cancer screening guidelines

8/8/2019 Cancer Screening Guidelines

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Cancer Screening

Guidelines

Prepared by: DR. Hanan

Abbas



Several studies show that primary care physicians do not always comply with

cancer screening guidelines.

One reason is that recommendations for cancer detection and screening are often

fragmented, developed by different organizations, which make decisionmaking difficult as whichrecommendations to follow.



B reast Cancer

Breast cancer ranks 2nd cause of cancer

related deaths in women.

Numerous clinical trials have evaluated

the benefits of the three most commonly

recommended screening tests:

Mammography , breast self exam, and

clinical breast exam.



Screening Recommendations

for Low Risk Pts

CTF PH C recommend screening by

mammography every year in women ages50-69.

E vidence suggests that such screening is

associated with a significant decrease inmortality in this age group.



US P S TF recommends mammography

every one to two years, with or without

clinical breast exam, in women ages 50-

69.



T he American Cancer Society ( AC S )

recommends mammography annually

after age 40, clinical breast exam is

recommended every 3 years in women

between 20 & 39 years of age and

annually after age 40 .



Cervical Cancer T here is a consensus among medical

organizations for regular cervical cancer

screening with papanicolaou (Pap )tests inwomen who have ever been sexuallyactive.

CTF PH C recommends annual screening with a Pap test and pelvic examination inall women who are or who have been sexually active or who are 18 years and

older .



CTF PH C recommends Pap tests every

three years until the age of 69.



T he frequency may be increased if any risk

factors are present including age 18 or

younger at the time of first sexual intercourse, having numerous sexual

partners, smoking or having a low

socioeconomic status.

US P S TF recommend Pap tests at least

every 3 years for all women who have ever

had sexual intercourse and who have a

cervix.



A Pap test every one or two years as compared

with every 3 years has been found to improve

the screening effectiveness by less than 5 %.

US P S TF recommends discontinuing regular

pap testing after age 65 in women who have

had consistently normal results on previoustests.



US P S TF recommendations state that

pap testing is not required in women who

have undergone a hysterectomy in which

the cervix was removed .



Colorectal C ancer

I t is the third most common cancer.

High risk pts include pts younger than 60 years with a history of hereditary

nonpolyposis colorectal cancer, familial

polyposis, ulcerative colitis, high risk

adenomatous polyps or previous

colorectal cancer.



S creening Recommendati ons f or Low

Risk Pts

US P S TF recommends fecal occult blood testing ( FOBT ) yearly beginning at age 50.

Sigmoidoscopy screening is also suggested as an alternative to ( FOBT ) but with norecommended frequency.

US P S TF concludes that there is insufficient evidence to support screening with thedigital rectal exam ( DRE ) , barium enema,or colonoscopy.



CTF PH C states that there is insufficient

evidence to recommend use of ( FOBT )

screening, sigmoidoscopy or colonoscopy in

the general population older than age 40.



S creening Recommendati ons f or

High Risk Pts

US P S TF recommends regular endoscopic screening in pts with a family history of

hereditary syndromes associated with ahigh risk of colon cancer (familial polyposisand hereditary non polyposis rectal cancer ) and in pts with ulcerative colitis, high risk

adenomatous polyps or colon cancer.

Referral to sub specialist is appropriate in such cases.



End ometrial C ancer

I ncidence rates are higher among white

women(22.4/ 100.000 ) than among black

women (15.3/ 100.000 ).

T he incidence of endometrial cancer

increases with age, peaking at

100.7/100.000 women between the ages of 70& 75.




Risk Pts

CTF PH C and US P S TF have not issued any

recommendations for endometrial cancer

screening such as biopsy or ultrasound in

women at low risk of this disease.




High Risk Pts

AMERI C AN C AN C ER S OC IE TY (AC S)

recommends endometrial biopsy starting at

menopause and then periodically at thediscretion of the physician in women at high

risk of endometrial cancer.



Lung cancer

Lung cancer is a leading cause of death in men

and women accounting for 28 % of all cancer

related deaths.

T he five year survival rate is estimated to be

less than 13%.




Risk Pts

T here is no evidence that screening for lung

cancer is effective.

Cytological exam of the sputum has not

proven useful.

Consequently, US P S TF does not

recommend screening with chest

radiographs or sputum cytology. US P S TF

advises physicians to counsel against

tobacco use.




High Risk Pts

According to CTF PH C and US P S TF , the

evidence is strong that periodic screening with

chest radiographs in high risk pts does not reduce mortality from lung cancer.

Radiography and sputum cytomorphologic

exam lack sufficient accuracy to be used inroutine screening of pts with a history of

smoking.



