• University of Michigan Health System. Adult preventive health care: cancer screening. Ann Arbor (MI): University of Michigan Health System; 2004 May. 12 p. [4 references]

This is the current release of the guideline.

Note from the National Guideline Clearinghouse (NGC): The following key points summarize the content of the guideline. Refer to the original guideline document for additional information.

The levels of evidence [A–D] are defined at the end of the "Major Recommendations" field.

Breast Cancer Screening:

• Modality. Mammogram. Evidence is insufficient to recommend for or against clinical breast exam and breast self examination.
• Initiate.
  • Average risk. Recommend screening mammography for women age 40 and older. Evidence for mortality reduction is strongest for women aged 50 and older [A]. Evidence is weaker and absolute benefit of mammography is smaller for women age 40 to 49.
  • High risk. Women at increased risk of breast cancer (see Table 1 in the original guideline document) may benefit from earlier screening and discussion of risk reduction strategies [D].
• Frequency. Little evidence is available regarding frequency of screening. Most experts recommend mammography either annually or every 1 to 2 years [D].
• Terminate. Consider screening depending on life expectancy (even for women over 69) [D].

Cervical Cancer Screening:

• Modality. Papanicolaou (Pap) smear of cervical cells or liquid based cervical cytology (ThinPrep®).
• Initiate. Start within 3 years after onset of vaginal intercourse [B] or at age 21 for women who are not sexually active [D]. Women who have undergone a total hysterectomy do not require screening unless the hysterectomy was performed because of cervical cancer or its precursors [C].
• Frequency.
  • Low risk. Annually with conventional Pap smears or every two years using the ThinPrep until age 30. Starting at age 30, women who have had three consecutive technically satisfactory normal or negative cytology results may be screened every two to three years [C] (see original guideline document for details).
  • High risk. Screen annually [D].
• Terminate. Screening may be discontinued in women past age 65 (as recommended by the United States Preventive Services Task Force) or age 70 (as recommended by the American Cancer Society and the National Comprehensive Cancer Network) who have at least three normal or negative smears in the past 10 years and no previous history of cervical abnormality [C].

Colon Cancer Screening:

• Modality. Recommended methods include: fecal occult-blood testing (FOBT), flexible sigmoidoscopy (FS), or colonoscopy. (Digital rectal exam is not effective in screening for colorectal cancer.)
• Initiate. For average risk, asymptomatic patients, screening should begin at age 50.
• Frequency.
  • Average risk. FOBT: annually [A]. FS: every 5 years [A]. FOBT/FS: annually/every 5 years [B]. Colonoscopy: every 10 years [B]. Air or double-contrast barium enema (acceptable modality, but not recommended): every 5 years [B]. The frequency of screening has not been adequately evaluated in clinical trials.
  • High risk. Patients at increased risk of colorectal cancer should undergo more aggressive screening; details of screening vary based upon the nature of the increased risk.
• Terminate. No definite age cutoff exists for discontinuing screening.

Prostate Cancer Screening:

• Modality. Prostate-specific antigen (PSA) and digital rectal examination. Both have specificity limitations.
• Initiate. Clinicians who screen for prostate cancer should share decision making with patients [A], giving objective information about the potential risks and benefits of screening.
  • Average risk. For men >age 50, consider initiating PSA screen.
  • High-risk. For men with positive family history and for African Americans, consider starting PSA screening at age 40 [D].
• Frequency. Annually
• Terminate. Stop when life expectancy is less than 10 to 15 years [C].

Definitions:

Levels of Evidence

1. Randomized controlled trials
2. Controlled trials, no randomization
3. Observational trials
4. Opinion of expert panel

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Conclusions were based on prospective randomized clinical trials (RCTs) if available, to the exclusion of other data; if RCTs were not available, observational studies were admitted to consideration. If no such data were available for a given link in the problem formulation, expert opinion was used to estimate effect size.

• University of Michigan Health System. Adult preventive health care: cancer screening. Ann Arbor (MI): University of Michigan Health System; 2004 May. 12 p. [4 references]

Not applicable: The guideline was not adapted from another source.

2004 May

University of Michigan Health System - Academic Institution

University of Michigan Health System

Adult Preventive Guideline Team

Team Members: Connie J. Standiford, MD, General Medicine; Steven J. Bernstein, MD, General Medicine; Sandeep Vijan, MD, General Medicine; Mack T. Ruffin, MD, Family Medicine; R. Van Harrison, PhD, Medical Education

Consultants: Daniel F. Hayes, MD, Breast Oncology; Mark A. Helvie, MD, Breast Radiology; James E. Montie, MD, Urology; R. Kevin Reynolds, MD, Obstetrics and Gynecology; Philip S. Schoenfeld, MD, Gastroenterology

Guidelines Oversight Team: Connie J. Standiford, MD; Lee A. Green, MD, MPH; R. Van Harrison, PhD

The University of Michigan Health System endorses the Guidelines of the Association of American Medical Colleges and the Standards of the Accreditation Council for Continuing Medical Education that the individuals who present educational activities disclose significant relationships with commercial companies whose products or services are discussed. Disclosure of a relationship is not intended to suggest bias in the information presented, but is made to provide readers with information that might be of potential importance to their evaluation of the information.

Team Member/Consultant; Relationship; Company

Steven J Bernstein, MD (none)
R Van Harrison, PhD (none)
Daniel F Hayes, MD (none)
Mark A Helvie, MD (none)
James E Montie, MD (none)
R Kevin Reynolds, MD (none)
Mack T Ruffin, MD (none)
Philip S Schoenfeld, MD (none)
Connie J Standiford, MD (none)
Sandeep Vijan, MD (none)

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on October 12, 2004. The information was verified by the guideline developer on October 22, 2004.

This NGC summary is based on the original guideline, which is copyrighted by the University of Michigan Health System (UMHS).