Management

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Screening - General Population

Numerous professional organizations have published cancer screening guidelines for practicing physicians to follow. Many similarities exist among the recommendations; however, complete agreement between the professional organizations does not exist. The website for the American Academy of Family Physicians hosts a page summarizing screening guidelines from most major medical organizations.


For early detection of cancer in people without cancer symptoms, the American Cancer Society (ACS) recommends that people from ages 20 to 39 have a cancer-related checkup every 3 years. The ACS also recommends that people age 40 and older have a similar checkup annually. The checkup should include the procedures listed below, health counseling (smoking cessation, physical fitness plan, etc.), and examinations for cancers of the thyroid, testes, prostate, oral region, ovaries, skin, and lymph nodes. The guidelines outlined below may be found in their entirety at ACS.


Breast

  • Monthly breast self-examination for women 20 and older
  • Clinical breast examination every 3 years for women 20 to 39
  • Annual clinical breast examination for women 40 and older
  • Annual mammography for women 40 and older


Cervical

  • Annual conventional Pap test or liquid-based Pap test every 3 years for women starting 3 years after becoming been sexually active, but no later than age 21

  • Pap test may be performed every 2 to 3 years for women age 30 and older who have had at least 3 consecutive normal Pap tests

  • Pap test may be discontinued in women who undergo a total hysterectomy and in women who are 70 years and older who have had 3 normal Pap tests in the last 10 years


Colorectal

  • Annual fecal occult blood tests OR
  • Flexible sigmoidoscopy every 5 years OR
  • Combination of fecal occult blood tests and flexible sigmoidoscopy every 5 years OR
  • Colonoscopy every 10 years OR
  • Double-contrast barium enema every 5 years

Colorectal cancer screening is recommended for men and women 50 and older.


Endometrial

Women should be informed about the risks and symptoms of endometrial cancer and should be asked about any unexpected bleeding or spotting.


Prostate

  • Annual Prostate-Specific Antigen (PSA) test for men age 50 and older
  • Annual digital rectal examination (DRE) for men age 50 and older

Both PSA and DRE should be offered at age 45 to men who are at high risk (African-Americans or those with a strong family history).