Are You Picking the Most Effective Cancer Screening Tool?

With the uptick in cancers (and Turbo Cancers), IMA Senior Fellow Dr. JP Saleeby is here to tell you about SAFE and effective options for cancer screening and surveillance.

Cancer screening can certainly feel overwhelming. How often should cancer screenings be performed? And what tests should be taken?

IMA Senior Fellow Dr. JP Saleeby, frequent contributor and practicing physician, breaks down the pros and cons of various screening methods to help you make personalized decisions about your health. The tips below will be useful for both health care professionals (the ones performing the tests) and those of us who need to get cancer screenings ourselves with prevention in mind.

This article originally appeared on Dr. Saleeby’s Substack, where he regularly shares evidence-based insights on integrative medicine topics. Follow his Substack for more practical health guidance for patients and providers that cuts through the noise.

With the uptick in cancers (and Turbo Cancers), here are some SAFE and effective options for cancer screening and surveillance. Cancer is soon to overtake cardiovascular disease in America as the top killer. There has been an exponential upsurge in cancers (and even more specifically, stage-4 cancers referred to as Turbo-Cancers) in the last half-decade.

That being said, we would like to be able to intervene with cancer therapies before we get to the stage-4, late-stage or terminal point. Part of this is a healthy helping of PREVENTION, and that is being discussed on platforms such as Independent Medical Alliance and other proactive preventive medicine forums.

Here, I will outline some traditional (Standard of Care Guidelines outlined by several organizations within allopathic medicine) and more friendly, safer, less risky diagnostics that I use in my integrative and functional medicine practice.

Screening for cancers involves using tests, exams, or procedures to detect cancer before symptoms appear. The goal is early detection, which can lead to better outcomes. Screening recommendations depend on the type of cancer, age, gender, family history, and risk factors.

Here’s an overview of common cancer screenings:

🔹 Breast Cancer

• Method: Mammogram (X-ray of the breast)
• Who: Women aged 40–74 (varies by guidelines from multiple national health organizations – no proper consensus among them all)
• Frequency: Every 1–2 years, depending on age and risk factors
• Alternatives to mammography are: MRI, Thermography (Thermoscan) and Ultrasound (HerScan)

🔹 Cervical Cancer

• Method:
  • Pap smear (detects precancerous cells)
  • HPV test (detects the virus that can cause cancer)
• Who: Women aged 21–65
• Frequency:
  • Pap smear every 3 years (ages 21–29)
  • Pap + HPV test every 5 years (ages 30–65)

🔹 Colorectal (Colon) Cancer

• Methods:
  • Colonoscopy (every 10 years)
  • FIT test (stool test, yearly)
  • Sigmoidoscopy (every 5 years)
  • Virtual Colonoscopy
  • Advanced stool testing (ColoGuard; Septn-9; others)
• Who: Adults aged 45–75
• Frequency: Depends on the method and risk factors

🔹 Lung Cancer

• Method: Low-dose CT (LDCT)
• Who: Adults aged 50–80 with a significant smoking history (30 pack-years), who currently smoke or quit within the past 15 years
• Frequency: Yearly

🔹 Prostate Cancer

• Method: PSA (Prostate-Specific Antigen) blood test ± digital rectal exam (DRE)
• Biopsy after elevated PSA
• Urine biomarker testing for repeated elev.PSA with negative biopsy results
• Who: Men aged 50+ (or 40–45+ if high risk, e.g., African American or strong family history)
• Frequency: Based on the discussion with doctor

🔹 Skin Cancer

• Method: Visual skin exam by doctor or self-checks
• Who: All adults, especially fair-skinned or high sun exposure
• Frequency: No universal guideline; depends on risk

🔹 Other Cancer Screenings (Only in Specific Situations)

• Ovarian, pancreatic, thyroid, or testicular cancers: No standard screening for average-risk people; may be screened if high risk (e.g., genetic syndromes like BRCA, Lynch)

🧬 Genetic Testing for Cancer Risk

• If you have a strong family history of cancer, testing for genetic mutations (e.g., BRCA1/2, Lynch syndrome) might be recommended.
• Not as reliable or sensitive as we once thought

🧬 Advanced Biomarkers (liquid biopsy)

• Newer technology blood testing
• Whole body Scan (MRI) for solid tumors
• See a list of several biomarkers used today (below)

Screening can depend on gender, age, race and genetic factors; At risk individuals such as smokers, those with history of other cancers, family history of cancer, should be more diligent.

Controversy with a few screening techniques outlined by a particular epidemiologist Dr. H. Gil Welch for example, with

• this summary of his book in this YouTube video.
• Published in JAMA on issues with Mammography; published book “Less Medicine, More Health” and summarized it here on another YouTube video.

Dr. H. Gilbert Welch, a physician and researcher known for his work on cancer screening, overdiagnosis, and the potential harms of early detection.

