Cancer Screenings

Thousands of people will get screening exams for breast cancer, cervical cancer and lung cancer this year. Others will get diagnostic tests or scans – such as chest X-rays – for other reasons. Some will be asked to come back for additional scans or testing.

If you’re one of those people, you might have some questions. For instance, what does it mean if your Pap test is “abnormal?” Why would your mammogram be considered “inconclusive?” And what else might be causing a “shadow” to appear on a chest X-ray?

Here are five things to keep in mind, if you get a call back from the doctor’s office that your results are abnormal or inconclusive.

1. Don’t panic.

The first thing to do is remain calm. While it may be alarming to learn you need additional testing, don’t automatically assume the worst. There are many reasons your doctor might have requested it. Here are some of the most common:

• Breasts: If this is your very first mammogram, your doctor may be trying to establish a solid baseline against which all future images can be compared. Dense breast tissue can also make it difficult to identify breast cancer with a regular mammogram. So, your doctor might request a 3D mammogram or an ultrasound to see additional detail.
• Cervix: An abnormal Pap test and/or positive human papillomavirus (HPV) test could be a sign of pre-cancerous changes in your cervix. But bubble baths, vaginal dryness, and intercourse can also cause cells to look distorted or atypical. Additional testing will help your provider clarify whether the initial test results are significant or if treatment is necessary.
• Lungs: “Shadows” in the lungs can be caused by respiratory infections, such as influenza, pneumonia or COVID-19, or by the scar tissue they leave behind. One such type of radiographic finding is known as “ground glass,” because that’s how it appears on scans: as hazy areas that are hard to see through, but not entirely opaque. Additional testing can help determine if one of these infections is the culprit for something unclear on a lung scan.

“Even among patients with a heavy smoking history, the vast majority of the spots we find on screening scans are not ultimately found to be cancers,” says pulmonologist Scott Evans, M.D.

2. The odds are actually in your favor.

Screening tests are designed to detect abnormalities in tissue, such as cervical dysplasia. Their purpose is to rule out cancer as a possible cause or to find it at its earliest stages, when it’s the most treatable.

So, getting called back for additional testing does not necessarily mean that you have cancer; it just means your doctors need more information to clarify what they’ve seen through a microscope or on an image.

“Less than 1% of Pap tests result in a cancer diagnosis each year,” notes gynecologic oncologist Kathleen Schmeler, M.D. “However, women with an abnormal Pap or HPV test may have pre-cancerous cells, which can be treated to prevent progression to cancer.”

3.  Next steps are mostly non-invasive.

Breasts: If you get called back after a screening mammogram, the first step is usually a diagnostic mammogram, which takes a more detailed look at your breast tissue. If additional imaging is needed, your doctor may order an ultrasound. Both of these are non-invasive procedures.

If a tissue sample is needed to make a final determination, a breast biopsy may be called for. But even then, it does not mean you have cancer.

“About 70% of women who have a breast biopsy will NOT be diagnosed with cancer,” says Marion Scoggins, M.D. “Most breast biopsies turn out to be benign.”

Cervix: If a Pap or HPV test comes back abnormal, the next step may be a colposcopy: a simple, in-office procedure that doesn’t require anesthesia. Your doctor will place acetic acid on your cervix to highlight any concerning areas, then examine them more closely with a special instrument called a colposcope.

Anything unusual will be biopsied and sent off to a lab for interpretation. Depending on the results, your doctor may wish to schedule a loop electrosurgical excision procedure (LEEP), another in-office procedure in which a wire loop is heated with an electrical current and used to remove abnormal cells from the cervix, so they don’t progress to cancer.

Lungs: If a chest X-ray shows an area of concern in the lungs, most patients will have a CT scan to get a more detailed image of it. If additional testing is called for, the doctor may recommend a biopsy using a bronchoscope, surgery or a CT-guided needle to obtain tissue for examination under a microscope — but these are rarely necessary.

4. It’s OK to need support.

Most abnormal findings do not result in a cancer diagnosis. But it’s absolutely natural to experience scanxiety, so don’t hesitate to reach out if you need help in dealing with it.

Even if it’s only for moral support, ask a loved one (from your own household, during the pandemic) to drive or ride with you to the subsequent testing, or to sit in on the virtual doctor visits in which you’ll learn the results. Consider having them take notes, too, or even ask questions of their own if you think that might be helpful.

