The great screening debate

Prof Carol-Ann Benn discusses the screening debate so you can determine which side of the fence you are on…Do you screen yourself for diseases or not?

There are compelling arguments for both sides. I screen, from top to bottom literally, and it is not fun, nor is it easy. It can be extremely stressful, and I mentally go through all the “what ifs” every time I get myself checked.

What is screening? 

Screening is the process of checking; Yes, medical tests with any direct reason (you think your stomach is hurting – doctor time vs. let’s go make sure everything is running as it should be). Screening helps that problems can be detected early.

The definition of what to screen for and when, relies on the screening test to be effective in finding the health concern, as well as being accurate and cheap, with the added small print saying that finding the disease early must be able to alter the outcome and improve the survival.

It is pointless picking up little “nasties” and not being able to do anything about them. Just knowing they are there, little terrorist bombs that we could not do anything about, would be awful, like a slow count down with the bomb, not sure if the correct wire can be clipped in time.

What else can we screen for?

Young girls and any women who are sexually active should have a pap smear, this is to check out the cells of the cervix for abnormalities. Remember if your pap smear is normal and you are under the age of 44, going for a vaccination against HPV (human papilloma virus) will significantly decrease you chance of developing the virus and that of developing cervical cancer.

Seeing a gynecologist once a year is a useful screening tool (I am not sure what is worse, the gyne or the dentist, but both useful screening).

In older women or those with a history of ovarian cancer, a transvaginal ultrasound, as well as a CA -125 (blood test) add to the security blanket of decreasing the risk of detecting ovarian cancer early.

First step

The first step is to understand that screening is not skipping along the Disney sidewalk, but rather a walk along the yellow brick road, with all the heartless lions and tin-men along the way. The premise of screening is going on the trip of looking, to find out if there is something wrong. One needs to be brave to screen, the head-in-the-sand mentality is so much easier, however, doesn’t stop the lion biting your ass left in the open. I say “fire in the hole” head down and Que Sera, Sera (what will be will be) …

I often give the analogy to the ladies I see, who seem so surprised by the fact that they go for their mammograms regularly and they can’t believe that something concerning has been found. Screening is like wearing your seatbelt whilst driving. Your seatbelt does not prevent an accident, but rather protects you if you are in an accident.

Therefore, if you are a seatbelt wearing anxious neurotic, like me, what should and can you screen for and when should you?

We can go:

Top to bottom (head to toe)

Outside to inside


Before deciding to be a screening convert, get an idea from your family (if you can) as to what diseases were or are prevalent on either your father or mother’s side.

What to ask: 

Ask about cancers, and with particular care to the age of the person when they were diagnosed with cancer. It is less relevant that “Gogo” died of cancer at 95, and more relevant if two cousins had breast cancer under the age of 40.

Family history is not just about your cancer history; it is about heart disease, diabetes, tendency to clots – deep vein thrombosis or pulmonary embolus.

The skin

We should check our skin. Some people should check more vigilantly than others. Fair of face, gorgeous redheads, ginger complexion, and family history of melanoma. Find a friendly dermatologist for a skin assessment and if necessary a mole mapping. They can tell you how often you need screening specifically for your needs. Do not rush into the slice and dice of 1000 knives of little moles been cut out of your body! Just in case, make sure a proper assessment is done before your little unknown blemishes are burnt, because unless a small critter is properly cremated, the seed remains and should it be a weed (a melanoma), you could be in trouble.

The breasts

Picking up cancers early makes sense or does it? The simplest form of breast screening actually applies to your whole body – know your breasts, know your body!

Examine your breasts by doing the following: 

Stand in front of the mirror, not an easy sight (I know). Feel you breasts; let someone else check them too (50% of lumps are picked up by a significant other). 

Don’t squeeze your nipples, they are glorified plugs. Don’t lift your arm above your head when checking your armpit (axilla) for glands.

Remember most lumps are not cancer!

Mammogram screening can start at any age from above 35. Some medical aids pay for it annually, some from 40, some from 50, and some only every two or three years, while some not at all. This is because screening is about health economics. Screening is not offered to all women in South Africa, as this is not financially viable. In fact, crunching the numbers in the worlds current economic climate means that the analysis of the data is such that most countries are reassessing screening guidelines.

A screening mammogram is a single view of the breast tissue; this is not what usually happens when you go for a mammogram paid for by your medical aid, or what happens when you go to a good government breast unit because you have a concern… Going for a mammogram in South Africa means that you have a mammogram with two views and usually an ultrasound. The mammogram picks up changes in density, and small calcifications (graveyards of cells), while the ultrasound picks up masses (solids or cysts) and lymph nodes.

Should a concerning area be found on the screening mammogram, your doctor will suggest that you have a fine needle biopsy (core), not a surgical biopsy.

The rule about GIT (gastrointestinal) cancers is a gastroscopy from 40 (10- yearly if all fine from there) and a colonoscopy from 50.

I do think that men need to screen more routinely for prostate cancer! What is the problem with a small finger, ultrasound probe or blood test? Surely you guys are manly enough to cope with that annually from the age of 40 or 45.

I have not even crossed the great divide of non-cancer screening.

It’s very important and a no-brainer to regularly check your blood pressure and fasting cholesterol. Your fasting insulin (yes) and glucose, plus your vitamin D level. Understanding the strain your body, or working engine, takes every day is critical!

If your fasting glucose is normal but your fasting insulin is 30 – well hello Houstin – your body is revving in the red…

The nice thing is that all these problems are fixable, unlike the cancer screening.

Moral of the story, wear your seatbelt (screen), drive your car (exercise) and see the sights (enjoy life), plus put the best fuel in (eat well), and enjoy the journey! 


Prof Carol-Ann Benn heads up breast cancer centres at Helen Joseph Hospital and Netcare Milpark Hospital. She lectures at Wits University and, in 2002, established the Breast Health Foundation.

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