How to Detect Cancer Early: A Guide

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Cancer sucks.

Let me rephrase that:

Cancer really sucks.

I recently lost a close family friend to cancer, and soon after that the mother of one of my best high school friends succumbed to a recurrent breast cancer.

To top it off, in December, Rachel, my co-founder here on Longevity Advice, learned her mother had been diagnosed with a rare form of abdominal cancer.

Cancer is one of the top four leading causes of death in the United States and I’d venture a guess that almost everyone reading this post has been touched, in some way, by the utter disaster that is this disease.

In fact, it was the loss of that close family friend that was part of my motivation to finally get off my butt in early retirement and start Longevity Advice.

Because I know cancer is a disease for which risk increases with age, so the better we are able to treat aging itself, the less cancer we should have to deal with.

Harvard researcher and longevity expert Dr. David Sinclair, in his longevity book Lifespan, makes the claim that, “Aging is going to be remarkably easy to tackle. Easier than cancer.”

And it seems like current anti-aging interventions already have a beneficial impact on preventing or fighting cancer, including things like fasting, regular aspirin use, and turmeric, curcumin, and resveratrol.

But it’s possible that if you already have some cancers and don’t know it, certain life-extension interventions could actually be harmful. For instance, NAD boosters like NMN and Niacin may help the survival and growth of all cells in the body including, if you have them, certain cancer cells like glioblastoma or colon cancer.

Of course, some conflicting research indicates NAD boosters may actually protect against and treat cancer, so the jury is still out on whether NAD boosters are a net negative or positive for cancer prevention.

However, given this level of uncertainty, anyone interested in human life extension should err on the side of caution. (And not just around NAD boosters, other longevity interventions like growth hormone could increase prostate cancer risk, and certain cancers thrive in a high telomerase environment so telomere boosters like ashwaganda may not be safe if you have cancer.) Spanners might be interested in running as many tests as safely as possible to guard against the possibility of having cancer before starting to take any longevity supplements or treatments.

I know I plan to get tested before starting anything like NMN, and I’m hoping to get my family members tested as well.

Plus, early detection of cancer is one of the most important factors in increasing life expectancy after a cancer diagnosis, so even if you don’t plan to live to 150 or ingest handfuls of life-extension pills, it still makes sense to periodically test for cancers, and maybe even do so more frequently than your doctor recommends.

The American Cancer Society only recommends regular screening for five different types of cancer (and not even the top five!), which seems insane to me. And while I’m not a doctor, some actual doctors, writing in Scientific American, agree with me that this is insane (though they don’t use those exact words).

We estimate that these five single cancer screening tests collectively detect only 16 percent of the 1.2 million cancers diagnosed each year in those aged 50–79 in the US…

[E]arly cancer detection is suffering from a common ailment in medicine and public health: the streetlight effect. We are looking for five cancers “over here” under the streetlight where we have early detection tests, but about 70 percent of cancer deaths are occurring “over there,” in the dark, where we aren’t even looking. Some may assume that we aren’t screening for these cancers because we don’t have treatments, but a review of practice guidelines and the literature shows that nearly all early cancers have effective treatments…

With that information in mind, I came into the topic of how to detect cancer early with a bunch of questions:

• What cancers are most prevalent and deadly that I should screen for?
• What is the current state-of-the-art on cancer detection?
• What tests are available, relatively easy and inexpensive to have your doctor do?
• How frequently should you test for these cancers?

I’m hoping to answer each of these below, and give you (and myself) a straightforward blueprint for how to detect cancer to use at your next doctor’s visit.

But first, a caution about cancer screening tests.

Ok, now let’s get right into each of the tests that are currently out there, how they work, how to get them, and how frequently you might want to do them (keeping the above cautions in mind).

And don’t worry, we’ll eventually cover some cancer prevention and treatment options from a longevity perspective in a future post.

For a TL;DR skip down to the “An example cancer screening blueprint” section near the bottom.

Tests to detect cancer early

The problem with cancer is there’s not just one kind to test for. There are at least 140+ different types of cancer and many of these require a unique test to detect them.

The types of screening tests for cancer are as varied as the cancers themselves: from organ biopsies to blood tests, stool tests, pap smears, mammograms, and even self-tests (for things like testicular and breast cancer), there’s a whole universe of possible cancer detection tests to choose from.

So to try and bring some order from the noise and prioritize where to start, I decided to look at the top most-deadly and most-prevalent cancers and the tests to detect them, with a focus on tests that can detect multiple different cancer types.

