Cancer Screening

By Bruce A. Chabner, MD, Professor of Medicine;Clinical Director, Harvard Medical School;Massachusetts General Hospital Cancer Center ; Elizabeth Chabner Thompson, MD, MPH, Private Practice, New York Group for Plastic Surgery

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Patient Education

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Overview of Cancer
Introduction to Overview of Cancer
Cellular and Molecular Basis of Cancer
Cancer Diagnosis
Cancer Screening
Clinical Sequelae of Cancer
Metastatic Carcinoma of Unknown Primary Origin
Paraneoplastic Syndromes

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 Understanding Medical Tests and Test Results : 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.
Modified from the American Cancer Society Guidelines for the Early Detection of Cancer.