Cancer Screening in India: Which Tests You Need, and at What Age

What screening is, and what it is not

Screening means testing people who feel well to find cancer, or the changes that come before it, before any symptom appears. It is only worthwhile for a cancer when three things hold: a reliable test exists, people will accept it, and finding the disease early genuinely improves the outcome. That is a short list of cancers, which is why good screening advice is specific rather than "test everything".

Screening is also not a substitute for acting on a symptom. A woman with a breast lump needs an assessment now, not a screening mammogram next year. If you have noticed something that worries you, the right step is an examination, whatever your screening schedule says.

The screening schedule at a glance

These are the tests worth knowing about for adults at average risk. A strong family history, or a habit such as tobacco use, can bring them forward or make them more frequent, and that is the conversation to have with your doctor.

Cervical cancer: the most preventable cancer on the list

Almost all cervical cancer is caused by long-term infection with high-risk types of the human papillomavirus (HPV), and the cancer develops slowly, over years, through pre-cancerous changes that screening can find. Treating those changes is usually a short, simple procedure that stops a cancer from ever forming. That long, detectable run-up is what makes cervical cancer so preventable.

There are three screening tests. An HPV test looks for the virus itself and is the most sensitive, so it can be repeated less often. A Pap smear looks for abnormal cells. VIA, visual inspection with acetic acid, is a simple examination used widely in India's public programme. Any of them, done regularly, is far better than none.

HPV vaccination, recommended for girls aged 9 to 14, prevents infection with the virus types behind most cervical cancers, and HPV vaccines are available in India. Vaccinated women still need screening, because the vaccine does not cover every high-risk type.

Breast: awareness, examination and mammography

Breast awareness means knowing how your breasts normally look and feel, and reporting any change promptly: a lump, a change in shape, dimpling of the skin, a nipple turning inwards or a discharge. Many breast cancers are still first noticed by the woman herself.

A clinical breast examination by a doctor is part of India's national screening programme from age 30. Mammography, a low-dose X-ray of the breast, can find cancers too small to feel, and is usually advised every one to two years from the 40s. Younger women's breasts are often denser, which makes mammograms harder to read, so ultrasound is commonly added or used instead.

A strong family history changes the plan. A mother, sister or daughter with breast cancer, particularly before the age of 50, or relatives with both breast and ovarian cancer, is a reason to start screening earlier and to discuss genetic counselling.

Mouth cancer: a two-minute examination

Mouth cancer is among the most common cancers in Indian men, and among the easiest to screen for: a doctor looks at and feels the inside of the mouth, the tongue and the neck. It takes a couple of minutes and needs no equipment.

Anyone who uses tobacco in any form or chews areca nut should have this examination regularly, and can check their own mouth in a mirror once a month for white or red patches, ulcers that do not heal and lumps. Stopping tobacco and areca nut is the single most effective step against this cancer.

Bowel, prostate and lung

• •Bowel: A stool test for hidden blood (FIT) once a year, or a colonoscopy about every ten years, from around 45 to 50. Colonoscopy has the advantage that polyps, the growths most bowel cancers start from, can be removed during the same procedure. A family history of bowel cancer brings screening forward.
• •Prostate: The PSA blood test can find prostate cancer early, but it also finds slow-growing cancers that would never have caused harm, and treating those carries side effects of its own. Whether to test is a decision for each man to make with his doctor, usually from around 50, or earlier with a close relative diagnosed young.
• •Lung: For adults aged 50 to 80 with a long, heavy smoking history, a yearly low-dose CT scan reduces deaths from lung cancer. An ordinary chest X-ray is not an effective screening test for lung cancer.

Family history and inherited risk

Most cancers are not inherited, but a minority run in families because of a single gene, such as BRCA1 and BRCA2 for breast and ovarian cancer, or Lynch syndrome for bowel and uterine cancer. These patterns in a family are the ones to mention to your doctor, because they can mean earlier screening and genetic counselling:

• •Several close relatives on the same side of the family with the same or related cancers.
• •Cancer diagnosed at a young age, typically before 50.
• •A relative with more than one separate cancer, or cancer in both breasts.
• •Breast cancer in a male relative.

What a full-body cancer check-up gets wrong

Health-check packages often include a panel of tumour markers, such as CEA, CA-125, CA 19-9 and AFP, and sometimes a whole-body scan, sold as a cancer check-up. They are not recommended for screening people without symptoms, for two reasons.

First, they miss cancers: many early cancers do not raise these markers at all, so a normal result gives false reassurance. Second, they raise false alarms: harmless conditions push the markers up. CA-125 rises with periods, endometriosis and ovarian cysts, and CEA is higher in smokers, which leads to anxiety, repeat tests and sometimes unnecessary scans or procedures. Whole-body scans add radiation and routinely turn up harmless findings that then have to be chased.

The tests in the table above are the ones with evidence behind them. Chosen for your age, sex, habits and family history, they do far more than a panel of markers.

Planning your own screening

The simplest approach is to work out, once, which tests apply to you and when each is next due, and to review that list every year or two. Bring what you know about your family's history of cancer, including the type and the age at diagnosis, since that changes the plan more than anything else.

At SriJothi Cancer Care in Kodambakkam, Dr. S. Usha can examine the mouth and breasts, arrange cervical screening, mammography and other tests, and draw up a screening plan for you and, if you wish, for the rest of your family.