The six cancers that account for over 50% of cancer deaths in the U.S. are:

• Lung and bronchus: 131,880 annual deaths
• Colorectal: 52,980 annual deaths
• Pancreatic: 48,220 annual deaths
• Breast: 44,130 annual deaths
• Prostate: 34,130 annual deaths
• Liver and intrahepatic bile duct: 30,230 annual deaths

Here are the cancer screening tests I discovered for these cancer types, ordered by the total number and severity of cancers they each detect.

1. Whole-genome sequencing for cancer risk

• Cancers it detects: None
• Type of test: Saliva home kit
• Suggested age to start testing: Now
• Suggested frequency to test: Once

I’m adding this one in with a caveat; because while it’s extremely important for understanding your personal risk for different cancers, a DNA test or genome sequencing won’t, by itself, detect cancer that may already exist in your body.

But as we’ll see with things like lung and breast cancer below, understanding if you have any genetic mutations that put you at greater risk for certain cancers can help inform you of what cancer screening tests to take and how early in life to take them.

For instance, knowing you have the BRCA1/BRCA2 gene variant that puts you at increased risk for developing breast, pancreatic, and ovarian cancer, could help you decide to start mammograms or MRIs earlier in life. Or learning you have certain EGFR, ROS1, or ALK mutations (which put you at increased risk for early-onset lung cancer) might inform your strategy for when to start getting low-dose CT scans. Same for a p16-Leiden mutation and MRIs for pancreatic cancer.

While many genotyping tests like 23andMe or SelfDecode will test for some of these genes, especially BRCA1/BRCA2, a whole-genome sequencing test like Nebula Genomics might make more sense for cancer risk profiling because it sequences 100% of your genome, vs. ~0.1%, and so can catch even rare disease variants in your genes.

2. Cancer self-tests

• Cancers it detects: Breast, skin, testicular, thyroid
• Type of test: Self-examination
• Suggested age to start testing: After puberty
• Suggested frequency to test: Monthly

There are at least four (if you know of others please add them in the comments!) different self-tests you can do right now, at home, to check for cancer symptoms and these are so easy (and also, free) that everyone should probably be doing them with some regularity.

How to do a breast cancer self-test

1. Both men and women should perform this test, as both genders can get breast cancer, and it’s worth asking your doctor to give you a walkthrough of the procedure in person.
2. It’s recommended men perform this test monthly, while women should perform the test at the same stage of your menstrual cycle each time, ideally 3-5 days after your period starts.
3. Begin by standing in front a mirror with your arms at your side and look for:
   1. Any unusual puckering, dimpling, or bulges in the skin
   2. Changes in shape or size of the breast
   3. Any redness, rash, soreness, or swelling
   4. any inverted nipples or nipples that have changed position
   5. signs of any fluid coming out of either (or both) nipples
4. Raise your arms above your head and repeat the above visual examination.
5. Press your palms together or to your hips and repeat the above visual examination.
6. Next, lie down on your back and, using a spiral pattern, or by moving up and down in rows, examine the breast tissue with the pads (not tips) of your three middle fingers.
7. Repeat the exam with your fingers using different levels of pressure in order to feel to different depths of tissue.
8. If you find a hard lump or knot near your underarm, or notice unusual changes in the way your breasts look or feel, contact your doctor for additional screening.

How to do a skin cancer self-test

1. Once a month, grab a hand mirror, a blow-dryer, and two chairs, and stand in front of a full-length mirror.
2. Starting with your face, and moving to your hands, arms (including forearms and underarms), and then chest and torso (including under the breasts), look for anything new and unusual, or anything that has changed or grown since your last check. This includes things like moles, open sores, weird-looking spots, or colored growths.
3. Do the same inspection of your scalp, using the blow-dryer to move hair out of the way so you can see your skin in the mirror.
4. Turning your back to the big mirror, use the hand mirror to do the same examination on your back, shoulders, neck, butt, and the backs of your legs.
5. Sit down in one of the chairs and prop a leg up on the other. Use the hand mirror to do the same examination on your genitals and first leg and foot. Switch legs and do the same thing.
6. You may want to use a mole map to track the progression of any suspicious moles or other spots. These can be found either as printable tools or as smartphone apps (often free) that use your phone camera to help record areas you’re keeping an eye on.
7. If you discover any irregularities, contact your doctor for additional screening.

