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New Guidelines for Cancer Screening: What Tests to Get When

Confused about what cancer tests you need? The American Cancer Society (ACS) has released new guidelines for cancer screening.

The ACS updates its screening guidelines every year. This year’s list covers a wide range of cancers, including cancer of the breast, prostate, colon, rectum, cervix, and endometrium (the lining of the uterus).

Many people aren’t getting screened for cancer, write experts Robert Smith, PhD, and colleagues. Smith is the ACS director of cancer screening. Their report appears in CA: A Cancer Journal for Clinicians.

The chances of surviving cancer are often better with early detection. Routine tests can make a big difference, even for people who aren’t at high risk of cancer.

New Guidelines

The new guidelines touch on hot topics in cancer screening.

Digital mammography gets mentioned as a tool that may prove helpful, needs more study, and isn’t yet widely available. No cancer test is perfect, including mammography, but nondigital mammograms may still help, says the ACS.

Regarding prostate cancer, a prostate-specific antigen (PSA) test should be available to all men age 50 and older with a life expectancy of at least 10 more years, the guidelines state.

However, men should be told about the PSA test’s benefits and limits, and better tests for prostate cancer should be created, says the ACS.

The guidelines don’t require women to do regular breast self-exams. Such tests can be helpful, but not all cancers can be felt early on, and many breast lumps aren’t cancerous, so a doctor’s exam is a must for any new breast symptoms.

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What Tests, and When

Here’s a quick look at the guidelines, which target people at average risk for cancer. Those with a higher cancer risk many need earlier screening.

—Breast cancer:Women should get a clinical breast exam at least every three years, starting in their 20s, and get an annual mammogram starting at 40. Breast self-exams are optional. See a doctor about any breast symptoms.

—Colorectal cancer:Starting at age 50, men and women should get colonoscopy every 10 years or other tests more often (double-contrast barium enema every five years; annual fecal occult blood test or fecal immunochemical test; flexible sigmoidoscopy every five years, with or without a fecal occult blood test or fecal immunochemical test).

—Prostate cancer:Digital rectal exam and prostate-specific antigen (PSA) test should be available annually for men age 50 and older with a life expectancy of at least 10 more years. Doctors and patients should discuss the pros and cons of the PSA test.

—Cervical cancer:Women should get annual Pap tests starting about three years after first vaginal intercourse or by age 21, whichever comes first. At or after age 30, women who have three normal Pap tests may get screened every two or three years. After 70, screening may stop for women who’ve had three normal Pap tests in a row and no abnormal Pap tests for a decade.

—Endometrial (uterine) cancer:At menopause, women should be told about endometrial cancer’s warning signs and urged to tell their doctors if they have any unexpected bleeding or spotting.

Special appointments aren’t necessary to check for some cancers. Doctors can screen for skin cancer, oral cancers, and thyroid cancers anytime instead of requiring an extra appointment, the ACS notes.

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Falling Short

America’s record on cancer screening has room for improvement, the ACS notes.

Consider these 2004 ACS statistics, published along with the guidelines:

Fewer than six in 10 women aged 40 and older got a mammogram in the last year. Half of men aged 50 and older got a digital rectal exam in the past year. Barely half (52 percent) of adults aged 50 and older got tested for colon cancer in the past five years.

The most utilized test was the Pap test, which checks for irregularities in the cervix that may (or may not) be cancerous. More than eight in 10 eligible women got a Pap test in 2004, reports the ACS.

Those numbers are based on a national health survey.

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: Smith, R. CA: A Cancer Journal for Clinicians, January/February 2006; vol 56: pp 11-25. News release, American Cancer Society.