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Cancer Screening
Guidelines
Prepared by: DR. Hanan
Abbas
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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.
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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.
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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.
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US P S TF recommends mammography
every one to two years, with or without
clinical breast exam, in women ages 50-
69.
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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 .
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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 .
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CTF PH C recommends Pap tests every
three years until the age of 69.
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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.
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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.
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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 .
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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.
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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.
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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.
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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.
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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.
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S creening Recommendati ons f or Low
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.
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S creening Recommendati ons f or
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.
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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%.
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S creening Recommendati ons f or Low
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.
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S creening Recommendati ons f or
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.
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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.
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S creening Recommendati ons f or Low
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.
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S creening Recommendati ons f or
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
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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.
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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.
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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.
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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.
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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
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S creening Recommendati ons f or
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.
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S creening Recommendati ons f or
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.
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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.
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S creening Recommendati ons f or
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.
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S creening Recommendati ons f or
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.
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