Screenings

Screening guidelines for women at average risk (no symptoms, no history of prior breast cancer, no family history of breast cancer in a first-degree relative and no history of prior chest radiation) include an annual clinical breast exam beginning at age 25. Imaging screening includes an annual mammogram at age 40. This may be supplemented with a screening breast ultrasound, particularly if the breasts are dense. Patients are informed if their breasts are dense (per New York state legislation guidelines,) so that they can discuss with their physician if supplemental imaging screening is indicated.

High-risk women include those with a family history of first-degree relative with breast cancer, history of atypical hyperplasia or lobular carcinoma in situ (benign conditions associated with increased breast cancer risk), or history of chest wall radiation. Screening in this high-risk group includes annual mammography starting 10 years before the youngest family member was diagnosed and may also include annual breast ultrasound and MRI. Often the mammogram and ultrasound are done together, and the MRI is done 6 months later so that high-risk patients are followed with close imaging surveillance. These tests are usually followed by clinical breast exam every 6 months. Recommendations for optimal surveillance will be made by your clinical team as well as the dedicated breast radiologists.

These advanced radiology services are offered at three locations (White Plains Center for Advanced Medicine & Surgery, Armonk, and New Rochelle), with early morning and evening appointments for ease of scheduling. To help alleviate any anxiety associated with testing, patients are given the option to wait for the results of screening tests the same day. Imaging is done by our kind and compassionate staff, and interventional procedures are explained in detail in advance. Abnormal results are communicated both to the patient and the referring physician in a timely fashion to ensure continuity of care and appropriate follow-up.

Routine breast screening and mammograms are very important. The rationale for yearly breast imaging (i.e. a mammogram) is to detect a breast cancer as early as possible (prior to becoming palpable).

The radiologist reading the mammogram may request that you have additional mammogram views taken, an ultrasound or an MRI. Sometimes additional information is necessary to fully evaluate your breasts. The state of New York recently passed legislature requiring radiologists to inform women if they have dense breasts on a mammogram. A supplementary breast ultrasound may then be recommended.

At the bottom of each mammogram report will be a breast imaging reporting and data system (BIRADS) score. The BIRADS score tells you the recommendation for either a biopsy, short-term follow up or to return for breast imaging in one year.

Learn more about our women’s imaging services.

While many women with breast cancer have a family history, only 5% to 10% of breast cancer cases are due to hereditary gene mutations. Genetic testing may be recommended if several members of your family in different generations have had breast or other forms of cancer. Other reasons to pursue genetic testing are if your cancer was diagnosed at a young age (under 50), you had breast cancer in both breasts or your breast cancer is triple negative (meaning it is negative for estrogen, progesterone and Her2 receptors.)

At White Plains Hospital, our trained genetic counselors will take a complete personal and family history to help determine if genetic testing is indicated, and if so, which test to send. The test itself is usually a blood test, and the results come back in 2 weeks. Our counselors will help you to interpret results and give you detailed information on screening guidelines if you do turn out to have a genetic mutation. This information is also communicated to your primary physician. It is important to remember that genetic testing cannot definitively say whether you will actually develop breast cancer, but rather it is a tool to help guide risk assessment so that your treatment team can follow you appropriately.

Learn more about our genetic screening below.

Colorectal cancer is the third most common cancer in the US, but also one of the most preventable. Colorectal cancers are slow-growing and almost always start as a small growth in the colon—otherwise known as a polyp. Early detection through routine screening has been shown to significantly improve survival rates if a polyp or cancer is found.

White Plains Hospital has pledged to help increase colorectal cancer screening rates in Westchester County by supporting the 80% by 2018 initiative, led by the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC) and the National Colorectal Cancer Roundtable (an organization co-founded by ACS and CDC). The initiative strives to ensure that 80% of individuals ages 50 and over receive the recommended screenings for colorectal cancer by 2018. Screenings are now offered using non-invasive techniques, such as a High-Sensitivity Fecal Occult Blood Test (FOBT), a Fecal Immunochemical Test (FIT) or Cologuard—all of which can be done within the comfort of your own home.

Not all colorectal screenings are the same. Visual screenings include the colonoscopy; flexible sigmoidoscopy, which looks only at the first part of the colon; barium enema; and virtual colonoscopy, which is a CT-based test. Colonoscopy is the most effective screening tool, providing a direct visual of the colonic lining and rarely missing lesions. Colonoscopy is also the only method that allows doctors to both discover small polyps and remove them in one procedure.

Stool-based screenings, including guaiac testing—which checks for blood in the stool—fecal immunohistochemical testing (FIT), multitarget stool DNA tests and cologuard use non-invasive techniques and can be done in the comfort of your own home.

