Cancer Screening

You are considered to have average risk for breast cancer if you:

• Do not have a personal history of breast cancer
• Do not have a strong family history of breast cancer
• Do not have a genetic mutation known to increase your risk of breast cancer like the BRCA gene
• Have not had radiation to the chest before you were 30 years old

You are considered to have high risk for breast cancer if you:

• If you or an immediate family member have had genetic testing that showed high risk for breast cancer
• Had radiation therapy to your chest between the ages of 10 and 30 years old
• If you or an immediately family member have certain syndromes that lead to an increased risk of breast cancer, such as Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome

Learn more about your risk here: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html

The American College of Radiology and the Society of Breast Imaging recommend the following for breast cancer screening:

• All women, especially Black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be are aware and can benefit from more screening.
• Women with genetics or family history that might mean they have an increased risk or with a calculated lifetime risk of 20% or more should have a screening mammogram every year starting at age 30.
• Women at high risk should have a breast MRI screening every year along with their screening mammogram.

Hear from Parkland’s Breast Imaging Medical Director about breast cancer screenings at Parkland: https://youtu.be/t-_0_FtWQYo?t=832

Learn more about screenings here: https://www.cancer.gov/types/breast/patient/breast-screening-pdq

While breast cancer is very rare in men, men who do get breast cancer are more likely to die from it. This is largely because there is less awareness that men can get breast cancer. Due to this, men are less likely to think that a lump is breast cancer. Most men who do find a lump will find it underneath their nipple and areola. If you find a lump, tell your healthcare provider.

For information on breast cancer in men:

• https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
• https://malebreastcancercoalition.org/Survivor%20Stories/ernie-green/

A mammogram is an x-ray of the breast. During a mammogram, one breast will be placed between two plastic plates while you stand in front of the x-ray machine. The x-ray machine will take pictures from your front and your side. This will be done on both breasts.

A screening mammogram is used to look for signs of breast cancer in women who don’t already have breast symptoms or problems. If there is concern that cancer might be present, then a diagnostic mammogram will be done.

If you have breast cancer or a family history of breast cancer, you may have an inherited BRCA gene change that means you have a higher risk of getting breast cancer. your health care provider may ask you to meet with a genetic counselor and have genetic testing. This testing can tell us if you have an inherited risk for breast cancer.

Hear from a genetic counselor about inherited risks of breast cancer from last year’s Coming Together for the Cure Breast Health Webinar Series: https://www.youtube.com/watch?v=t-_0_FtWQYo

For more information on genetic testing and counseling at Parkland, use the link below:
Genetic Screening and Counseling

Talk with your health care provider about your risk for breast cancer and the best screening plan for you. Breast cancer screening is available at the Parkland Comprehensive Breast Center as well as the Parkland Mobile Mammography Van.

Mobile Mammography

Parkland’s Mobile Mammography van aims to bring the needed screenings to you. Click here to learn more.

For community members without insurance, free screening mammograms are offered at weekend community outreach events. To qualify for a free screening mammogram at a Parkland outreach event, you must meet certain criteria.

Mammogram Van locations:

• From Monday through Friday, mobile mammography services are located at different Parkland COPC locations each day of the week.
• On weekends, the mobile mammography van is located at different locations in the Dallas County community.

For information on locations of the mobile mammogram events, go to our Calendar Events page updated monthly.

Contact 214-266-3333 to be scheduled for a screening mammogram.

Moody Center for Breast Health

The Moody Center for Breast Health delivers high level care with a team put together to better serve our community. Talk to your doctor or call 214-266-3333 about steps you can take for breast health including screening mammography.

For more information about the these services, click here to learn more.

Human papillomavirus (HPV) causes most cervical cancers. Most people get HPV in their lives, and it usually goes away on its own. If it doesn’t, it can lead to cervical cancer. There are a lot of risk factors for cervical cancer including:

• Depending on your sexual history, you may have an increased chance of exposure to HPV
  • Becoming sexually active younger than 18 years old
  • Having a partner who is high risk
  • Having lots of sexual partners
• Women who are smokers are more likely than those who don’t to get cervical cancer
• Having a weakened immune system from HIV infection or while taking drugs to suppress your immune system response
• Having other sexually transmitted diseases, such as chlamydia
• Not having regular Pap tests and HPV tests done

• Cervical cancer screening should start at age 21 with a Pap test every 3 years.
• At age 30, you can continue a Pap test every 3 years or switch to HPV-based testing every 3 to 5 years. HPV is a common virus that can cause cervical cancer. Your health care provider should discuss these options with you.
• At age 65, some women can stop getting a cervical cancer screening if they had normal results from their cervical cancer screenings in the past 10 years. Those who want to continue screening, have a weakened immune systems, or had cervix cancer or precancer in the past 25 years should continue screening.

