Cancer Detection Guidelines

The American Cancer Society recommends that both men and women get a cancer-related checkup during a regular doctor's checkup. It should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures.

Breast Cancer Screening

• A clinical breast exam and mammogram should be used for routine breast cancer screening.
• Breast cancer screening (clinical breast exam and mammogram) should be initiated for women who are not at high risk at age 40.
• At age 20 and older, all women should practice monthly self-breast exam.
• Evidence supports annual screening for women of average risk starting at age 40.
• Since the evidence of the effectiveness of screening is well established for women 75 years of age or older, consideration of health status and anticipated benefits versus risks are particularly relevant to the screening decision among older women.

Colon and Rectum Cancer Screening
Beginning at age 50, both men and women should follow one of these five testing schedules:

• Yearly fecal occult blood test (FOBT)*
• Flexible sigmoidoscopy every 5 years
• Yearly fecal occult blood test plus flexible sigmoidoscopy every 5 years**
• Double-contrast barium enema every 5 years
• Colonoscopy every 10 years
  
  *For FOBT, the take-home multiple sample method should be used.
  **The combination of FOBT and flexible sigmoidoscopy is preferred over either of these two tests alone.

All positive tests should be followed up with colonoscopy.

People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors.

• a personal history of colorectal cancer or adenomatous polyps
• a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative younger than 60 or in two first-degree relatives of any age) Note: a first degree relative is defined as a parent, sibling, or child.
• a personal history of chronic inflammatory bowel disease
• a family history of hereditary colorectal cancer syndromes (familial adenomatous polyposis and hereditary non-polyposis colon cancer).

Cervical Cancer Screening
All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.

Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the conventional (regular) or liquid-based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection,or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.

Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.

Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.

Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

Endometrial Cancer Screening
The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors.

Prostate Cancer Screening
Both prostate-specific antigen (PSA) testing and digital rectal examination (DRE) should be conducted annually, beginning at age 50 years, to men who have at least a 10-year life expectancy. Men at high risk should begin testing at age 45 years. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.

• Men who choose to undergo testing should begin at age 50 years. However, men in high-risk groups, such as African Americans and men who have a first-degree relative diagnosed with prostate cancer at a young age, should begin testing at 45 years. Note: a first-degree relative is defined as a father, brother, or son.
• Testing for prostate cancer in asymptomatic men can detect tumors at a more favorable stage (anatomic extent of disease). There has been a reduction in mortality from prostate cancer, but it has not been established that this is a direct result of screening.
• An abnormal Prostate-Specific Antigen (PSA) test result has been defined as a value of above 4.0 ng/ml. Some elevations in PSA may be due to benign conditions of the prostate.