How to do a testicular cancer self-test

1. After puberty, men should perform this test monthly.
2. Take a nice warm shower or bath and begin the examination towards the end of it or just afterward, so your scrotal skin is relaxed and easier to feel around.
3. Shifting your penis out of the way, hold one testicle between the thumbs and fingers of both hands and roll it gently, feeling all around for any hard lumps or smooth, round masses, or any changes in size, shape, or texture.
4. Perform the same examination on the other testicle.
5. Note that it’s normal for one testicle to be larger than the other, and hang lower. Also make sure not to mistake the epididymis, the tubes that carry sperm and connect the testicles, for an abnormal mass.
6. If you discover any irregularities, contact your doctor for additional screening.

How to do a thyroid cancer self-test

1. Also known as the “neck check,” there are no recommendations I could find on how frequently to do this test, so I plan to do it monthly based on the recommendations for the other self-exams on this list.
2. Get a glass of water and stand in front of a mirror.
3. Locate your thyroid gland, which is above your clavicle but below your larynx (see picture below). If you’re a guy it’s below your Adam’s apple.
4. Tilting your head back, use the three middle fingers on each hand to gently massage both sides of your neck above your collarbone and below your larynx, feeling for any abnormal swelling, lumps, bumps, or sore spots.
5. While keeping your head tilted back, take a sip of the water and swallow it.
6. Watch your neck in the mirror while you swallow, again looking for any abnormal bumps, lumps or spots.
7. If you discover any irregularities, contact your doctor for additional screening.

3. Whole-body magnetic resonance imaging (MRI)

• Cancers it detects: Breast, lung, (possibly) pancreatic, colorectal, multiple myeloma
• Type of test: Magnetic resonance scan (no radiation)
• Suggested age to start testing: As early as 25 for people with environmental or genetic risk factors, and as early as 35 for people with certain pancreatic cancer genetic mutations
• Suggested frequency to test: Yearly

There’s some controversy around using whole-body MRI tests to screen for cancer, and I’ll note up-front that the U.S. Preventive Services Task Force doesn’t recommend them to detect cancer in healthy or asymptomatic people with low-risk profiles (and the same goes for the American Cancer Society). In fact, while private companies can offer whole-body MRIs in countries like the U.S. and Germany, in the Netherlands it’s actually illegal to do so because of the possibility for false positives that “can lead to unnecessary additional examinations, intervention, and treatment, with the associated risk of complications and costs.”

Several meta-analyses and reviews seem to support this position, with one 2019 review finding, “The proportion of false‐positive findings appears to be substantial,” while a 2020 review could form no firm conclusions on the efficacy of using whole-body MRI to screen for cancer in asymptomatic populations.

However, a raft of new research seems to indicate whole-body MRIs may have a generally positive impact on early cancer detection.

For instance, two papers published in the research journal The Lancet reported on results of the two Streamline cancer detection trials commissioned by the UK’s National Institute for Health Research. 

The first found that for imaging diagnosed lung cancer, whole-body MRIs “have similar accuracy to standard pathways, and reduce the staging time and costs” by six days and by almost half, respectively. The second study had similar results for colorectal cancer, finding a five-day speed increase and a nearly 25% cost reduction compared to traditional cancer imaging methods.

A 2020 paper on direct-to-consumer whole-body MRIs concluded, “Direct-to-consumer screening using whole-body MRI and cardiological testing is feasible and effective for the detection of clinically relevant and treatable abnormalities. Psychological harm was not frequently reported in study participants.”

A 2018 paper on using whole-body MRI (WB MRI) for cancer screening suggested, “WB MRI can be used in cancer screening and for regular health evaluations. WB MRI not only provides information about potential malignancy, but also provides information regarding nonmalignant abnormalities that require further evaluation.”

A 2015 study on children with genetic predispositions for cancers stated, “Unenhanced whole-body MRI is safe and produces excellent images. The high sensitivity, specificity, and NPV [negative predictive value] make whole-body MRI a valuable cancer screening tool in children with a genetic predisposition for cancer.”

So while the jury’s still out on the ultimate benefit of using whole-body MRI to detect cancer, I personally think it seems worthwhile, especially because it can possibly detect so many different types of cancers with one test. Given that recommendations for other screening methods suggest annual tests, I’ll also probably go with that for my own testing regimen.

From breast cancer, to the above-mentioned lung and colorectal cancer, to prostate cancer, brain cancer, multiple myeloma, liver cancer, and also possibly pancreatic cancer, whole-body MRIs seem to give a good bang for your buck, detection-wise.

