Screening Guidelines

Screen Out Your Risk

Cancer screening examinations are medical tests performed when you're healthy and you don't have any symptoms. They help ensure that any existing cancers are identified at their earliest, most treatable stages.

Take time to discuss your own cancer risks with your health care provider, who can best advise you on the screening exams and risk reduction strategies that are right for you. Your health care provider can let you know about the benefits, limitations and potential harms of cancer screening so that you can make an informed decision about testing.

Breast Cancer

All women should be familiar with their breasts so that they will notice any changes and report them to their doctor without delay. An approach to breast cancer screening should incorporate an individual's level of breast cancer risk, established by history and by use of a risk prediction model.

  • All female patients should discuss breast cancer screening with their doctors starting at age 40.
  • We recommend that women between the ages of 50 and 70 be screened with mammography.
  • We suggest that women over the age of 70 be screened with mammography if their life expectancy is at least 10 years.
  • The ideal interval for screening mammography is not known. We suggest screening every two years.
  • The efficacy of breast self-examination (BSE) is unproven.
  • Women at high risk for breast cancer (lifetime risk >20 to 25 percent) should be referred for genetic counseling to determine the likelihood of a BRCA mutation and to decide on management options.
  • Consider additional screening if you are at risk – Women at increased risk of breast cancer (e.g., family history, genetic predisposition, past breast cancer) should talk to their doctor about the benefits and limitations of starting mammograms earlier, having additional tests (e.g., breast ultrasound or MRI) or having more frequent exams.

Colorectal Cancer

Beginning at age 50, men and women should follow ONE of the five examination schedules below. Screening tests that visualize the colon are being favored.

  • Colonoscopy – Every 10 years. Polyps >6 mm should be removed.
  • Fecal occult blood test (FOBT) – When visualization of the colon is not feasible, a take-home multiple sample FOBT or fecal immunochemical test (FIT, which also is a take-home test) should be taken every year.
  • Flexible sigmoidoscopy(FS) – Every five years.
  • Annual FOBT or FIT and flexible sigmoidoscopy – Every five years. Having both of these tests is recommended over either test alone.
  • Double-contrast barium enema – Every five years.

All positive tests (FOBT, FIT, flexible sigmoidoscopy, barium enema) should be followed up with colonoscopy.

Prostate Cancer

Although screening for prostate cancer with PSA can reduce mortality from prostate cancer, the absolute risk reduction is very small, and there remain important concerns that the benefits of screening are outweighed by the potential harms to quality of life, including substantial risks for over diagnosis, and treatment-related complications.

  • Screening risks and benefits should be discussed with a health care provider.
  • We suggest that discussions begin at age 50 in average-risk men.
  • We suggest that discussions begin at age 40 to 45 in men at high risk for prostate cancer, including black men, men with a family history of prostate cancer, and men who are known or likely to have the BRACA1 or BRACA2 mutations.
  • We suggest that screening be performed with prostate specific antigen (PSA) test at intervals ranging from every two to four years.
  • When a decision is made to screen, we suggest that screening stop after age 69 or earlier when comorbidities limit life expectancy to less than 10 years.
  • We suggest that men with a PSA level between 4 ng/ml and 7 ng/ml undergo repeat testing several weeks later. Men with a repeat PSA level above 4 ng/ml should be referred for prostate biopsy.
  • Many experts suggest not performing a digital rectal examination (DRE) for prostate cancer screening, whether alone or in combination with PSA screening.

Cervical Cancer

Observational studies have demonstrated marked reductions in cervical cancer mortality following the implementation of national or regional Pap smear screening programs.

Women at average risk of cervical cancer:

  • Beginning 3 years after initiating vaginal intercourse (but no later than age 21) – Liquid-based Pap test every two years
  • Beginning at age 30 – Liquid-based Pap test and human papilloma virus (HPV) test every three years
  • HPV infection is common in women under age 30, and is usually transient. Therefore, HPV testing is not recommended as part of the Pap test for women under age 30 as studies have shown HPV screening at this age to be ineffective.
  • Genotyping to identify HPV 16/18, the two HPV types responsible for 70% of cervical cancer in the US, can be performed either by the Cervista 16/18 test as follow-up to an abnormal HPV test, or as part of the cobas HPV test.

Women at increased risk of cervical cancer still need to be screened annually. Speak with your doctor to determine if you have cervical cancer risk factors.

Women at lower than average risk should speak with their health care provider about less frequent screening:

  • Women age 70 or older with three or more normal Pap tests in a row and no abnormal Pap tests in the past 10 years
  • Women who have had a hysterectomy (removal of the uterus and cervix) that was not done for cancer or pre-cancer of the cervix

Skin Cancer

Promptly show your doctor any:

  • Suspicious skin area
  • Non-healing sore
  • Change in a mole or freckle

Lung Cancer

The best evidence now illustrates that low dose chest CT (LDCT) screening can save lives, but only if it is done well. Only a well-defined, high risk population that can potentially undergo curative treatment if a lung cancer is identified should be screen. Screening must be preceded by shared decision making based on counseling on the potential benefits as well as risks of LDCT screening. LDCT screening should be done only at centers with experience in using LDCT screening protocols.

Ovarian Cancer

Ovarian cancer is the leading cause of death from gynecologic malignancy in the United States. The strongest known risk factor for ovarian cancer is a family history. We suggest periodically screening women with a familial ovarian cancer syndrome, who have not undergone prophylactic oophorectomy, with a combination of CA 125 and transvaginal ultrasound. SOG and NCCN recommends screening these women every six months beginning between ages of 30 and 35 years.

We recommend NOT screening average-risk women for ovarian cancer.

Endometrial Cancer

Benefits of screening for individuals at average risk for endometrial, ovarian and lung cancer have not yet been proven, and screening is therefore not recommended. The following are related conditions to consider:

  • Women with hereditary non-polyposis colorectal cancer – Annual endometrial biopsy is recommended beginning at age 35.

Contact Dr. Gabriel Carabulea for the most recent changes/recommendations by USCSTF.

F. Martin

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