Of the 40 percent of Americans who will be diagnosed with cancer in their lifetime, no two will have the same experience with their disease. Although many factors impact both the course and outcomes of a cancer diagnosis, one of the most important is the stage of the cancer when diagnosed. Cancer staging describes the progression of disease based on several factors, like the size of a tumor and whether it is spreading.

For many types of cancer, early detection is key; by finding cancers before they progress to a more advanced and aggressive disease, we give ourselves the best chances of successful treatment. Breast cancer, for instance, has a 99 percent five-year survival rate (proportion of people who survive five years following diagnosis) in the US when diagnosed at the local stage (malignant cancer confined to the organ of origin), compared to just a 31 percent rate for those diagnosed at the distant stage (malignant cancer that has spread from the primary tumor to remote parts of the body) (Figure 1). Additionally, for colorectal and cervical cancer, screening can prevent many tumors from even developing. According to a 2020 study in the journal Medical Clinics of North America on cervical cancer screening, detection of precancerous lesions has been shown to prevent 50-80 percent of cases in areas with high screening participation.

A bar graph with the X axis main title reading Cancer Site and the subtitles on the graph reading: Cervical, Coloorectal, Female Breast, Lung, and Prostate. The Y axis main title reads %-Year Survival Rate (%) with numbers ranging from 0 to 100. There are three bars in each section each one representing a different Stage at Diagnosis: Local is Blue, Regional is green, and Distant is purple. Prostate has the highest bars in local regional, and distant, and lung has the lowest of the three.

Figure 1. Five Year Relative Survival Rates (%) by Stage of Diagnosis, US, 2013-2019. Rates are adjusted for normal life expectancy and are based on SEER 22 areas from 2013-2019. Source: American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society; 2024.

For common cancers where early detection significantly improves outcomes and treatment effectiveness, screening is recommended for at-risk populations. Cancer screening is the process of looking for cancer in people before any symptoms of the disease arise. Screening can, therefore, improve the chances of diagnosing and beginning cancer treatment earlier than it would have otherwise, in some cases drastically improving outcomes. Suggested cancer screenings to consider depend on a few variables:

  1. Sex: hormonal, physiological, and genetic differences play a role in determining cancer risk.
  2. Age: in general, cancer risk increases with age. Physiological changes at different stages of life impact which cancers may develop.
  3. Family History: cancer is a genetic disease, and a family history of one or many cancers may suggest an increased risk and need for screening.
  4. Other risk factors: lifestyle factors such as smoking, excessive alcohol consumption, sedentary behavior and unhealthy diets, as well as environmental exposures like asbestos and lead, impact cancer risk.

Many cancers are not included in general screening recommendations. The type of cancer may be rare, early detection may not improve outcomes, or the chances that a tumor develops into symptomatic disease is low. However, it is important to remember that screening recommendations vary widely, and each person may have different cancer screening needs than the general public.

While general recommendations are useful to gauge which cancer screenings to consider, consult a doctor to understand the most appropriate screening schedule. Each person has a unique risk of cancer based on genetics, lifestyle, living environment, and other interacting factors. This is why one person may want colorectal cancer screening before the U.S. Preventive Services Task Force (USPST) recommendation at 44, given a family history indicating an increased risk of developing the disease, or why it is recommended that those with a history of smoking receive annual lung cancer screening (Figure 2).

USPST Cancer Screening Guidelines

A horizontal floating bar chart comparing women and men cancer screening guidelines by age. They share the same bars for Colorectal and Lung, women have Breast and Cervical, and men have Prostate.

Figure 2. Source: www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations

It is also important to consider that cancer screening recommendations are for individuals with no signs or symptoms of cancer. If you experience any symptoms which are not going away or are worsening over time, it is important to communicate with a doctor. By understanding and communicating unique cancer risks with a doctor, you can increase the chances of early detection and successful treatment.

CANCER SCREENING RESOURCES IN MONTANA

With private insurance, most recommended cancer screening services are required to be covered with no out-of-pocket costs to patients under the Affordable Care Act. For those without coverage, the Montana Cancer Screening Program supports comprehensive cancer control by providing ongoing quality screening services to Montana women and education in a manner that is appropriate, accessible, cost-effective and sensitive to client’s needs. The Montana Cancer Screening Program provides services including mammograms, clinical breast exams, Pap testsand pelvic exams for the early detection of breast and cervical cancers. To qualify for free or low-cost screenings, you must be between ages 40-64 for breast cancer screening or 21-64 for cervical cancer screening, have no insurance or insurance that does not cover screening exams, and have a yearly income at or below 250 percent of the Federal Poverty level (Table 1).

Family size

Monthly income

Yearly income

1

$3,137

$37,650

2

$4,258

$51,100

3

$5,379

$64,550

4

$6,500

$78.000

5

$7,621

$91,450

6

$9,862

$104,900

7

$10,983

$118,350

8

$10,983

$131,800

Table 1. Income and family size for determining eligibility for free or low-cost breast and cervical cancer screening

To reduce the burden of cancer, the Montana Primary Care Association (MPCA) advocates for improved cancer care access. The MPCA represents the state’s Community Health Centers (CHCs), which are federally funded by the Health Resources & Services Administration (HRSA).

These 13 CHCs operate sites across rural and urban Montana (Figure 3), providing comprehensive healthcare services to all residents, regardless of insurance status or ability to pay. The MPCA also represents five Urban Indian Organizations (UIOs). Administered through the Indian Health Service and funded by Title V, these UIOs deliver high-quality, affordable, and culturally appropriate healthcare services to American Indian and Alaska Native populations.

A yellow map of the state of Montana, counties broken up by white lines. Blue dots mark Montana Community Health Centers, most residing in the north-western part of the state, and yellow stars mark Urban Indian Health Centers, most residing in the western part of the state.

Figure 3. Montana Community Health Centers Serving all 56 counties and 7 tribal reservations across the state.

Further cancer screening, treatment, and support resources are provided by the Montana Cancer Coalition (MTCC), a partner of the Montana Cancer Control Programs. The MTCC is a group of individuals and organizations working to reduce cancer incidence, morbidity and mortality across the cancer continuum. MTCC resource information and locations can be found online at Cancer Treatment Facilities in Montana.

The prospect of a cancer diagnosis can be incredibly frightening, but early detection through screening is a useful weapon against the disease. Talk to a doctor about which cancer screenings are appropriate, and for more information on cancer screening or other efforts in Montana, visit dphhs.mt.gov/publichealth/Cancer.

 

Ty McCaffrey, MSc, is an Epidemiologist at the Montana Cancer Control Programs.