Cancer screenings, navigating your options and the freedom to choose.

Cancer screening recommendations change over time because of evolving medical developments. Let’s start with one of the more confusing screening recommendations, Pap tests.

Pap tests. In the past, it was recommended that all women age 21 and over get a Pap annually. Now it’s every three or five years. Why the change?

Science shows that cervical cancer is directly related to human papillomavirus (HPV) spread through sexual contact. However, an HPV infection could clear in a few months and not result in cancer, or an infection may not show signs of cancer for several years. Overtreatment — causing pain, expense, and in some cases infertility — can be a huge burden on women who otherwise may not have ever presented with cancer.

Now we recommend a Pap test every three years for women between the ages of 21 and 30. At age 30, we do an HPV test along with the Pap. If those results show you do not have the HPV virus, the likelihood of developing cervical cancer is extremely rare, and you may be cleared to go five years without a Pap.

Mammograms and colonoscopies. While one is for women aged 40-plus and the other is for all adults aged 50 and over, they both have a lot in common. Some patients tell me they’re afraid of the discomfort, and some tell me they just don’t want to know the results. But the facts are that these two screenings can be life saving by finding cancers in the earliest stages while still treatable. And these screenings are really not all that invasive. Mammography has been refined over the years to where it’s not as uncomfortable as you might imagine; colonoscopies are performed under sedation.

Beyond the test results.

Keep in mind that all screening recommendations are going to be based on your age, personal health, and family health history. But what you choose to do in response to a result that’s positive for cancer should involve an in-depth discussion with your physician(s) that takes your beliefs, current health status, and expected outcomes into consideration. Are you able to withstand treatment physically, emotionally, and financially, or would it be better to let nature take its course?

For instance, there is no reason why an otherwise vibrant and healthy 70-year-old shouldn’t undergo treatment for colon cancer. On the other hand, a younger patient who suffers from severe heart disease or kidney failure may not be able to — or want to — endure surgery, chemo, and radiation for breast cancer. Does she want to spend her last year or two dealing with the additional cancer therapy?

Which brings me back to the point of screenings. When physicians and patients have open and truthful dialogue, better assessments can be made as to whether or not to have the cancer screenings at all. There’s no one-size-fits-all. Conversations should not only take guidelines and research into consideration, but also patient values and circumstances.

The bottom line: be informed. Get regular checkups. Talk with your physician. And know you still have the freedom to choose.