Research has shown that there are several risk factors that may increase an individual’s chances of developing colorectal polyps or colorectal cancer, but it’s important to understand that just because you have one or even several risk factors for a specific type of cancer, it doesn’t necessarily mean that you will develop the disease.

Age

The chances of developing colon cancer increases significantly after the age of 50, and 90% of individuals diagnosed with colon cancer are over the age of 50.

Personal history of colorectal polyps or colorectal cancer

If the polyps were noncancerous or large, you are at a greater risk of developing colon cancer. If you have been successfully treated for colon cancer, you are still at risk to develop a new cancer in other areas of the colon and rectum.

Personal history of inflammatory bowel disease

Crohn’s disease and ulcerative colitis are associated with an increased chance of colorectal cancer, because long-term chronic inflammation occurs with these diseases, leading to abnormalities in the cells of the intestinal lining, which can become cancerous over time. Individuals who have been diagnosed with irritable bowel syndrome, however, are not at increased risk for colon cancer.

Family history of colorectal cancer or colorectal polyps

As many as 1 in 5 people who develop colorectal cancer have other family members who have been affected by this disease, and the risk is doubled in those who have a sibling or parent who has been affected. It is unclear whether the cause is genetic, due to shared environmental exposures or a combination of both. You should talk to your doctor about whether or not early screening is right for you.

Inherited syndromes

Inherited syndromes account for 5% to 10% of all colorectal cancers and, in many cases, have been linked to specific gene defects that cause the disease. Sometimes these genetically related syndromes are also associated with other types of cancers, so knowing of any history of cancer in more distant relatives is also important. Your doctor will help you decide when early screening and even genetic testing is appropriate. The two most common types of inherited syndromes linked to colorectal cancers are familial adenomatous polyposis (FAP) and Lynch syndrome, or hereditary non-polyposis colon cancer (HNPCC). They account for 1% and 3% to 5% of colon cancers respectively. Lynch syndrome is particularly important in women because of its strong association with endometrial cancer as well as with cancers of the ovary, stomach, small bowel, pancreas, kidney, brain, ureters (tubes that carry urine from the kidneys to the bladder) and bile duct.

Other rare, inherited syndromes that are associated with an increased risk of colon cancer are Peutz-Jaeger Syndrome, Turcot’s Syndrome and MUTYH-associated polyposis.

Racial and ethnic background

African Americans have the highest incidence of colorectal cancer of all racial groups in the United States. They also have the highest mortality rates, but the reason has not yet been found. About 6% of Jews of Eastern European descent (Ashkenazi Jews) carry a genetic mutation called I-1307K APC, which also is associated an increased risk of colorectal cancer. It is the second most common cancer among Asian/Pacific Islanders and Hispanic women, and it is the third most common cancer among white, Black and Native American women.

Diet: Having a diet that is rich in fruits, vegetables and whole grains has been linked to a decreased risk of colorectal cancer. It’s also known that avoiding red or processed meats, like lamb, liver, beef, hot dogs and luncheon meats high in nitrates or nitrites, reduces your risk of colorectal cancer.

Physical activity: Maintaining a healthy level of physical activity has been shown to decrease the risk of developing colorectal cancer.

Obesity: Being overweight not only increases the risk of developing colorectal cancer in both men and women, but also increases the likelihood of a poor outcome. The link is stronger in men than it is in women.

Smoking and tobacco use: Smoking and tobacco use increases the likelihood that an individual will develop colorectal cancer, as well as many other types of cancers. Research suggests that the risk comes from exposure to the swallowed carcinogenic chemicals generated from the tobacco. Smoking also increases the likelihood of dying of the disease.

Heavy alcohol use: The heavy use of alcohol has been linked to an increased risk of colorectal cancer in both men and women. Research has suggested a relationship to low folic acid levels that result from heavy alcohol use. The American Cancer Society recommends no more than 2 drinks per day for men and 1 drink per day for women to avoid increasing the risk of developing colon cancer.

Head and neck cancers, if diagnosed early, are often very promising in prognosis. Men are almost twice as likely as women to develop these cancers, and people over the age 50 are also at greater risk than younger people. Most head and neck cancers are due to alcohol and tobacco use. However, the incidence of cancers of the throat, larynx, nose, sinuses and mouth caused by human papilloma virus (HPV) are rising in younger people, while incidence of these cancers caused by tobacco and excessive alcohol is on the decline.

