Cancer screenings help detect issues early, before the disease progresses and treatment has a better chance of success.
Preventive screenings are tests that look for diseases or conditions before you have symptoms. The goal is to find these diseases early, when they are easier to treat. Some screenings can be done in your primary care provider's office (PCP), and others may require special equipment at a clinic or outpatient facility.
The tests you need depend on your age, sex, family history, and risk factors you may have for certain diseases. That's why Medicare Part B covers a number of preventive screenings and services to help keep you healthy and identify and treat any conditions as soon as possible.
Of the different types of screenings covered, many are cancer screenings designed to catch cancer early, when treatment is more likely to be successful. Knowing which screenings are covered and what you may be due for, as well as the importance of getting screened when you're eligible, is an important part of managing your health.
Cancer screenings covered by Medicare
Medicare covers several tests that screen for different types of cancer, including:
- Breast cancer
- Colorectal (colon) cancer
- Cervical cancer
- Prostate cancer
- Lung cancer
Because not all these cancers have symptoms, and risk factors can vary, it's important to talk to your doctor about which tests are necessary for you and when you should get them. The good news is Medicare covers these screening tests for those who are eligible, so you can be screened and help catch cancer early, when it's easier to treat.
Breast cancer screening
Part B mammogram coverage includes:
- One baseline mammogram if you're a woman between ages 35-39
- Screening mammograms once every 12 months if you're a woman aged 40 or older
- Diagnostic mammograms more frequently than once per year, if medically necessary
Screening mammograms are $0, but if you get a diagnostic mammogram, you'd pay 20% of the Medicare-approved amount and the Part B deductible applies.
A screening mammogram is an X-ray picture of the breast used to look for early signs of breast cancer. Mammograms are the best way for doctors to find breast cancer early, even up to three years before it can be felt during a physical exam.
If your mammogram results are normal, your doctor will help you determine how often you should get one based on your age and other risk factors. And if your results are abnormal, that doesn't necessarily mean there's cancer. However, you may need to get additional tests to be sure.
Getting a screening mammogram regularly is important to help detect breast cancer when it's easier to treat. It's especially important if you're at high-risk for breast cancer. Risk factors can include:
- Age. Most breast cancers are diagnosed after age 50
- Inherited genetic mutations
- Reproductive history. Early menstrual periods before age 12, and starting menopause after age 55, increase your risk
- Dense breasts. This can make it more challenging to see tumors on a mammogram
- Personal history of breast cancer
- Family history of breast or ovarian cancer
- Previous treatment using radiation therapy
- Being overweight or obese after menopause
- Taking hormones, such as oral contraceptives and hormone replacement therapy
- Drinking alcohol
When it comes to symptoms of breast cancer, they can vary depending on the person. Some people don't have any symptoms or signs at all. However, if you do have any of the following symptoms, talk to your doctor immediately:
- A lump in your breast or underarm that doesn't go away
- Swelling in your armpit or near your collarbone
- Pain and tenderness
- A flat or indented area on your breast
- Breast changes such as size, contour, texture, or temperature
- Changes in your nipple, like one that pulls inward, is dimpled, burns, itches, or develops sores
- Unusual nipple discharge
- A marble-like area under your skin
Keep in mind there are many different types of breast cancer with different treatments, such as a lumpectomy, mastectomy, chemotherapy, and/or radiation. Your doctor will help you understand any symptoms, get you scheduled for a screening or diagnostic mammogram, and walk you through your treatment options.
Colorectal cancer screening
Colorectal cancer, or colon cancer, happens when cells in the colon or rectum grow out of control. Sometimes, abnormal growths, called polyps, form in the colon or rectum and over time, they may turn into cancer. Colorectal cancer screenings can help find these polyps so they can be removed, ideally before they turn into cancer.
There are several different types of screenings for colorectal cancer, each with different eligibility criteria but all covered by Medicare Part B:
If the provider accepts assignment, you pay $0. However, if a polyp or other tissue is found and removed, you may pay 20% of the Medicare-approved amount for doctor services, and a co-payment in a hospital setting. Part B deductible doesn't apply.
This exam is used to find abnormalities in the large intestine and rectum. During this test, a long, flexible tube is inserted into the rectum. A video camera at the end of the tube helps the doctor to see the inside of the colon. Polyps or other abnormal tissues can be removed through the scope during the procedure.
Your doctor may suggest a colonoscopy to investigate any symptoms you're having, if you're at risk for colon cancer, or to look for polyps if you've had them before.
