Marion County Medical Center

Health Shorts

April 2002

April is Cancer Control Month

American Cancer Society Cancer Detection Guidelines

Cancer-Related Checkup
A cancer-related checkup is recommended every 3 years for people aged 20-40 and every year for people age 40 and older. This exam should include health counseling and depending on a person's age might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries as well as for some non-malignant diseases.

Special tests for certain cancer sites are recommended as outlined below.

Breast

Breast self-exam monthly for women aged 20 and over
Breast clinical physical examination for women aged 20 - 40, every 3 years; over 40, every year. This exam should be done close to the time of the scheduled mammogram. Ideally, the clinical breast exam should be done before the scheduled mammogram.
Mammography for women aged 40 and over, every year.

Colon and Rectum
Beginning at age 50, both men and women should follow one of these five testing schedules:

Yearly fecal occult blood test (FOBT)*
Flexible sigmoidoscopy every 5 years**
Yearly fecal occult blood test plus flexible sigmoidoscopy every 5 years*,**
Double-contrast barium enema every 5 years
Colonoscopy every 10 years**

**The combination of FOBT and flexible sigmoidoscopy is preferred over either of these two tests alone.

*For FOBT, the take-home multiple sample method should be used.

All positive tests should be followed up with colonoscopy.

People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors.

a personal history of colorectal cancer or adenomatous polyps
a strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative younger than 60 or in two first-degree relatives of any age) Note: a first degree relative is defined as a parent, sibling, or child.
a personal history of chronic inflammatory bowel disease
families with hereditary colorectal cancer syndromes (familial adenomatous polyposis and hereditary non-polyposis colon cancer).

Cervical

Pap test and pelvic examination for women who are or have been sexually active or have reached age 18, every year; after 3 or more consecutive satisfactory normal annual exams, the Pap test may be performed less frequently at the discretion of the physician.

Endometrium

The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary nonpolyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.

Prostate
Guideline Statement: Both Prostate-Specific Antigen (PSA) and Digital Rectal Examination (DRE) should be offered annually, beginning at age 50 years, to men who have at least a 10-year life expectancy. Men at high risk should begin testing at age 45 years. Information should be provided to men regarding potential risks and benefits of early detection and treatment of prostate cancer.

Men who choose to undergo testing should begin at age 50 years. However, men in high risk groups, such as African Americans and men who have a first-degree relative diagnosed with prostate cancer at a young age, should begin testing at 45 years. Note: a first-degree relative is defined as a father, brother, or son.
Men who ask their doctor to make the decision on their behalf should be tested. Discouraging testing is not appropriate. Also not offering testing is not appropriate.
Testing for prostate cancer in asymptomatic men can detect tumors at a more favorable stage (anatomic extent of disease). There has been a reduction in mortality from prostate cancer, but it has not been established that this is a direct result of screening.
An abnormal Prostate-Specific Antigen (PSA) test result has been defined as a value of above 4.0 ng/ml. Some elevations in PSA may be due to benign conditions of the prostate.
The Digital Rectal Examination (DRE) of the prostate should be performed by health care workers skilled in recognizing subtle prostate abnormalities, including those of symmetry and consistency, as well as the more classic findings of marked induration or nodules. DRE is less effective in detecting prostate carcinoma compared with PSA.

References
The above information is from the American Cancer Society - www.cancer.org.

American Cancer Society. Cancer Facts and Figures, 2002. Atlanta, GA: American Cancer Society;, 2002

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