Cancer Screening – What Is New and What Is Old

Staying healthy as we age requires a team effort between you and your physician.

Recent news regarding cancer screenings states when you should be checked for certain cancers. Some reports suggest that cancer screenings performed unnecessarily can be costly, even leading to disability.

Most recently, prostate specific antigen (PSA) testing for prostate cancer has been revisited and refined (see below).

Cancer kills many Americans, many of whom are older than 65. The largest cause of death from cancer in both men and women is lung cancer, a disease for which there is no reliable screening method.  Screening methods are available for the next two major killers — breast and colon in women and prostate and colon in men. 

Following are the published guidelines advocated by the American Cancer Society. 
Please remember that unnecessary testing can cause undesirable effects, so only do what is optimal for you. Most screenings are covered by Medicare. 

BREAST CANCER

2003 - Present *,**	Breast Self Exam (BSE)	Over 20	Optional. Women should be told about benefits and limitations of BSE. They should report any new symptoms to their health care professional.
	Clinical breast exam (CBE)	20 - 39	Part of a periodic health exam, preferably every three years
		Over 40	Part of a periodic health exam, preferably every year
	Mammogram	Over 40	Yearly, continuing for as long as a woman is in good health

 
*May 2003 - May 2007: Women at increased risk (family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (breast ultrasound, MRI), or having more frequent exams.

**May 2007 - Present: 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%.

CERVICAL CANCER

2003 - Present	Pap Test	Start 3 years after first vaginal intercourse but no later than 21	Yearly with conventional Pap test or every 2 years with liquid-based Pap test
		Over 30	After 3 normal results in a row, screening can be every 2 – 3 years. An alternative is a Pap test plus HPV DNA testing every 3 years.*
		Over 70	After 3 normal Pap smears in a row within the past 10 years, women may choose to stop screening**
	Pelvic Exam	Not specified	Discuss with health care provider

*Doctors may suggest a woman be screened more often if she has certain risk factors, such as a history of DES exposure, HIV infection, or a weak immune system
**Women with a history of cervical cancer, DES (diethylstilbestrol) exposure, or who have a weak immune system should continue screening as long as they are in reasonably good health

COLON AND RECTAL CANCER

March 2008 – Present	Follow one of these schedules2:
	Flexible sigmoidoscopy3	Over 50	Every 5 years
	Colonoscopy	Over 50	Every 10 years
	Double-contrast barium enema (DCBE)3	Over 50	Every 5 Years
	CT colonography (virtual colonoscopy)3	Over 50	Every 5 Years
	Fecal occult blood test (FOBT)**,3	Over 50	Yearly
	Fecal immunochemical test (FIT)**,3	Over 50	Yearly
	Stool DNA test3	Over 50	Interval uncertain

*A digital rectal exam should be done at the same time as sigmoidoscopy, colonoscopy, or DCBE.
**For FOBT or FIT, 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.
***Yearly FOBT or FIT plus flexible sigmoidoscopy every 5 years is preferred over either option alone.
¹ The fecal immunochemical test (FIT) was adopted as part of the ACS guidelines in 2003.
² The first 4 tests (flexible sigmoidoscopy, colonoscopy, DCBE, and CT colonography) are designed to find both early cancer and polyps. The last 3 tests (FOBT, FIT, and Stool DNA test) will primarily find cancer and not polyps. The first 4 tests are preferred if they are available to you and you are willing to have one of these more invasive tests.
³ If test results are positive, colonoscopy should be done.

PROSTATE CANCER

2009 – 2010+	Health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing and offer the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE). 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).	Over 50 (average risk)	Discussion and offer of testing should be done yearly for men with at least a 10-year life expectancy
		Over 45 (high risk**)	Discussion and offer of testing should be done yearly***
2010 - present	Men should have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. After the discussion about screening, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.	50 and over (average risk)	Discussion at age 50 for men with at least a 10-year life expectancy and then periodically. If PSA is 2.5 ng/ml or greater, testing should be repeated yearly. Men with a PSA of less than 2.5 ng/ml may be tested every other year.
		45 and over (high risk**)	Discussion at age 45 for men with at least a 10-year life expectancy and then periodically. If PSA is 2.5 ng/ml or greater, testing should be repeated yearly. Men with a PSA of less than 2.5 ng/ml may be tested every other year.****

*High risk defined as African-American men or those with a strong family history - that is, those with 2 or more affected first-degree relatives (father, brother, son).
**High risk defined as African-American men or those with a strong family history of 1 or more first-degree relatives (father, brothers) diagnosed at an early age (younger than 65).
***Men at even higher risk, due to several close relatives affected at an early age, should have this discussion with their health care professional at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.
**** Men at even higher risk, due to several close relatives affected at an early age, should have this discussion with their health care professional at age 40. If PSA is 2.5 ng/ml or greater, testing should be repeated yearly. Men with a PSA of less than 2.5 ng/ml may be tested every other year.
+NOTE: This represents a language clarification, not a change in the guidelines, as the previous language was often misinterpreted.

From: http://www.cancer.org/docroot/home/index.asp