Covered once every 3 years if you meet the following:
If the provider accepts assignment, you pay $0.
This non-invasive lab test helps find DNA changes in the cells of a stool sample, which can be associated with colon cancer, and detect hidden blood in the stool. It's specifically intended for those who have no symptoms.
This exam requires no preparation. During the test, you collect a stool sample and submit it to your provider's office or mail it to a designated lab.
You pay 20% of the Medicare-approved amount for your doctor's services. A co-pay may apply in a hospital outpatient setting. Part B deductible does not apply.
This procedure consists of an X-ray exam that detects changes or abnormalities in the large intestine. A liquid that contains barium is injected into your rectum through a small tube, which coats the lining of the colon.
Your doctor may recommend this test if you have symptoms such as pain, rectal bleeding, unexplained weight loss, or changes in bowel habits. Your doctor will give you specific instructions for preparing. Depending on the findings, your doctor may recommend additional testing so any abnormalities can be examined, biopsied, or removed.
Covered once every 12 months if you're age 50 or older. You must get a referral from your provider.
You pay $0 for this test if the provider accepts assignment.
A FOBT is a lab test used to check for hidden blood in stool samples. If blood is detected, additional testing may be required, but it could indicate colon cancer or polyps. This test is not recommended if you have colon cancer symptoms, but the test isn't always accurate because there could be other reasons for the blood in the stool.
There are a couple of different types of FOBT kits, such as an iFOBT, FIT, or gFOBT kit. Your doctor will help determine which is right for you.
Covered once every 48 months for most people 50 or older. If you aren't high-risk, covered 120 months after a previous screening colonoscopy.
You pay $0 for this test if the provider accepts assignment. If the test results in the biopsy or removal of a lesion or growth during the same visit, this procedure is considered diagnostic, and you may have a co-pay or co-insurance. The Part B deductible doesn't apply.
During this exam, a flexible tube (called a sigmoidoscope) is inserted in the rectum to exam the lower part of the large intestine. A tiny camera allows the doctor to view the inside of the colon, and tissue samples can be taken through the scope if necessary.
The downside to this test is that the doctor can't see the entire colon, so this test alone cannot detect cancer or polyps further in the colon.
Because there are many options with different coverage and criteria, your doctor will help you determine which test is right for you.
While getting a colon cancer screening is important in order to detect colon cancer early, it's especially important for those who are at high-risk for colon cancer, including those who have:
- Inflammatory bowel disease
- A personal or family history of colorectal cancer or polyps
- Certain genetic syndromes
- Lifestyle factors such as lack of exercise, diet low in fruit and vegetables, a low-fiber and high-fat diet, obesity, tobacco use, and alcohol consumption
Symptoms of colorectal cancer may include:
- A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
- A feeling that you need to have a bowel movement that's not relieved by having one
- Rectal bleeding with bright red blood
- Blood in the stool
- Cramping or abdominal pain
- Weakness and fatigue
- Losing weight without trying
However, colorectal cancer often doesn't have symptoms until it's grown or spread. It's important to talk to your doctor as soon as possible if you're experiencing any of the symptoms above, but it's also critical to get your preventive colorectal cancer screenings when you're due.
Cervical cancer screening
Medicare Part B covers Pap tests and pelvic exams, which can help check for and detect cervical and vaginal cancers. These screenings are covered once every 24 months. If you're at high-risk for cervical cancer, or if you're of child-bearing age and had an abnormal Pap test in the past 36 months, these screenings are covered once every 12 months.
Additionally, Part B also covers Human Papillomavirus (HPV) tests (as part of the Pap test) once every five years if you're ages 30-65 and don't have symptoms of HPV.
You pay $0 for this these tests if your doctor accepts assignment.
Cervical cancer forms in tissues of the cervix. It's typically slow-growing, and often doesn't have may symptoms, so the only way to detect it is through regular Pap tests. Almost always caused by the HPV, it's one of the most successfully treatable cancers if detected early.
The Pap test looks for precancers, or cell changes on the cervix, that may become cervical cancer if not treated. The HPV test looks for the virus that can cause these cell changes. Both can be done in your PCP's office or through your OBGYN. During the test, the provider will insert an instrument called a speculum to widen your vagina. This helps them examine the cervix and collect a few cells and mucus from the cervix and surrounding area. These cells are then sent to a lab for testing.
