Screening tests are used to help identify an unrecognized disease in patients who are not symptomatic. The goal of screening is to help recognize diseases at very early stages, even pre-cancerous stages, to allow for earlier diagnosis and treatment, ultimately resulting in an increased likelihood of survival. Based on your age, as well as personal and family history, you may qualify for screening investigations primarily for cervical, breast and colon cancer. Screening testing has both benefits and risks associated with the tests that are being completed.

In general, the benefits of completing screening testing is to detect cancer at very early stages, possibly even pre-cancerous stages, to allow for earlier treatment and improvement in morbidity and mortality.

The risks associated with screening testing include the possibility of false positives, false negatives, over-treatment and over-diagnosis.

Mammogram

The primary test used for routine breast cancer screening in Ontario is a mammogram. A mammogram is an x-ray of the breasts with low dose radiation. Mammograms can be completed at certain clinics as well as hospitals. When completing a mammogram, your breast is placed between two plastic plates that are pressed together, in order to compress your breast tissue and allow for the most accurate imaging.

A mammogram can be somewhat uncomfortable, so here are some tips:

• If possible, do not arrange for your mammogram within 7-10 days of the initiation of your menstrual period. This is typically when your breasts are most tender.
• Avoid food and drinks that contain caffeine prior to the mammogram.

Fecal Immunochemical Test (FIT)

The most common test used for routine colorectal cancer screening is the FIT testing method. Recently this has been changed from the FOBT testing method to the FIT testing method. The FIT is more sensitive and specific than the previous FOBT testing, which means it is superior in detecting colon cancer compared to the previous FOBT testing. The FIT testing method works by detecting small amounts of blood in your stool, which could be present due to colon cancer or pre-cancerous polyps. This test is not affected by medications, diets or specific foods. To obtain a FIT testing kit, you must speak to your primary care practitioner (family physician, NP, PA, etc.) or the RAAMP clinic can also order this for you. You will then be sent a FIT testing kit in the mail. The testing kit includes the following; 1 FIT tube, 1 stool collection paper, 1 plastic bag with absorbent material, and 1 pre-paid yellow return envelope. There will also be instructions included with the FIT testing kit. To complete the FIT, you should urinate first and flush, then place the stool collection paper in the toilet, and proceed to have a bowel movement. Take the FIT tube and uncap it, then run the grooves of the stick along your stool until grooves are covered, and re-cap the FIT tube. You can flush the stool and collection paper. Place the FIT tube in the plastic bag with absorbent material, seal this, and place in the return envelope. You must then mail or drop off your FIT test to a LifeLabs as soon as possible. It is recommended you return the test to LifeLabs within 2 days of completing the test. Below is a link for LifeLabs locations:
https://locations.lifelabs.com/locationfinder

Flexible Sigmoidoscopy

Flexible Sigmoidoscopy is another type of investigation that can be utilized in routine cancer screening. The purpose of this procedure is to allow the physician to visualize the lining of the rectum and sigmoid, which is the lower third of the colon. This test is performed using a sigmoidoscope. This is a small, thin, flexible tube with a lens and light attached to the end.

In order for accurate testing, the rectum and sigmoid colon must be empty prior to the test, thus there is a bowel preparation associated with the flexible sigmoidoscopy. Your physician may require you to take laxatives, or an enema, or a combination of both.

To complete the test, the patient is asked to lay on their side, with their knees tucked up to their chest. First, the physician may perform a digital rectal examination (DRE). The physician will insert one finger, with lubricant, into the anus to ensure the rectum is not blocked. Then, the sigmoidoscope is inserted through the anus, and moved into the rectum and sigmoid colon. If needed, a physician can take biopsies of polyps/lesions by passing small tools through the sigmoidoscope. The sigmoidoscope is then slowly removed. Typically, there is no sedation associated with this procedure and people can return home after the test and continue with activity as normal.

Common side effects that you may experience after the flexible sigmoidoscopy include discomfort in the lower abdomen, gas, bloating, diarrhea or small amounts of rectal bleeding. Very rarely, a hole or tear can be made in the colon when completing a sigmoidoscopy. This is a more serious complication of the procedure and may require surgical assessment.

