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At just 42 years old, the news that the Princess of Wales has been diagnosed with cancer is a stark reminder that this disease can impact anyone.
One effective way to protect ourselves against some cancers is to attend screenings. These are free, regular checks, which help to either prevent cancer or catch it early. But who is eligible, what should you do if you cannot get screened, and is it ever worth going private?
The NHS currently has three national cancer screening programmes, for breast, bowel and cervical cancer, which are detailed below. Other cancers, including lung, prostate, womb and ovarian cancers are not currently screened for routinely.
There are, however, a growing number of private testing services available. While it might be tempting to get tested “just in case”, experts say there’s very little evidence to support this – and false positives could lead to unnecessary stress and overtreatment.
“Please do not waste your money on private testing for cancers – and I say that as someone who works in private practice,” says Dr Nighat Arif (@DrNighatArif), an NHS and private GP, and author of The Knowledge: Your guide to female health from menstruation to the menopause.
“The screening programmes we offer [on the NHS] are the ones that evidence shows do more good than harm,” explains Sian Taylor-Phillips, Professor of Population Health at the University of Warwick. “Potential harms of screening include false positive results and overdiagnosis, which is where we detect diseases that would never have troubled you with any symptoms, and so you receive unnecessary treatment.
“Private testing companies don’t have the same requirement to balance those risks and benefits, so the information they’re providing won’t necessarily do you any good,” she adds.
Instead, the most important thing is for people to know their bodies, says Dr Anisha Patel (@doctorsgetcancertoo), an NHS GP, bowel cancer survivor, and author of Everything You Hoped You’d Never Need to Know About Bowel Cancer. “Do a monthly, all-over body MOT scan – your breasts, your penis and testicles or vulva and vagina, your moles, et cetera – so you notice if anything, anywhere in your body, looks or feels different,” she advises.
“Warning signs include unexplained weight loss; night sweats; lack of appetite; changes to bowel or bladder habits; back or pelvic pain; unexplained tiredness; persistent coughs, bloating, tummy aches or headaches that last more than three weeks; and any unexpected bleeding from anywhere. If you experience any of these symptoms, please get them checked out by your GP.”
Breast
Breast cancer is the most common cancer in the UK, with 80 per cent of cases diagnosed in women over 50. NHS England figures for 2022/23 show that breast screening led to cancer being detected in nearly 19,000 women, who may otherwise have been diagnosed and treated at a later stage.
Anyone registered as female with their GP is invited for screening, known as a mammogram, every three years between the ages of 50 and 71. This involves placing your breasts between two plates, and uses an X-ray to show cancers that are too small to see or feel. “Mammograms can cause a bit of discomfort, but it’s usually short-lived,” Dr Patel says.
You will automatically receive an invitation for your first screening between the ages of 50 and 53. Trans men, trans women and non-binary patients between these ages are also eligible, but you may need to speak to your GP surgery or call the local breast screening service if you’re not automatically invited.
Most breast cancers aren’t inherited, but if you have a strong family history of breast, ovarian and prostate cancer, or you have Jewish ancestry, you may be eligible for BRCA gene testing to identify whether you have a gene mutation that puts you at increased risk.
Bowel
Ninety-four per cent of bowel cancers are diagnosed in people over 50 and, if diagnosed early, 90 per cent of cases can be treated successfully. People over the age of 54 are now sent a bowel screening faecal immunochemical test (FIT), every two years – and this is gradually being expanded to include all over-fifties.
This test is done at home and involves sending off a poo sample to be tested for microscopic traces of blood, which could be a sign of cancer. “Nine times out of ten, it isn’t cancer. But, if it is, we know that early detection improves your chances of having curative treatments,” explains Dr Patel.
Rates of bowel cancer in under-fifties – who aren’t currently screened – are on the increase globally. Dr Patel, who was diagnosed at 39, says this is a tricky issue. “My cancer would probably have been picked up earlier if I’d had screening. But the NHS would have to screen so many people [to detect these cases] that it’s not worth their while, and we don’t currently have the infrastructure to do it,” she says.
If a family member has been diagnosed with Lynch Syndrome – which increases the risk of bowel, womb, ovarian and pancreatic cancers – you may also be eligible for genetic testing.
Cervical/gynaecological
Cervical screening is offered to women and people with a cervix (including trans men and non-binary people) every three to five years between the ages of 25 and 64. This test detects high-risk strains of HPV, a common virus which causes most cases of cervical cancer.
The idea of cervical screening is to prevent cancer from developing, by catching and either treating or monitoring any abnormal cell changes that might be caused by HPV. It’s important to be screened even if you had the HPV vaccine at school.
A doctor or nurse will use a tool called a speculum to open your vagina and take a sample from your cervix. Many women find this challenging, for lots of reasons, but Jo’s Cervical Cancer Trust has tips on making it easier. There are currently pilots under way to assess the use of at-home self-sampling kits, but these aren’t yet widely available in the UK.
Cervical screening cannot identify any of the other gynaecological cancers – ovarian, womb/endometrial, vulval and vaginal.
Lung
There is no national screening programme for lung cancer, which is the third-most common cancer in the UK. A targeted programme is being rolled out in some areas for people aged 55-74 at high risk of lung cancer, such as current and former smokers. This involves a CT scan to detect small tumours in the lungs.
Prostate
Prostate cancer is the second most common cancer in the UK, affecting more than 50,000 men a year. “We have the PSA (prostate-specific antigen) test for prostate cancer, but it isn’t reliable enough for a national screening programme,” Dr Arif explains. If you’re experiencing symptoms, your GP may do a PSA test and a rectal examination, she adds.
Men over 50 can also request a PSA test from their GP as part of the informed choice programme for prostate cancer risk management.
Skin
Finally, melanoma skin cancer is the fifth-most common cancer in the UK and is not routinely screened for. “People do pay privately [for screening] but honestly it’s a waste of money,” says Dr Arif. “You’re better off just photographing and measuring your moles regularly to check for any changes.
“Use the ABCDE rule: Asymmetry, Border, Colour, Diameter, Elevation, Firm, Growing, and see your GP if anything looks different,”
