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Cancer Screening

by Bruce A. Chabner, MD, Elizabeth Chabner Thompson, MD, MPH

Cancer can sometimes be detected in asymptomatic patients via regular physical examinations and screening tests.

Physical examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, prostate, and ovaries should also be a part of routine medical care.

Screening tests are tests that are done in asymptomatic patients at risk (see also Testing : Screening Tests). The rationale is that early diagnosis may decrease cancer mortality by detecting cancer at an early and curable stage. Early detection may allow for less radical therapy and reduce costs. Risks, however, include false-positive results, which necessitate confirmatory tests (eg, biopsy, endoscopy) that can lead to anxiety, significant morbidity, and significant costs; and false-negative results, which may give a mistaken sense of security, causing patients to ignore subsequent symptoms.

Screening for cancer should be done in the following circumstances:

  • When distinct high-risk groups can be identified (eg, people who have a strong family history of breast or prostate cancer)

  • When the disorder has an asymptomatic period during which treatment would alter outcome (breast cancer, colon cancer)

  • When the morbidity of the disorder is significant if detection is delayed

  • When a screening test is available that is sensitive, specific, and cost effective

Recommended screening schedules are constantly evolving based on ongoing studies (see Screening Procedures in Average-Risk Asymptomatic People as Recommended by the American Cancer Society*).

Screening Procedures in Average-Risk Asymptomatic People as Recommended by the American Cancer Society*

Type of Cancer

Procedure

Frequency

Breast cancer

Breast self-examination (BSE)

Monthly or periodically after age 20

Clinical breast examination

Every 3 yr between ages 20 and 39, then yearly

Mammography

Yearly, starting at age 40

MRI

Yearly (in addition to mammography), starting at age 40 only for certain women at high risk

Cervical cancer

Papanicolaou (Pap) test sometimes with the human papillomavirus (HPV) test

Pap test every 3 yr between ages 21 and 29

Pap test plus HPV test every 5 yr between ages 30 and 65 or Pap test every 3 yr

After age 65, no testing if previous testing was done and results were normal

Uterine and ovarian cancers

Pelvic examination

Every 1 to 3 yr between ages 18 and 40, then yearly

Prostate cancer

Blood test for prostate-specific antigen

Because the benefit of screening is uncertain, patient and physician should discuss the risks and possible benefits of prostate cancer screening.

Rectal and colon cancer

Stool testing: Fecal occult blood, fecal immunochemical test, or stool DNA test

or

Yearly, starting at age 50

Flexible sigmoidoscopy

or

Every 5 yr, starting at age 50

Colonoscopy

or

Every 10 yr, starting at age 50

CT colonography

Every 5 yr, starting at age 50

*Examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries should also be done during routine medical care.

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