🔍 Key Ideas from Dr. H. Gilbert Welch

1. Overdiagnosis in Cancer Screening
   • Welch argues that cancer screening often finds tumors that would never have caused harm (e.g., slow-growing or non-lethal cancers).
   • This can lead to unnecessary treatments—surgeries, radiation, or chemotherapy, immunotherapy—with no benefit and sometimes serious harm or disfigurement, or even death.
2. Lead-Time and Length Bias
   • Screening may appear to improve survival just because cancers are found earlier (lead-time bias), not because people live longer.
   • It also tends to find slow-growing cancers more than fast-growing ones (length bias), which skews perceived benefits.
3. The Problem with “Early Detection Saves Lives”
   • Welch cautions that this phrase oversimplifies reality.
   • He emphasizes informed decision-making: understanding both the potential benefits and harms of screening.

📚 Notable Books by Dr. H. Gilbert Welch

• “Overdiagnosed: Making People Sick in the Pursuit of Health” (with Lisa Schwartz & Steven Woloshin)
• “Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care”
• “Should I Be Tested for Cancer? Maybe Not and Here’s Why”

📌 The Bottom Line on his research and publications:

Welch’s work challenges the conventional wisdom that “more screening is always better,” advocating for a more nuanced, evidence-based approach to healthcare.

Read the full article on Dr. Saleeby’s Substack to find two Key Sets from well-respected Medical journals JAMA and NEJM where Dr. Welsh published his work.

So once you have decided to ‘‘screen or not” the question is then what type. We don’t want to do harm by rather invasive harmful procedures (colonoscopy with bowel perforation) or by ionizing radiation (virtual CT colonoscopy; repeated mammography, etc.)

Alternative Tests are many… Here I will outline a few:

🩻 Purpose

• Detect early signs of cancer (in asymptomatic individuals)
• Monitor individuals with hereditary cancer syndromes
• Follow up on known cancer cases for metastasis
• Offer peace of mind to high-risk or health-conscious individuals

✅ Pros

• No radiation exposure (unlike CT or PET scans)
• Can detect a broad range of tumors, especially soft tissue abnormalities, solid tumors, not useful in cancers without masses (leukemia)
• May catch asymptomatic cancers early
• Helpful in high-risk populations (e.g., BRCA mutation carriers, Li-Fraumeni syndrome)

⚠️ Cons / Limitations

• Expensive and not typically covered by insurance if used for screening without medical indication
• False positives are common, which may lead to unnecessary anxiety or follow-up tests/biopsies; overdiagnose
• May miss small or early-stage cancers, especially in lungs or gastrointestinal tract
• Not specific — can detect benign abnormalities that mimic malignancies
• Not a substitute for organ-specific screenings (like colonoscopy, mammogram, or low-dose CT for lungs); but one can still go down that rabbit hole.

Liquid biopsy

Liquid biopsy is an emerging, non-invasive method for cancer screening diagnosis, and monitoring. Instead of relying on traditional tissue biopsies (which require surgery or needle extraction), liquid biopsy analyzes biological fluids, usually blood, to detect cancer-related biomarkers.

🔬 What these biomarkers Detects

• Circulating tumor DNA (ctDNA) – fragments of DNA shed by tumors into the bloodstream.
• Circulating tumor cells (CTCs) – whole cancer cells that break away from the tumor.
• Exosomes and extracellular vesicles – tiny particles that carry cancer-related proteins or RNA.
• Tumor-derived RNA – including microRNAs.

💡 Applications in Cancer

1. Early Cancer Detection / Screening

• Detects signs of cancer before symptoms appear.
• Multi-cancer early detection (MCED) tests are being developed (e.g., Galleri test by GRAIL).

1. Diagnosis

• Helps identify the type and genetic makeup of the tumor.
• Useful when a tumor is hard to access for biopsy.

1. Treatment Selection
   • Determines mutations (e.g., EGFR, KRAS, BRAF) for targeted therapies.
2. Monitoring and Surveillance

• Tracks response to treatment.
• Detects minimal residual disease (MRD) and early recurrence.

✅ Benefits

• Minimally invasive
• Repeatable over time for monitoring
• Faster turnaround than tissue biopsy
• May detect heterogeneity (genetic variations within a tumor)

⚠️ Limitations

• Sensitivity: Early-stage tumors may release very little ctDNA, making detection harder.
• False positives/negatives: Risk of overdiagnosis or missed detection.
• Validation: Not all tests are FDA-approved or widely available.
• Cost: Advanced tests like MCED are expensive and not always covered by insurance.

