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The following tables give the history of cancer detection
tests
that have been recommended by the American Cancer Society for people
who are at
average risk for cancer (unless otherwise specified) and do not have
any
specific symptoms.
People who are at increased
risk for certain cancers may need to follow
a different testing schedule, such as starting at an earlier age or
being tested more often. Those with symptoms that could be related to
cancer should see their doctor right away.
This is not meant to be an official document for American
Cancer
Society recommendations.
Breast cancer (women)
|
Dates
|
Test
|
Age
|
Frequency
|
|
Pre 1980
|
Breast self-exam (BSE)
|
Start during high school years
|
Monthly
|
|
Clinical breast exam (CBE)
|
Over 20
|
"Periodically"
|
|
Mammogram
(starting in 1976)
|
35 – 39
|
Only if personal
history of breast cancer |
|
40 – 49
|
May have mammogram if they or their
mother or sisters had breast cancer
|
|
Over 50
|
May have mammograms yearly
|
| |
|
1980 – 1982
|
Breast self-exam (BSE)
|
Start during high school years
|
Monthly
|
|
Clinical breast exam
(CBE)
|
20 – 39
|
Every 3 years |
|
Over 40
|
Yearly |
|
Mammogram
|
35
– 39 |
Baseline mammogram |
| 40
– 49 |
Consult personal
physician |
| Over
50 |
Yearly |
| |
|
1983 – 1991
|
Breast self-exam (BSE)
|
Over 20
|
Monthly
|
|
Clinical breast exam
(CBE)
|
20 – 39
|
Every 3 years |
|
Over 40
|
Yearly |
|
Mammogram
|
35
– 39 |
Baseline mammogram |
| 40
– 49 |
Every 1
– 2 years |
| Over
50 |
Yearly |
| |
1992 –
March 1997 |
Breast
self-exam
(BSE) |
Over
20 |
Monthly |
Clinical breast exam
(CBE) |
20
– 39 |
Every 3 years |
| Over
40 |
Yearly |
| Mammogram |
40
– 49 |
Every 1
– 2 years |
| Over
50 |
Yearly |
| |
March 1997 –
May 2003 |
Breast
self-exam
(BSE) |
Over
20 |
Monthly |
Clinical
breast exam
(CBE) |
20
– 39 |
Every 3 years |
| Mammogram |
Over
40 |
Yearly |
| Over
40 |
Yearly |
| |
|
May 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 3 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 (women)
|
Dates
|
Test
|
Age
|
Frequency
|
|
Pre 1980
|
Pap test
|
Not specified
|
As part of a
regular checkup |
| |
|
1980 – 1987
|
Pap test
|
Over 20; under 20
if sexually active
|
Yearly, but after 2 negative exams 1
year apart, at least every 3 years
|
|
Pelvic exam
|
20 – 39
|
Every 3 years
|
|
Over 40
|
Yearly |
| |
|
1987 – 2002
|
Pap test
|
18 & over or sexually
active
|
Yearly, but after 3 consecutive
normal exams, less frequently at the discretion of the doctor
|
|
Pelvic exam
|
18 & over or sexually
active
|
Yearly |
| |
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 rectum cancer (men &
women)
|
Dates
|
Test
|
Age
|
Frequency
|
|
Pre 1980
|
Proctosigmoidoscopy
|
Over 40
|
As part of a
regular checkup |
|
1980 – 1989
|
Digital Rectal exam
(DRE)
|
Over 40
|
Yearly, but after 2 negative exams 1
year apart, at least every 3 years
|
|
Fecal occult blood test
(FOBT)
|
Over 50
|
Every 3 years
|
|
Proctosigmoidoscopy
|
Over 70
|
Yearly |
| |
|
1989 – 1997
|
Digital Rectal exam
(DRE)
|
Over 40
|
Yearly
|
|
Fecal occult blood test
(FOBT)
|
Over 50
|
Yearly |
|
Sigmoidoscopy
(preferably flexible)
|
Over 50
|
Every 3 to 5
years, based on advice of physician |
| |
| 1997 – 2001 |
Follow 1 of these 3 schedules*: |
|
Fecal occult blood test
AND
Flexible sigmoidoscopy
|
Over 50
|
Every 5 years
|
|
Colonoscopy
|
Over 50
|
Every 10 years |
|
Double-contrast barium enema (DCBE)
|
Over 50
|
Every 5 to 10
years |
| |
| 2001 – 2008 |
Follow 1 of these 5 schedules*: |
|
Fecal occult blood test
(FOBT)** or
Fecal immunochemical test1 (FIT)***
|
Over 50
|
Yearly |
|
Flexible sigmoidoscopy***
|
Over 50
|
Every 5 years |
|
FOBT** or FIT1
AND
Flexible sigmoidoscopy***
|
Over 50
|
Yearly
Every 5 years
|
|
Colonoscopy
|
Over 50
|
Every 10 years |
|
Double-contrast barium enema (DCBE)
|
Over 50
|
Every 5 years |
| 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.
1The 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.
3If test results are positive, colonoscopy
should be done.