A pep smear, also called a Pap test, is used to screen women for cervical cancer. A pap smear involves collecting cells from your cervix- the lower, narrow end of your uterus that’s at the top of your vagina. A pap smear can detect abnormal cervical cells early, which is the first step in catching cervical cancer early. Pap smears can also prevent cervical cancer by catching any changes early.

An HPV test looks for DNA from HPV in cells from your cervix. The test is done because HPV can lead to cervical cancer.

You can be screened for cervical cancer at any of the Parkland Outpatient COPC locations. To find the nearest COPC location for an appointment, click this link: https://www.parklandhealth.org/locations?taxonomy=Community-Oriented-Primary-Care-Clinics You can also ask about a cervical cancer screening at women’s health clinics and family planning programs located at these COPCs.

For more information, talk your healthcare provider about what screening is right for you.

• Information about cervical cancer screening: https://www.nccc-online.org/hpvcervical-cancer/cervical-cancer-screening/
• Information about cervical cancer: https://www.foundationforwomenscancer.org/gynecologic-cancers/cancer-types/cervical/
• Information about cervical cancer screening: https://cerving.bwhi.org/

Most people should begin screening for colorectal cancer at 45 years old. Make sure to talk to your healthcare provider about getting a colorectal cancer screening if any of the following describe you:

• You are 45 years old or older; the risk of colorectal cancer goes up as you age.
• You or a close family member have had colorectal polyps or colorectal cancer
• You have inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis. IBD is different from irritable bowel syndrome (IBS), which has not been linked to increase risk for colorectal cancer.
• Have an inherited syndrome - a small number of people have inherited gene changes that can lead to them getting colorectal cancer. For example, if you have a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome).

Learn more about colorectal cancer risk factors here: https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html

Screening for colon cancer is recommended for men and women starting at age 45. When repeated every year, colorectal cancer screening tests save lives from colon cancer. Talk to your healthcare provider for more information.

A Fecal Immunochemical Test, often called a FIT Test, is a colon cancer screening test you do at home that looks for tiny amounts of blood in your poop or stool. Invisible blood in your stool may be a sign of cancer, precancer polyps, or other problems. This test is very easy to do because you do it at home. No bowel preparation or doctor’s visit is needed. You mail the FIT kit back to Parkland after completing it or return it to the clinic. You will find out the results of your test from your doctor or clinic that gave you the FIT kit. If your test is normal, then you would need to repeat it every year. If your test results are not normal, then you will need to get a follow-up colonoscopy to look into your intestine. This is to see where the blood may be coming from and make sure it is not due to cancer or polyps.

For more information about the colorectal cancer test kits available at Parkland, click here. You can watch a video about this test at: www.tinyurl.com/huevc3c

A colonoscopy looks directly into your colon (large intestine) and rectum to see if there is cancer or growths that can turn into cancer (polyps). It uses a colonoscope which is a narrow, flexible tube with a light and small video camera on the end used to look for cancer or polyps. Not all polyps turn into cancer, but all colorectal cancers start as polyps. Your doctor can remove polyps during a colonoscopy to help prevent colorectal cancer.

A colonoscopy requires that you do full bowel prep to clean out your intestine. The colonoscopy takes a few hours and is done in the hospital or outpatient procedure center with sedation. You might be scheduled for a colonoscopy if your FIT test results are not normal.

You can request a FIT test from your primary care provider or a Parkland community clinic (COPC) if you are not up-to-date on your colorectal cancer screening. The colorectal cancer FIT test kits available at Parkland are offered at no cost for most patients with insurance or the Parkland Financial Assistance program

For more information:

• Information from the American College of Gastroenterology about colorectal cancer screenings: https://gi.org/topics/colorectal-cancer/#tabs2
• Information from the CDC about colorectal cancer and colorectal cancer screenings: https://www.cdc.gov/cancer/colorectal/
• Information from the American Cancer Society about colorectal cancer risk, screening, and treatment: https://www.cancer.org/cancer/colon-rectal-cancer.html

The main risk factors for HCC include scarring of the liver (Cirrhosis) due to disease, such as hepatitis C infection, hepatitis B infection, fatty liver disease, alcohol abuse, or a combination of these diseases.