🧪 Currently Available Cutting-Edge Tests

• Galleri (GRAIL) – Screens for 50+ cancers from one blood draw. Used as a general screening too at the CHM centers. Not all cancers are detected equally (Breast Cancer is a low yield for this particular test)
• Signatera (Natera) – Personalized ctDNA test for recurrence monitoring.
• Guardant360 / Guardant Health – For tumor profiling in advanced cancer.
• FoundationOne Liquid CDx – Comprehensive genomic profiling from blood.

🔍 Future Outlook

• Integration into routine screening for high-risk individuals or even the general population.
• AI and bioinformatics to improve sensitivity and specificity.
• Clinical trials are ongoing to validate and expand use in early-stage and rare cancers.

A look at a particular cancer (Prostate):

1. PCA3 Test (Prostate Cancer Antigen 3)

• Detects RNA from the PCA3 gene, which is overexpressed in prostate cancer cells.
• Higher PCA3 scores = higher likelihood of cancer.
• Used primarily to help decide whether a repeat biopsy is necessary after a negative one. Requires a DRE to ‘‘milk’’ the prostate gland before capturing urine.
• FDA-approved.

2. SelectMDx

• Measures expression of two cancer-related genes (HOXC6 and DLX1).
• Helps assess risk of clinically significant prostate cancer.
• Can help decide whether a biopsy is needed.
• CE-marked in Europe; used in some US clinics.

3. ExoDx Prostate (IntelliScore)

• Detects exosomal RNA biomarkers (ERG, PCA3, SPDEF) in urine without requiring a DRE.
• Helps distinguish between high-grade (aggressive) and low-grade or benign conditions when PSA is elevated.
• Non-invasive; FDA Breakthrough Device status. Used at the CHM center in Charleston, SC.

And this is just for males and prostate cancer screening without repeated low-yield biopsy (prostate biopsy is invasive and not without complications)

General Cancer Biomarkers (Used Across Multiple Cancers)

• CEA (Carcinoembryonic antigen)-Protein-Colorectal, lung, breast – monitoring recurrence
• CA 19-9-Protein-Pancreatic and GI cancers – monitoring
• CA 125-Protein-Ovarian cancer – diagnosis, monitoring
• LDH (Lactate dehydrogenase)-Enzyme-General tumor burden and progression
• TP53-Gene mutation-Multiple cancers – prognostic
• KRAS-Gene mutation-Colorectal, lung, pancreatic – predictive of treatment response
• BRAF V600E-Gene mutation-Melanoma, colorectal – targeted therapy
• PD-L1-Protein-Various cancers – immunotherapy response
• MSI-H / dMMR-Genetic instability-Colorectal, endometrial – immunotherapy eligibility
• TMB (Tumor Mutational Burden)-Genomic-Immunotherapy prediction (many cancers)

Lung Cancer Biomarkers

• EGFR-Gene mutation-Targeted therapy
• ALK rearrangement-Gene fusion-Targeted therapy
• ROS1, MET, RET, NTRK-Gene alterations-Targeted therapy
• KRAS G12C-Gene mutation-Targeted therapy
• PD-L1-Protein-Immunotherapy prediction

Pancreatic Cancer Biomarkers

• CA 19-9-Protein-Monitoring, prognosis
• KRAS-Gene mutation-Common mutation (limited treatment implications)
• BRCA1/2, PALB2-Gene mutation-Risk, targeted therapy with PARP inhibitors

Bladder Cancer Biomarkers

• NMP22-Protein (urine)-Diagnosis, monitoring. I used this aggressively in high-risk special agents with ATF who were exposed to explosives material, while I had a DOD contract in Savannah, GA. They were a high-risk population for bladder cancer.
• UroVysion FISH-Chromosomal-Detection of recurrence
• FGFR3-Gene mutation-Targeted therapy in advanced bladder cancer
• TERT promoter mutation-Gene mutation-Early detection (in development)

Emerging Biomarkers (Liquid Biopsy Focus)

Saliva Tests (Emerging)

• Saliva contains biomarkers like DNA, RNA, and proteins that are being explored for detecting:
  • Oral cancers
  • Lung cancer
  • Pancreatic and other systemic cancers
• Still mostly in research or early clinical stages.

Breath Analysis (Emerging and promising)

• Detects volatile organic compounds (VOCs) released by tumors.
• Non-invasive, rapid, and no blood or radiation.
• Being studied for:
  • Lung, gastric, breast, and colon cancers.

OBVIOUSLY, this is a partial list of the many others already established or in study.

The take-home message is that cancer screening and surveillance is a very personal, individualized process utilizing the best precision medicine has to offer. Pick wisely and remember “First Do No Harm”.

If you as a clinician, intend to screen, use the least invasive and least harmful method. Weigh the pros and cons and the risk-benefit ratio.

For more ideas re: “Cancer Prevention”, check out the latest guide from Dr. Kristina Carman, with tips on how nutrition and healthy lifestyle can reduce your cancer risk by up to 40%.