Ovarian C ancer

Ovarian cancer is the second most common gynecologic cancer.

A women has a one in 70 risk of ovariancancer in her lifetime.

T he incidence of ovarian cancer increases withage, from 1.4 cases /100.00 in women younger

than age 40 to 45 cases / 100.000 in womenolder than 60 years.

Ovarian cancer is the most lethal of all the gynecologic cancers.




Risk Pts

T he effectiveness of routine screening of

asymptomatic women using pelvic exam,

abdominal or vaginal ultrasound or serumcarcinoembryonic antigen ( C EA-125 ) has not

yet been established.

CTF PH

C , US P S

TF do not recommend

routine screening for ovarian cancer.

AC S recommends annual pelvic exam starting

at age 18 or when the women become sexually

active.




High Risk Pts ACS states that women with a high risk of

epithelial ovarian cancer, such as those with avery strong family history of the disease, may be

screened with transvaginal ultrasound and C E A-125.

C TF PHC indicates that evidence is insufficient to recommend for or against ovarian cancer

screening in women who have more than one first-degree relative with the disease.3

Only 5 to 10 percent of patients with ovariancancer have a significant family history. F amilial syndromes have been identified: site-

specific ovarian cancer, familial breast-ovarian



I n 1980, a tumor suppression gene ( B RCA 1 )

was discovered on chromosome 17. T he B RCA 1

mutation is associated with site-specific ovariancancer and familial breast-ovarian cancer

syndromes. T hese syndromes are transmitted in

an autosomal dominant fashion with variable

penetrance. Women with certain mutations in B RCA 1 have an increased risk of ovarian

cancer and breast cancer. T he cumulative risk

of ovarian cancer in women with B RCA 1 has

been estimated to be 56 % by age 70.



A task force organized by the N I H and the

National Human Genome Research I nstitute

recommends ovarian cancer screening bymeans of annual or semiannual transvaginal

ultrasound and serum C E A-125 levels

beginning at ages 25 to 35 in B RCA 1 mutation

carriers.



Pr ostate C ancer

I t is the second leading cause of cancer-related

deaths in men. T he incidence of prostate

cancer rises rapidly in each decade of life after the age of 50.

I n whites, the age-adjusted incidence is 108.3

cases per 100,000; in blacks, it is 142.0 per 100,000.

Prostate cancer occurs more frequently among

men with a family history of prostate cancer.



F or many years, DRE has been one of the

major screening methods for the detection of

prostate cancer, although its true value as a screening tool has never been proven

conclusively. T he majority of studies on the use

of DRE for prostate cancer screening have

been observational and have yielded varying

measures of sensitivity and survival. None

have shown that regular DR E screening

reduces mortality from prostate cancer.



Currently, use of the serum prostate-specificantigen ( P S A ) test as a screening tool for

prostate cancer is controversial. One problemis that the P S A test is prone to high rates of

false-positive results, ranging from 67 to 93 %,which leads to more invasive diagnostic

procedures than are necessary.3 Data also suggest that P S A screening detects what maybe indolent, nonaggressive prostate cancer.T he treatment of such a cancer with radiation

or radical prostatectomy may result in




Low-Risk Patients

T here is no consensus for using P S A to screenlow-risk patients.

Citing insufficient evidence in support of DRE and P S A screening, CTF PH C and US P S TF do not recommend routine DRE or P S A

screening for asymptomatic men.

ACS recommends offering annual DRE and P S A screening, beginning at age 50 in menwho have at least a 10-year life expectancyand beginning at a younger age in men at high

risk.




High Risk Pts

ACS recommends annual testing of high-risk

patients beginning at age 45.

High-risk patients include African-Americans

and patients who have two or more first-

degree relatives with prostate cancer.



T esticul ar C ancer

T esticular cancer represents 1.1 percent of

cancers among men.

T he lifetime probability of developing

testicular cancer is 0.30 % and the lifetime

probability of dying of this disease is 0.03 %.

I t is the most common cancer in males ages 15to 34.




Low-Risk Patients

CTF PH C and US P S TF state that there is

insufficient evidence to indicate that screening

(either with testicular self-examination or by a primary care physician ) would result in a

decrease in the mortality rate from this cancer.

ACS advises a testicular examination as part of a routine cancer-related checkup.




High-Risk Patients AC S and CTF PH C recommend that

individuals at increased risk of testicular

cancer, such as those with testicular atrophy,ambiguous genitalia or cryptorchidism, beinformed of their increased risk and counseled regarding screening options.

While AC S suggests monthly examinations inhigh-risk patients, CTF PH C indicates that theoptimal frequency of such examinations hasnot been determined and should be left to

clinical discretion.

cancer screening guidelines

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