Of course, expense is a big consideration for whole-body MRIs, with the procedure often costing up to $2,000 and many times not covered by insurance (though HSA and FSA dollars can sometimes be used).

4. Low-dose computed tomography (CT) scan

• Cancers it detects: Lung and bronchus, colorectal, (possibly) pancreatic, multiple myeloma
• Type of test: X-ray
• Suggested age to start testing: 50 for lung, 45 for colorectal, but possibly as early as 28 for people at high-risk of lung cancer due to genetic mutations
• Suggested frequency to test: Yearly

Lung cancer is the cancer with the highest death toll in the U.S., and your risk for it increases with age and, especially, with a history of smoking. The most-recommended test to detect lung cancer is the low-dose CT scan, sometimes also called a low-dose spiral or helical CT scan. This is a test that sticks you into an imaging machine and uses multiple x-rays to build up a 3-D picture of your insides.

Research indicates low-dose CT scans may reduce lung cancer deaths via detection by 20% when compared to using traditional chest x-rays.

Draft guidelines suggest people who are 50 years old or older, and have a “20 pack-year smoking history” (calculated as the number of daily packs of cigarettes smoked times the total number of years smoked: for example two packs a day for ten years, or one pack a day for 20 years would both amount to a 20 pack-year smoking history) should get annual low-dose CT scans to check for lung cancer.

That said, lung cancer incidence is increasing in people under 40, especially in women, and often in people who have no history of smoking. Some 13,000 young adults are estimated to die of lung cancer each year in the United States. This may be due to genetic causes, including EGFR mutations, ROS1 rearrangements, and ALK rearrangements. The bad news is this cancer is often already stage IV when detected.

Whole-body low-dose CT scans can also be used to detect multiple myeloma, a white blood cell cancer, through looking at bone lesions as well as colorectal cancer (especially if it’s higher up in the intestine) using what’s called a “low-dose CT colonography” or “virtual CT colonography.” Given that colorectal cancer is the 2nd-most deadly cancer in the U.S., it’s recommended to get a virtual CT colonography starting at age 45 and then every five years after.

It’s also possible that low-dose CT scans can detect pancreatic cancer, which is notoriously difficult to catch early because of how deep in the abdomen the pancreas is located and how minimal the initial symptoms are. A whole-body MRI may also pick up pancreatic cancer.

While x-ray radiation can potentially cause cancer, especially in larger doses and if you’re exposed to it frequently over time, the newer low-dose CT scan machines use about five times less radiation than conventional CT machines. A low-dose CT scan exposes you to the equivalent of about six months of the normal, cosmic background radiation you get exposed to just by walking around and living your life normally.

However, it’s still a risk you want to minimize (though, also, maybe not?), especially if your genetics make you decide to start getting screened earlier in life (thus exposing you to more radiation over time).

5. At-home colon cancer test kit

• Cancers it detects: Colorectal
• Type of test: Fecal immunochemical test (FIT)
• Suggested age to start testing: 45, but possibly as early as 25 for people with environmental or genetic risk factors
• Suggested frequency to test: Yearly

Cancer of the colon and rectum is the second leading cause of cancer deaths in the U.S., and while your risk for it rises with age, worrying trends have shown increasing rates of colorectal cancer in people under the age of 50. Black Panther actor Chadwick Boseman’s tragic death in 2020 at age 43 from the disease was an especially visible indication of the rising impact of colorectal cancer on young people.

Nick Engerer of The Longevity Blog has a great write-up of the importance of early colorectal cancer screening, which I urge you to read in full, but it essentially boils down to:

1. Colon cancer screening tests are relatively cheap and easy to access.
2. More young people are getting colorectal cancer so why wait to screen yourself?
3. At-home colon cancer screening kits are really accurate and even if you get a false-positive, the follow-up risks of a colonoscopy to confirm the diagnosis are super minimal.
4. Colon cancer caught early (before spreading to other organs) has a 91% five-year survival rate, compared to only 11% survival rate if caught later.

There are now lots of at-home colon cancer screening kits that use a fecal immunochemical test (FIT) to test for blood (even small amounts) in your stool sample. The process isn’t quite as gross as it sounds since you don’t have to handle your own poop directly; you just brush it (or the water in your toilet depending on the test) with an included brush and then brush that onto the test card. Then seal and mail the kit and you’ll get results back in around a week.