Colonoscopy

A colonoscopy is another form of colon cancer screening, however this test is typically reserved for patients who are at a high risk of being diagnosed with colon cancer compared to the general population. A colonoscopy is a test that is not only used for screening, but can also be used for diagnostic purposes in patients who have had other abnormal investigations such as an abnormal FOBT. The purpose of this procedure is to allow a physician to visualize the lining of the rectum and entire colon. The colonoscope (endoscope) is a small, thin, long tube with a camera and light on the end.

In order for accurate testing, a special bowel preparation is required beginning two days prior to the test. Patients are asked not to eat solid foods for 1-2 days prior to the procedure. You will also be required to use a laxative or enema, or both to flush out the colon.

This procedure is performed in hospital, on an outpatient basis. This means you will not be required to be admitted to hospital for this test. To complete the test, the patient is asked to lay on their side, with their knees tucked up to their chest. For this test, you will be given sedation, thus an IV will be placed in one of your arms in order to administer medication. First, the physician may perform a digital rectal examination (DRE). The physician will insert one finger, with lubricant, into the anus to ensure the rectum is not blocked. Then, the endoscope will be inserted into the anus, rectum and colon. If needed, biopsies can be performed by inserting small tools through the endoscope. This test may take approximately 30-40 minutes. After the procedure, the patient will be monitored in a recovery room for 1-2 hours. The patient is then discharged, however they are unable to drive for the rest of the day.

Common side effects that you may experience after the colonoscopy include discomfort in the abdomen, gas, bloating, diarrhea or small amounts of rectal bleeding. Very rarely, a hole or tear can be made in the colon when completing a colonoscopy. This is a more serious complication of the procedure and may require surgical assessment.

Pap Test

A Pap Test (Papanicolaou test) is used to screen for cervical cancer. The purpose of this test is to look for abnormal cells of the cervix.

This test is performed at your doctor’s office. The patient is required to undress below the waist and is given a gown to put on. The patient will lie on their back on the examination table. The physician will insert an instrument called a speculum into the vagina to allow for the cervix to be seen. A special instrument is used to collect cells from the cervix, which will then be sent to the laboratory for analysis. The test is not usually painful, however you may experience a small amount of discomfort or pressure.

Tips to prepare for the Pap Test:

• Try to schedule for Pap Test when you are not experiencing your menstrual period
• Avoid having sexual intercourse within 24 hours of your Pap test
• Avoid applying any vaginal medicines, tampons, vaginal foams or gels within 48 hours of the Pap Test, as this can obscure abnormal cells
• Try to empty your bladder prior to the Pap Test, as having a full bladder may make the examination more uncomfortable

PSA

Prostate specific antigen (PSA) test is a blood test performed that measures the amount of PSA in the blood. PSA is made by the prostate gland.

PSA testing may be completed for multiple reasons, including but not limited to:

• Detect prostate cancer early in men who do not yet have any symptoms
• Check for prostate cancer in men who do present with signs and symptoms of prostate cancer
• Help to predict if cancer has spread, and the prognosis of a patient diagnosed with prostate cancer
• Monitor men who have been diagnosed with early stage prostate cancer, who are currently being treated with active surveillance
• Help determine if cancer treatments are working
• Monitor for recurrence of cancer

Results of the PSA test can mean different things for each individualized patient. For instance, the PSA level will naturally increase in men as they age, which is a normal process. Your PSA test result should be discussed with your physician and interpreted according to your signs and symptoms, personal and family history, as well as compared to previous PSA testing if possible.

Furthermore, a high PSA level does not necessarily mean a diagnosis of prostate cancer. PSA levels can be increased for many reasons, including but not limited to:

• Benign Prostatic Hypertrophy
• Prostatitis (infection of the prostate gland)
• Urinary Tract Infection
• Urinary Catheter
• A recent medical investigation or test on the prostate or bladder
• Prostate Cancer