 and is an independent, volunteer panel of national experts in prevention and evidence-based medicine. “The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. All recommendations are published on the Task Force’s Web site and/or in a peer-reviewed journal.”

The American Cancer Society recommends women should get mammograms on an annual basis from age 45 to age 54. 

When it comes to our health, we must have agency and information. Oftentimes you’ll only hear about the recommendations from the ACS, but be aware there are other recommendations out there, so be fully informed before you make any decisions. But whatever you do, get screened!

(1) https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html

(2) https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html