Risk factors for cervical cancer include:
- Infection by the HPV
- Sexual history
- Weakened immune system from HIV/AIDS
- Presence of certain sexually transmitted infections
- Long-term use of oral contraceptives
- Having multiple full-term pregnancies
- Young age at first full-term pregnancy
- Family history of cervical cancer
Advanced cervical cancer may cause bleeding or discharge that is not normal for you, and you should talk to your doctor if you experience this. Otherwise, you'll typically not have signs or symptoms.
Cervical cancer can't necessarily be prevented, but there are some things you can do to reduce your chances of developing the cancer. For example, you can get the HPV vaccine to protect against infection with the HPV types most linked to cancer. You can also practice safe sex, and if you smoke, quit.
Prostate cancer screening
Direct rectal exams and prostate specific antigen (PSA) blood tests are covered by Medicare Part B once every 12 months for men over age 50.
The prostate is a small, walnut-shaped gland in males that produces the seminal fluid that nourishes and transports sperm. Prostate cancer, which is one of the most common types of cancer, happens when cells in the prostate develop changes in their DNA, and accumulating abnormal cells can form a tumor.
A direct rectal exam (DRE) is when the doctor inserts a gloved, lubricated finger into the rectum to feel the prostate for hard, lumpy, or abnormal areas. With Medicare, you'd pay 20% of the Medicare-approved amount for the exam. The Part B deductible applies, and if you receive the exam in a hospital outpatient setting, you'd have a co-pay.
A prostate specific antigen blood test measures the level of PSA, or protein produced by normal and malignant cells of the prostate gland, in the blood. Elevated levels of PSA may mean prostate cancer, but it could also be caused by other benign conditions that would be treated differently.
Some types of prostate cancer grow slowly and may not cause serious harm, but others can be aggressive and spread quickly. Some types are easier to treat than others and may even need no treatment at all.
That said, prostate cancer that's detected early, when it's still confined to the prostate gland, is the easiest to treat and has the best chances for successful treatment.
Prostate cancer often doesn't have symptoms, but if you have any of the following, you should talk to your doctor as soon as possible:
- Difficulty starting urination
- Weak or interrupted flow of urine
- Frequent urination
- Difficulty emptying your bladder completely
- Pain or burning during urination
- Blood in the urine or semen
- Pain in your back, hips, or pelvis that doesn't go away
- Painful ejaculation
Some of these symptoms could be caused by other conditions, but it's best to talk to your doctor about next steps and treatment.
Regular screenings are also important because all men are at risk for prostate cancer. The most common risk factor is age, because the older you get, the greater your chance of developing this cancer. Those at higher risk include African American men, and those who have a family history of prostate cancer.
Lung cancer screening
Lung cancer screenings with Low Dose Computed Tomography (LDCT) are covered by Medicare Part B once per year if you meet all these conditions:
- You're ages 50-77
- You don't have signs or symptoms of lung cancer
- You're either a current smoker, or have quit smoking within the last 15 years
- You have tobacco smoking history of at least 30 "pack years," which is an average of one pack (20 cigarettes) per day for 30 years
- You get a written order from your doctor
These screenings are $0 if your doctor accepts assignment.
Before your first screening, you'll need to schedule a lung cancer screening counseling and shared decision-making visit with your doctor, where you'll talk about the benefits and risks of this screening. Work closely with your doctor to understand if this screening is right for you.
During this scan, you'll lie on a table and an X-ray machine will use a low dose of radiation to create images of your lungs. The scan takes just a few minutes and can help detect lung cancer. However, there are three risks to be aware of with this screening:
- It could suggest a person has lung cancer when no cancer is present
- It could find cases of cancer that may have never caused a problem
- Radiation from repeated LDCT scans can be dangerous
That said, it can help find abnormal areas in the lungs that may be cancer, even before symptoms start, which can help lower the risk of dying from lung cancer. The earlier the cancer is found, the better chances of successful treatment.
Because lung cancer symptoms don't appear until it's typically at an advanced stage, these screenings are critical if they are recommended by your doctor. Some symptoms may include:
- Coughing that gets worse or doesn't go away
- Chest pain
- Shortness of breath
- Coughing up blood
- Feeling very tired all the time
- Weight loss with no known cause
Some of these symptoms can happen for other reasons besides cancer, so talk to your doctor about any concerns you may have.
The biggest risk factors that may increase your chances of developing lung cancer include smoking or being around secondhand smoke. Radon exposure can also cause lung cancer, as well as other substances like asbestos, arsenic, diesel exhaust, and others. Personal or family history of lung cancer and radiation therapy to the chest also increase your risk.
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