MD Anderson patients can also request a referral to one of our psychiatrists or social work counselors for help in managing their fears.

“Notice if your mind is jumping ahead or catastrophizing,” says psychiatrist Dr. Rachel Lynn. “If you feel your worries building, getting ‘too fast or too loud,’ try to take control back with some intentional breathing, slow and steady. You might also want to consider using one of the many relaxation apps available.”

5. Cancer caught through early detection is the most treatable.

If additional testing does lead to a cancer diagnosis, don’t despair. Screening exams are designed to give doctors the best possible chance of finding cancer early, when it’s the most treatable.

“The earlier we find cancer, the better the odds are of being able to cure it,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center. “That’s why we encourage people to start getting screened at the recommended ages, and then continue being screened regularly after that.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

This week, the American Cancer Society (ACS) released updated cervical cancer screening guidelines for individuals at average risk. They now recommend that cervical cancer screening begin at age 25, instead of 21, and place a greater emphasis on human papillomavirus (HPV) testing as the preferred primary screening strategy. 

“Cervical cancer is very rare in women under age 25, and most abnormalities resolve on their own at this age,” says Andrea Milbourne, M.D., professor of Gynecologic Oncology and Reproductive Medicine. “Pushing the screening age back to 25 would put the U.S. in line with the rest of the world and with our own science.”

The previous ACS guidelines recommended cervical cancer screening begin at age 21 with a Pap test every three years until age 29, then a Pap test every three years or co-testing with a Pap test and HPV test every five years from age 30 to 65. 

The new ACS guidelines recommend that individuals with a cervix at average risk for cervical cancer begin screening at age 25 with a primary HPV test alone every five years. This applies to most women. Milbourne notes that HPV testing alone detects more abnormalities than Pap alone, especially in young women. The guidelines include co-testing with a Pap test and HPV test every five years or a Pap test every three years as acceptable options.

“This is the first time that HPV testing alone has been a part of the primary recommendation for cervical cancer screening, and in fact, is the preferred screening,” says Therese Bevers, M.D., medical director of MD Anderson’s Cancer Prevention Center.

HPV causes almost all cervical cancer cases

HPV is the cause of almost all cervical cancers. The HPV vaccine prevents most cervical, anal, vaginal and vulvar cancers, and reduces the risk of most HPV-related cancers of the throat and penis.

The new guidelines, which were last updated in 2012, come as the number of young adults vaccinated for HPV continues to rise in the U.S. According to the most recent National Immunization Survey-Teen, more than half of adolescents ages 13 to 17 have received at least one dose of the HPV vaccine. Our experts agree it’s safe and important to have your children vaccinated for HPV during the COVID-19 pandemic.  

About 80% of men and women will get an HPV infection in their lifetime. Most people with HPV don’t know they’re infected and their bodies are able to clear the virus before it causes any health problems. But in some cases, the infection persists and leads to cancer. The goal of cervical cancer screening is to find cervical cancer at an early, or precancerous, stage, when the chances for successful treatment are the greatest.

Emphasis on HPV testing offers potential to reach even more women

Thanks to cervical cancer screening, cervical cancer rates have fallen by 70% in the U.S. since the 1950s, but the American Cancer Society estimates more than 13,000 new cases will be diagnosed in 2020.

“Cervical cancer is most common in underscreened and unscreened women,” Milbourne says. “Screening with a Pap test requires a visit to the doctor’s office, but making HPV testing the preferred screening method might open the door to self-screening, which might get more women screened.”

While at-home HPV testing is already promoted in other countries, including Australia, which has some of the lowest cervical cancer rates in the world, it hasn’t received Food and Drug Administration approval in the U.S. yet.

“The new ACS cervical cancer screening guidelines are the first step toward HPV testing alone being the only primary screening modality,” Bevers says. “It also carries the possibility of women eventually being able to do cervical cancer screening in the privacy of their own home and only going to the doctor for a Pap test if the HPV test is positive.”

Experts expect that convenient, at-home HPV testing could increase the number of women to receive cervical cancer screening and prevent even more cancer deaths. Studies to assess the possibility of at-home HPV testing in the U.S. are underway in early stages.

“Remember the old days of pregnancy tests? You had to go to a doctor to get one,” Bevers says. “Now you can do a pregnancy test at home and see the obstetrician only if the test is positive. These guidelines carry that possibility for cervical cancer screening in the future.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.