• Cirrhosis
  • Cirrhosis is a type of long-term liver disease where your liver cells are replaced by scar tissue. It can be caused by hepatitis B infection, hepatitis C infection, heavy alcohol use on a regular basis, non-alcoholic fatty liver disease (NAFLD), inherited metabolic disease, and other things.
• Hepatitis B
  • Hepatitis B (hep B) virus is spread by contact with blood or other bodily fluids. You can lower your risk by getting vaccinated against hep B. You should get tested for hep B and get medical care if you have hepatitis.
• Hepatitis C
  • Hepatitis C (hep C) is a virus spread by contact with blood or other bodily fluids. Chronic (long-term) hep C infection can lead to cirrhosis, end-stage liver disease, and liver cancer. Millions of Americans are infected with hep C but many don’t know it. A one-time hep C screening test is recommended for adults born between 1945 and 1965 as well as for people at high risk, including people who have used or currently use injection drugs or had a blood transfusion before 1992.
• Non-alcoholic fatty liver disease (NAFLD)
  • NAFLD is now the most common liver disease in the US and one of the most common causes of HCC. NAFLD is a build-up of extra fat in liver cells, which can damage the liver and cause it to swell. This disease tends to develop in people who are overweight, obese, diabetic, or have high cholesterol or high triglycerides. However, some people develop NAFLD even if they do not have those things. Patients with NAFLD should be checked for cirrhosis, given increased risk of HCC at that stage.

At early stages, most people with HCC do not have symptoms. Without screening, most cancers are found at a late stage when the patient has symptoms and treatment options are limited. This is why it is important for at-risk patients to be screened for HCC. There is currently no recommended routine liver cancer screening test for people at average risk for liver cancer.

If you have cirrhosis or chronic hepatitis B you are at higher risk for liver cancer and your healthcare provider should have you do liver cancer screening tests.

Liver cancer screening tests are done every 6 months. This includes an ultrasound of your liver and a blood test to check for alpha-fetoprotein (AFP). A high AFP might be a sign of liver cancer. This blood test can help find cancers that may be missed you just had a screening ultrasound. You may have follow-up tests if you do have a high AFP or an ultrasound that finds a nodule.

To be screened for liver cancer at Parkland, talk to your primary care provider to find out if it is right for you. If you are already being seen in the GI liver clinic, your provider there may also refer you for liver cancer screenings tests.

• https://www.cdc.gov/cancer/liver/index.htm
• https://www.cancer.gov/types/liver
• Liver Tumor Cancer Clinic

Things that increase your risk for lung cancer include:

• Smoking - Smoking is the biggest risk factor for lung cancer. The more you smoke and the longer you have smoked, the higher your risk.
• Secondhand Smoke - If others smoke around you, you have a higher risk for lung cancer. This includes smoke from other people’s cigarettes, pipes, or cigars.
• Radon -If you live or work in a building with a high radon concentration, you have a higher risk of developing lung cancer. Radon is a gas that cannot be seen or smelled. The gas comes from rocks and dirt and it can get trapped indoors. The Texas Department of Health Services encourages everyone to test their home for radon.
• Asbestos exposure - If you work in a mine, mill, plant, or other places where asbestos is used, you are at a much higher risk for developing lung cancer. Asbestos has been used in building materials and other things.
• Family history - If you or your immediate family have had lung cancer, you have a higher risk for lung cancer.
• Radiation Therapy – cancer survivors who had radiation therapy to the chest are at a higher risk for lung cancer
• Chemical substance exposure – exposure to chemicals at work like asbestos, arsenic, diesel exhaust, and some forms of silica and chromium can increase your risk for lung cancer

You should talk to your provider about getting a yearly lung cancer screening If you are:

• 50-80* years old,
• Have a 20* pack-year smoking history, and
• Currently smoke or have quit in the last 15 years

*Note in 2021, the U.S. Preventive Services Task Force changed the recommended age to start screening for lung cancer from 55 to 50 years old and changed packed years from 30 pack year to 20 pack year.

A low-dose CT is a way to take pictures of your lungs to look for lung cancer. A CT scanner uses x-rays to take multiple pictures as you lie on a table that slides in and out of a machine. A computer then puts those pictures together to create a detailed picture of your lungs. A low-dose CT is a non-invasive test which does not involve needles and lasts about 30 seconds.

Talk to your healthcare provider at your next appointment to find out if a yearly lung cancer screening is right for you. If you do not have a healthcare provider at Parkland, click here to find one.

The American Lung Association made the attached pdfs to help you talk to your provider about lung cancer screening.

[Insert English pdf LdCT Doctor Conversation Guide]

[Insert Spanish pdf LdCT Doctor Conversation Guide]

If your healthcare provider already placed an order for a low-dose CT without contrast for lung cancer screening, you need to call Radiology to schedule your appointment at 214-590-0062. The lung screening appointment will be at the Ron J. Anderson (RJA) building on the 2nd floor. Click here for directions to RJA.