Other risk factors may include:

• A history of excess sun exposure, sun burning or sun poisoning
• A history of mononucleosis/mono
• Poor dental or oral care
• Exposure to noxious fumes (i.e. asbestos, wood, paint fumes)
• Use of marijuana
• Poor nutrition
• Reflux disease
• Weakened immune system

People at risk are encouraged to seek screening for head and neck cancers from a trained medical professional. Screenings are quick, painless and designed to advance early diagnosis, which can lead to better outcomes. During a screening, a doctor looks in the nose, mouth and throat for abnormalities and feels for lumps in the neck.

White Plains Hospital Center for Cancer Care offers head and neck screening events several times throughout the year. Additionally, highly skilled medical specialists who treat diseases of the ear, nose and throat are available to conduct screenings by appointment.

Lung cancer screening allows individuals to be checked for early signs of lung cancer before the development of any symptoms. Identifying early, potentially curable lung cancer is of great benefit.

Several studies have shown the benefits of CT scans of the chest as a screening procedure to identify early-stage lung cancer. At White Plains Hospital, the Department of Thoracic Surgery provides a comprehensive screening program that includes low-dose CT scans.

The U.S. Preventive Services Task Force (USPSTF) recommends yearly lung cancer screening for people who:

• Have a 20 pack-year or more smoking history
• Smoke now or have quit within the past 15 years
• Are between 50 and 80 years old

A pack-year is smoking an average of one pack of cigarettes per day for one year.

To learn more about the lung cancer screen program, call 914.849.7655.

People at risk are encouraged to seek screening for lung cancers from a trained medical professional. The most significant cause of lung cancer is cigarette smoking and tobacco use. Tobacco smoke has been shown to contain over 4,000 chemical compounds that are cancer-causing.

The risk of lung cancer in individuals who smoke begins to increase once that individual has smoked for 10 pack years. A pack year refers to smoking one pack of cigarettes per day for one year. Therefore, someone who smokes two packs a day will reach 10 pack years in five years and someone who smokes one half pack per day needs 20 years to reach 10 pack years. While the risk of lung cancer increases at 10 pack years, it significantly increases at 30 pack years.

It has been estimated that the risk of lung cancer in a cigarette smoker is 25 times higher than a non-smoker and five times higher in pipe and cigar smokers.

How is a lung cancer screening CT scan performed?

• A low-dose CT scan of the chest requires that an individual lie on a table that slides into a doughnut-shaped CT scanner that takes multiple x-ray pictures of your chest.
• The procedure is completely painless and only requires several minutes.
• The average radiation dose received from a low-dose CT scan is 1.5 mSv (by comparison, high mileage airplane flyers receive 6 to 8 mSv, and individuals living at high altitude, such as Denver, Colorado, received 6 mSv.

How long does a lung cancer screening CT scan take?

• Advances in CT scanning now allow individuals to undergo a painless, noninvasive scan that takes about 20 seconds once you have registered, changed clothing and are on the scanning table.
• The entire process of registering and filling out our simple questionnaire can be completed in less than half an hour.

Pancreatic cancer is the fourth leading cause of cancer-related death in the U.S. in both men and women. It typically presents at an advanced, incurable stage. Identifying and testing individuals with an elevated risk for developing pancreatic cancer may lead to improved outcomes.

Currently there are no standardized recommendations for screening individuals who have an elevated risk for pancreatic cancer. White Plains Hospital offers a clinical trial that follows the outcomes of elevated risk individuals who undergo early detection testing, using the most modern and up-to-date testing methods, and employing the most advanced options for elevated risk.

Do you...

• Have an immediate family member under the age of 50, or multiple family members, who have had pancreatic cancer?
• Carry a BRCA2 gene mutation?
• Carry a p16 gene mutation for Familial Atypical Multiple Mole Melanoma?
• Carry a BRCA1 gene mutation AND have family members with pancreatic cancer?
• Carry a gene mutation for other cancers (including colon cancer) AND have family members with pancreatic cancer?
• Have Peutz-Jeghers Syndrome?
• Have Chronic Pancreatitis Syndrome?
• Have other risk factors for the development of pancreatic cancer?

If you answered YES to ANY of these questions, then you may be eligible to undergo testing to screen for pancreatic cancer and enroll into this clinical trial.

To learn more about pancreatic screening, call 914.849.7667

Enrolled individuals will be offered testing with endoscopic ultrasound (EUS) of the pancreas, subsequently alternating with an MRI (Magnetic Resonance Imaging) of the pancreas and will then be followed with testing and monitoring every 6 to 12 months for up to five years.

Testing may be covered by most major insurances for individuals who have an elevated risk for the development of pancreatic cancer. Efforts are made to secure necessary authorizations from insurance carriers.

A complete family history is an important part of anyone’s medical history. Genetic counseling with DNA testing may be recommended as part of the eligibility process.