The following cancer screening guidelines are recommended for those
people at average risk for cancer (unless otherwise specified) and
without any specific symptoms.
People who are at increased risk for certain cancers may need
to follow a different screening schedule, such as starting at an
earlier age or being screened more often. Those with symptoms that
could be related to cancer should see their doctor right away.
Cancer-related checkup
For people aged 20 or older having periodic health exams, a
cancer-related checkup should include health counseling, and depending
on a person's age and gender, might include exams for cancers of the
thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well
as for some non-malignant (non-cancerous) diseases.
Special tests for certain cancer sites are recommended as
outlined below.
Breast cancer
- Yearly
mammograms are recommended starting at age 40 and continuing for as
long as a woman is in good health.
- Clinical breast exam (CBE) should be part of a periodic
health exam, about every 3 years for women in their 20s and 30s and
every year for women 40 and over.
- Women should know how their breasts normally feel and
report any breast change promptly to their health care providers.
Breast self-exam (BSE) is an option for women starting in their 20s.
- Women at high risk (greater than 20% lifetime risk) should
get an MRI and a mammogram every year. Women at moderately increased
risk (15% to 20% lifetime risk) should talk with their doctors about
the benefits and limitations of adding MRI screening to their yearly
mammogram. Yearly MRI screening is not recommended for women whose
lifetime risk of breast cancer is less than 15%.
Colon and rectal cancer
Beginning at age 50, both men and women at average risk for
developing colorectal cancer should use one of the screening tests
below. The tests that are designed to find both early cancer and polyps
are preferred if these tests are available to you and you are willing
to have one of these more invasive tests. Talk to your doctor about
which test is best for you.
Tests that find polyps and cancer
- flexible sigmoidoscopy every 5 years*
- colonoscopy every 10 years
- double contrast barium enema every 5 years*
- CT colonography (virtual colonoscopy) every 5 years*
Tests that mainly find cancer
- fecal occult blood test (FOBT) every year*,**
- fecal immunochemical test (FIT) every year*,**
- stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are
positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample
method should be used. A FOBT or FIT done during a digital rectal exam in the
doctor's office is not adequate for screening.
People should talk to their doctor about starting colorectal
cancer screening earlier and/or being screened more often if they have
any of the following colorectal cancer risk factors:
- a personal history of colorectal cancer or adenomatous
polyps
- a personal history of chronic inflammatory bowel disease
(Crohns disease or ulcerative colitis)
- a strong family history of colorectal cancer or polyps
(cancer or polyps in a first-degree relative [parent, sibling, or
child] younger than 60 or in 2 or more first-degree relatives of any
age)
- a known family history of hereditary colorectal cancer
syndromes such as familial adenomatous polyposis (FAP) or hereditary
non-polyposis colon cancer (HNPCC)
Cervical cancer
- 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. 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 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.
- 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 pre-cancer. Women who have had a hysterectomy without removal
of the cervix should continue to follow the guidelines above.
Endometrial (uterine) cancer
The American Cancer Society recommends that at the time of
menopause, 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. For women with or at high risk
for hereditary non-polyposis colon cancer (HNPCC), annual screening
should be offered for endometrial cancer with endometrial biopsy
beginning at age 35.
Prostate cancer
The American Cancer Society (ACS) does not support routine
testing for prostate cancer at this time. ACS does believe that health
care professionals should discuss the potential benefits and
limitations of prostate cancer early detection testing with men before
any testing begins. This discussion should include an offer for testing
with the prostate-specific antigen (PSA) blood test and digital rectal
exam (DRE) yearly, beginning at age 50, to men who are at average risk
of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be
tested. Men should actively take part in this decision by learning
about prostate cancer and the pros and cons of early detection and
treatment of prostate cancer.
This discussion should take place starting at age 45 for men
at high risk of developing prostate cancer. This includes African
American men and men who have a first-degree relative (father, brother,
or son) diagnosed with prostate cancer at an early age (younger than
age 65).
This discussion should take place at age 40 for men at even
higher risk (those with several first-degree relatives who had prostate
cancer at an early age).
If, after this discussion, a man asks his health care
professional to make the decision for him, he should be tested (unless
there is a specific reason not to test).
References
American Cancer Society. Cancer
Facts & Figures 2008. Atlanta, Ga: American Cancer
Society; 2008.
Levin B, Lieberman DA, McFarland, et al. Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Published online March 5, 2008. CA Cancer J Clin. 2008;58.
Saslow D, Boetes C, Burke W, et al for the American Cancer
Society Breast Cancer Advisory Group. American Cancer Society
guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin.
2007;57:75-89.
Revised: 03/05/2008
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