The Parkland Lung Cancer Screening Patient Navigation Program was started in July 2021 to provide support to Parkland patients who have been referred for a lung cancer screening. Our patient navigators are available from 8 am- 4pm Monday through Friday to:

• Talk to you about your lung cancer screening appointment
• Connect you to support services if you have anything that would make it hard to go to your appointment
• Help you schedule or reschedule your lung cancer screening appointments
• Information on programs to help you stop or cutback on smoking

• https://www.screenyourlungs.org/
• https://www.cdc.gov/cancer/lung/basic_info/screening.htm
• https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/saved-by-the-scan
• https://effectivehealthcare.ahrq.gov/decision-aids/lung-cancer-screening/patient.html

According to the American Cancer Society, the main risk factors for developing prostate cancer include:

• Increasing age - It is rare for men younger than 40 to get prostate cancer. After the age of 50, your risk is much higher.
• Race/ethnicity - African American men and Caribbean men of African ancestry are more likely to get prostate cancer. They also tend to get prostate cancer at a younger age.
• Family history - If you have a family history of prostate cancer, you are more likely to get prostate cancer too. Having a father or brother with prostate cancer increases your risk for prostate cancer. However, men without a family history of prostate cancer can still get it, so it is still important to be screened.

If you are 55 to 69 years old you should talk to your doctor about the benefits and harms of being screened for prostate cancer.

A Prostate Specific Antigen (PSA) test is a blood test to measure the level of PSA in your blood. A high level of PSA in your blood could mean you have prostate cancer. The PSA level can also be high because of other reasons, like due to some medicines, an enlarged prostate, a prostate infection, and certain medical procedures. A rapid rise in PSA may be a sign that something is wrong. If your PSA test is abnormal, your healthcare provider may schedule a biopsy to find out if you have prostate cancer.

A digital rectal exam is when a healthcare provider feels the shape and thickness of the prostate.

If you are interested in being screened for prostate cancer, talk to your healthcare provider. You can find a Parkland primary care provider near you by visiting www.parklandhealth.org/phhs/locations.

• Information from the American Cancer Society about prostate cancer screening: https://www.cancer.gov/types/prostate/patient/prostate-screening-pdq
• Information from the CDC about prostate cancer risk, screening, and treatment: https://www.cdc.gov/cancer/prostate/basic_info/risk_factors.htm
• Information from the ZERO – The End of Prostate Cancer website: https://zerocancer.org/

According to the American Society of Clinical Oncology (ASCO), you may have an increased risk of developing non-melanoma skin cancer if:

• You live at high altitudes or in areas with bright sunlight year-round
• You spend a lot of time outside from 10 am to 2 pm
• You have a weakened immune system
• You have had an organ transplant
• You use indoor tanning beds, tanning salons, or sun lamps
• You have a precancerous skin condition
• You are over the age of 50; however, younger people can also develop non-melanoma skin cancer
• You have a history of sunburns or fragile skin
• You have had skin cancer before
• You have had arsenic exposure
• You are taking medicines that make your skin very sensitive to sunburns
• You have had previous treatment with radiation therapy
• You have a cancer syndrome like Cowden syndrome or Gorlin syndrome

Click on this link for more information on how to reduce your skin cancer risk:

If you spot a change in your skin that has an unusual color, size, shape or texture, you should tell your healthcare provider. Skin Cancer screening methods used by Parkland healthcare providers include physical exams that may use a high-powered magnifying glass to look at your skin close-up and full-body baseline photos to help look for changes to your skin over time. The American Academy of Dermatology recommends everyone know the ABCDEs of melanoma to help you spot melanoma early:

• A is for Asymmetry: One half of a mole does not match the other half.
• B is for Border irregularity: The edges are ragged, notched, or blurred.
• C is for Color that varies from one area to another.
• D is for Diameter: While melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller.
• E is for Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape, or color.

If you have a mole that has gotten bigger or changed color or have any skin changes that worry you, report it to your health care provider. Other signs of early skin cancer can be a sore that does not fully heal. If you do not have a primary health care provider, click on this link to find a provider near you: https://www.parklandhealth.org/locations

• Information on skin cancer from the National Cancer Institute: https://www.cancer.gov/types/skin/patient/skin-screening-pdq
• Information on skin cancer from the CDC: https://www.cdc.gov/cancer/skin/basic_info/index.htm
• Information on skin cancer from UT Southwestern Medical Center: https://utswmed.org/conditions-treatments/skin-cancer/skin-cancer-diagnosis/