Screenings

There are tests, called screening examinations, that are used to find a disease such as cancer in people who do not have any symptoms. Screening tests offer the best opportunity to detect cancer at an early stage when successful treatment is likely.

Click on the links below to learn about recommended screening tests for certain cancer sites from the American Cancer Society Guidelines for the Early Detection of Cancer:

• Breast Cancer
• Cervical Cancer
• Colon and Rectal Cancer
• Prostate
• Uterine Cancer

Breast Cancer

• 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
• 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.
• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
• 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

The goal of screening for cervical cancer is to find cervix cell changes and early cervical cancers before they cause symptoms. Screening tests offer the best opportunity to detect cervical cancer at an early stage when successful treatment is likely, and to actually prevent most cervical cancers by detection and treatment of abnormal cervix cell changes before they have a chance to turn into a cervical cancer.

A regular Pap tests is one of the best and proven steps you can take to prevent cervical cancer or detect it early. The Pap test looks for changes in the cervix that might lead to cancer. If it is detected early, cervical cancer is one of the most successfully treatable cancers. Changes in the cervix are often caused by a virus called HPV, which is short for human papilloma virus. HPV infections can lead to cervical cancer. The most important message for women is to have regular Pap tests to help prevent cancer of the cervix from ever occurring.

The American Cancer Society recommends the following guidelines for early detection:

• All women should begin cervical cancer screening about three 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 two years using the newer liquid-based Pap test.
• Beginning at age 30, women who have had three 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 three 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 three 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.

Some women believe that they do not need exams by a health care professional once they have stopped having children. This is not correct. They should continue to follow American Cancer Society guidelines.

Although the Pap test has been more successful than any other screening test in preventing a cancer, it is not perfect. One of its limitations is that Pap tests are examined by humans, so an accurate analysis of the hundreds of thousands of cells in each sample is not always possible. Engineers, scientists and doctors are working together to improve this test. Because some abnormalities may be missed (even when samples are examined in the best laboratories), it is not a good idea to have this test less often than American Cancer Society guidelines recommend.

Colon and Rectal Cancer

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

• yearly fecal occult blood test (FOBT)* or fecal immunochemical test (FIT)
• flexible sigmoidoscopy every five years
• yearly FOBT* or FIT, plus flexible sigmoidoscopy every five years**
• double-contrast barium enema every five years
• colonoscopy every 10 years

*For FOBT, the take-home multiple sample method should be used.

**The combination of yearly FOBT or FIT flexible sigmoidoscopy every five years is preferred over either of these options alone.

All positive tests should be followed up with colonoscopy.

People should talk to their doctor about starting colorectal cancer screening earlier and/or undergoing 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 [parent, sibling or child] younger than 60 or in two first-degree relatives of any age)
• a personal history of chronic inflammatory bowel disease
• a family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)

Prostate Cancer

Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy.

Digital Rectal Exam (DRE): During a digital rectal exam (DRE), a physician inserts a gloved finger into the rectum to assess the texture and size of the prostate.

PSA Blood Test: Prostate-specific antigen (PSA) is a protein that is normally secreted and disposed of by the prostate gland. High PSA levels may indicate the presence of prostate cancer cells or other noncancerous prostate conditions.

HIGH RISK

Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives [father, brothers] diagnosed before age 65) should begin testing at age 45. 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.

Information should be provided to all men about what is known and what is uncertain about the benefits, limitations and harms of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

Endometrial (Uterine) Cancer

Periodic gynecologic evaluation is crucial for the early detection of 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.