Women's Cancer Screening
Women's Cancer Screening
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Endometrial Cancer
• No current recommendations for universal screening, because most patients present early, allowing for timely treatment.
Breast Cancer
• USPSTF recommends screening mammography with or without clinical breast exam (CBE) every 1-2 years for women 40 years and older (B recommendation)
• Insufficient evidence to recommend for or against routine CBE alone or breast self-exam (BSE)
• Fair evidence that breast self exam (BSE) is associated with increased risk of false positive findings and unnecessary biopsies.
• ACP's 2007 clinical guideline addresses screening mammography in women 40-49. It recommends individual risk assessment and shared decision making, considering the risks and benefits of screening.
Cervical Cancer
• USPSTF strongly recommends pap smear screening for cervical cancer in women who have been sexually active and have a cervix (A recommendation)
• USPSTF recommends beginning paps at 21 or within 3 years of onset of sexual activity, whichever comes first and screening at least every 3 years
• USPSTF recommends against routine paps in women who have had a total hysterectomy for benign reasons
• Most organizations recommend discontinuing screening in women 65-70 as long as they have had adequate recent screening with normal paps.
• ACS recommends annual screening with conventional paps, or screening every 2 years if liquid-based (Thin Prep) paps, until 30; thereafter screening interval can be extended to every 2-3 years if negative unless continued risk factors. Or at 30, can do pap combined with HPV testing and if both negative, screen every 3 years.
• ACOG recommends beginning paps within 3 years of sexual activity or age 21, whichever comes first and screening annually until 30. Women older than 30 with 3 negative paps can be screened every 2-3 years with conventional cytology. Or pap with HPV an option over 30; if negative, no screening for 3 more years. Stopping screening is on an individual basis.
Ovarian Cancer
• Women at average risk: DO NOT SCREEN with CA-125 or ultrasound (no group recommends)
• USPSTF and American College Preventive Medicine do not recommend periodic pelvic exam for screening, ACS and ACOG do
• Best way to detect is high level of suspicion, so know signs/symptoms: increased abdominal size, bloating, urinary urgency, pelvic pain. If present, do transvaginal ultrasound.
Colorectal Cancer
• USPSTF strongly recommends screening men and women 50 years and older for colon cancer (A recommendation).
• For average risk patients initiate screening at age 50 (in higher risk groups start sooner); discontinue screening when comorbid conditions limit life expectancy--some advocate stopping at age 80.
• Screening Strategies: Home FOBT annually, Flexible sigmoidoscopy every 5 years, Combination of annual FOBT with flex sig every 5 years, Colonoscopy every 10 years, OR double contrast barium enema every 5 years
• There is little evidence to support office DRE or single office FOBT
• The above recommendations address average risk patients. High risk patients include those with inflammatory bowel disease, hereditary syndromes, and family history. There is little data to guide screening practices in high risk patients, but expert opinion has generally suggested starting screening 10 years prior to the age at which a family member was diagnosed with colorectal cancer.
Lung Cancer
• Evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer.
Skin Cancer
• Evidence insufficient for USPSTF to recommend for or against screening using a total body skin exam.
• Some organizations do recommend screening.
References:
US Preventive Services Task Force. Guide to clinical preventive services, 3rd ed. Washington, DC: Agency for healthcare research and quality, 2005.
Screening Mammography for Women 40 to 49 Years of Age: A Clinical Practice Guideline from the American College of Physicians. Ann Int Med 2007;146:511-515.
American Cancer Society. Available at: . Accessed October 12, 2004.
Physicians' Information and Education Resource (PIER). Available at: . Accessed October 12, 2004.
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