Endometrial cancer (women) - see also
cervical cancer.
|
Dates
|
Test
|
Age
|
Frequency
|
|
Pre 1980
|
Pap test
|
Not specified
|
As part of a regular checkup
|
|
Pelvic exam
|
At menopause
|
Not specified
|
|
Endometrial tissue sample
|
At menopause
(only in those at high risk*)
|
Not specified |
| |
|
1980 – 1987
|
Pap test
|
Over 20; under 20
if sexually active
|
Yearly, but after 2 negative exams 1
year apart, at least every 3 years
|
|
Pelvic exam
|
Over 40
|
Yearly |
|
Endometrial tissue sample
|
At menopause
(only in those at high risk*)
|
Not specified |
| |
| 1987 – 1992 |
(Pap test recommendations were separated out as
screening for cervical cancer. See above.) |
|
Pelvic exam
|
Over 40
|
Yearly
|
|
Endometrial tissue sample
|
At menopause
(only in those at high risk*) |
Not specified |
| |
| 1992 – 2001 |
|
Pelvic exam
|
Over 40
|
Yearly
|
|
Endometrial tissue sample
|
At menopause
(only in those at high risk*) |
At the discretion
of the physician |
| |
|
2001 –
Present
|
|
At menopause
(average risk)
|
Women should be informed about the
risks and symptoms of endometrial cancer and strongly encouraged to
report any unexpected bleeding or spotting to their doctor.
|
|
|
At menopause
(increased risk*)
|
Women should be
informed about the risks and symptoms of endometrial cancer and
strongly encouraged to report any unexpected bleeding or spotting to
their doctor. They should also be informed about the potential
benefits, risks, and limitations of early endometrial cancer detection. |
|
Endometrial biopsy
|
By age 35
(high risk***)
|
Should be offered
yearly. Women should also be informed about the risks and
symptoms of endometrial cancer, and about the potential benefits,
risks, and limitations of early endometrial cancer detection. |
*High risk was defined as having a history of infertility,
obesity, failure of ovulation, abnormal uterine bleeding, or use of
estrogen therapy or tamoxifen.
**Increased risk was defined as a history of estrogen therapy or
tamoxifen, late menopause, having no children, infertility or failure
to ovulate, obesity, diabetes, or high blood pressure.
***High risk was defined as women with or at risk for hereditary
non-polyposis colorectal cancer (HNPCC) due to a known or suspected
gene mutation.
Lung cancer (men & women)
|
Dates
|
Test
|
Age
|
Frequency
|
|
Pre 1980
|
Chest x-ray
|
Not specified
|
Supported use of chest x-ray for
those in whom lung cancer is most often found (heavy smokers, asbestos
workers, etc.)
|
| |
|
1980 – Present
|
None
|
Not specified
|
No recommendation
|
| |
Prostate cancer (men)
|
Dates
|
Test
|
Age
|
Frequency
|
|
1980 – 1992
|
Digital Rectal Exam (DRE)
|
Over 40
|
Yearly |
|
1992 – 1997
|
Digital Rectal exam
(DRE)
|
Over 40
|
Yearly
|
|
Prostate-specific antigen
(PSA) blood test
|
Over 50
|
Yearly
|
|
1997 – 2000
|
Digital Rectal Exam (DRE) and
prostate-specific antigen (PSA) blood test
|
Over 50
(Earlier, i.e. 45, for men at high risk*)
|
Should be offered
yearly (along with information
on potential risks & benefits) to men with at least a 10-year
life
expectancy |
|
2001 – 2008
|
Digital Rectal Exam (DRE) and
prostate-specific antigen (PSA) blood test
|
Over 50
(average risk)
|
Should be offered
yearly (along with information
on potential risks & benefits) to men with at least a 10-year
life
expectancy |
|
Over 45
(high risk**)
|
Yearly (along
with information on potential risks & benefits)*** |
| |
|
2009 – Present+
|
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)
|
Should be offered
yearly (along with information
on potential risks & benefits) to men with at least a 10-year
life
expectancy |
|
Over 45
(high risk**)
|
Discussion and
offer of testing should be done yearly*** |
*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.
+NOTE: This represents a language clarification,
not a change in the
guidelines, as the previous language was often misinterpreted.
Cancer-related checkup (men &
women)
|
Dates
|
Test
|
Age
|
Frequency
|
|
Pre 1980
|
Physical exam
|
Not specified
|
"Regularly" |
| |
|
1980 - 2002
|
Physical exam* and health
counseling
|
20 – 39
|
Every 3 years
|
|
Over 40
|
Yearly
|
| |
| 2003
– Present |
Physical
exam* and health counseling** |
Over
20 |
On the occasion of
a periodic health exam |
*Should include examinations for cancers of the thyroid,
testicles, mouth, ovaries, skin, and lymph nodes.
**Should include counseling about tobacco, sun exposure, diet and
nutrition, risk factors, sexual practices, and environmental and
occupational exposures.
Last Medical Review: 02/12/2009
Last Revised: 02/12/2009
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