Kits cost anywhere from $8 to $100, and can be ordered from online labs like Everlywell, Personalabs, and LetsGetChecked. Some may even be covered by your insurance, so be sure to check before ordering.

6. Prostate-specific antigen (PSA) blood test

• Cancers it detects: Prostate
• Type of test: Blood test
• Suggested age to start testing: 40, but possibly as early as 15 for men with environmental or genetic risk factors
• Suggested frequency to test: Yearly

One of several different different blood tests you can get to detect cancer, the PSA test is another one that has mixed results in the research. High PSA results may not mean you have prostate cancer, and low PSA results may not mean you don’t. However, a continuous increase in PSA levels over time could be a good indicator of prostate cancer.

Given the increasing incidence of prostate cancer among men under 50, it may be prudent, especially for those with genetic mutations like in the BRCA1/BRCA2 genes that increase risk for prostate cancer, to start PSA testing at an early age and continue testing regularly in order to establish trends in your PSA levels.

7. Mammogram

• Cancers it detects: Breast
• Type of test: X-ray
• Suggested age to start testing: 40, but possibly as early as 25 for people with environmental or genetic risk factors
• Suggested frequency to test: Yearly

This x-ray screening is one of the five recommended by the American Cancer Society for early detection of cancer. It’s one of the few cancer screens in this post to have pretty unequivocally positive results at reducing cancer mortality in those screened.

A 2020 study found that yearly mammograms started at age 40 led to a 49% decrease in mortality compared to women who only started mammograms at age 50. Other studies have found anywhere from a 10% reduction in cancer deaths due to regular mammograms, to a 20% reduction and more.

With rates rising among women aged 25-39, if you have a family history of the disease, or have things like the BRCA1/BRCA2 gene variant that puts you at increased risk for developing breast cancer, it may be prudent to start this testing earlier. Though, as with the low-dose CT scan discussed above, mammograms do subject you to small doses of radiation so it’s worth weighing the risks of starting screening too early compared to the risks of developing breast cancer.

An example cancer screening blueprint

So given all the above, here’s what I’m thinking for my own cancer testing regimen as a 34-year-old male with no (known) comorbidities.

1. A whole genome sequencing (likely with Nebula) taken once, with the below tests modified/added to based on what I learn.
2. Self-tests for skin, testicular, breast, and thyroid cancer done monthly.
3. An at-home colon cancer test kit (possibly from Everlywell) taken annually.
4. A PSA blood test for prostate cancer taken annually.
5. A whole-body MRI taken annually.
6. A GRAIL Galleri test (once they’re out on the market: see below) taken annually.

Any other tests to detect cancer early that you think I’m missing? Let me know in the comments!

Addendum: multi-cancer early detection (MCED) tests and liquid biopsies

If you’re reading this post after June, 2021, hopefully 80% of the above information has already been rendered obsolete.

That’s because the first major “multi-cancer early detection” test should have just been put on the market by a company called GRAIL (part of gene sequencing giant, Illumina) and made available at any Quest Diagnostics lab location with a prescription. This test, called Galleri and also known as a “liquid biopsy,” uses a simple blood sample to detect more than 50 different cancer types with up to 99% accuracy. 

By sequencing the cell-free DNA (which is exactly what it sounds like: floating bits of DNA that got loose from a cell when it got eaten for energy or when it died from disease, theorized to be more prevalent if you have cancer) present in the blood sample, the liquid biopsy can tell if you have a cancer and, if so, which one(s). This means not only can it indicate the presence of cancer, it can predict the location of it in the body based on the specific genetic signature of that cancer type.

Other companies are also developing liquid biopsies, like Thrive’s CancerSEEK, which can test for eight different cancer types, including big killers like pancreatic cancer that currently have no standard screening tests.

Models suggest these tests could prevent at least 26% of all cancer deaths.

All this to say: hopefully once these multi-cancer early detection tests come out, you can get a simple blood draw to test for all the cancers I covered above, and might not have to worry about many of those other tests and invasive cancer screening methods I just described. We’ll update this piece if that happens.

Fingers crossed.

J.P.

I’m the co-founder of Longevity Advice and have been passionate about radical life extension ever since I was a teenager. Formerly I was a content marketing director in the B2B software space. I’m also a sci-fi novelist, wargame rules writer, and enthusiast for cooking things in bacon fat. My sister once called me “King of the Nerds” and it’s a title I’ve been trying to live up to ever since.