YOU SHOULD KNOW

Cancer Screenings:
What You Should Have and When

Every woman should have a cancer-related checkup as part of her annual physical. Depending on your age, your physician may examine your thyroid, oral cavity, skin, lymph nodes, and ovaries.

Special cancer screenings may also be recommended, based on your age, history and risk factors. Following are cancer detection guidelines from the American Cancer Society.

Breast Cancer

Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.

Clinical breast exams (CBE) should be part of a periodic health exam, about every three years for women in their twenties and thirties, and every year for women age 40 and over.

Women should report any breast changes promptly to their health care providers. Breast self exam (BSE) should be practiced by women, starting in their twenties.

Women at increased risk of breast cancer (due to family history, genetic tendancy, or who have previously had breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening at an earlier age. They might also wish to inquire about having additional tests done, such as breast ultrasound or MRI, or having more frequent exams.

Colon and Rectal Cancer

Beginning at age 50, men and women should follow one of these testing schedules to help provide early detection of colon or rectal cancer:

• Yearly fecal occult (FOBT) or fecal immunochemical test (FIT)
• Flexible sigmoidoscopy ever five years
• Yearly FOBT or FIT plus flexible sigmoidoscopy every five years
• Double-contrast barium enema every five years
• Colonoscopy every 10 years

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

ALSO NOTE: The combination of yearly FOBT or FIT plus flexible sigmoidoscopy every five years is preferred over either of these options alone.

All positive tests should be followed up with a colonoscopy.

People should begin colorectal cancer screening early 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 (Family history refers to cancer or polyps being present in a first-degree relative younger than age 60, or in two first-degree relatives of any age. A first-degree relative is defined as a parent, sibling or child.)
  
  
• A family history of an hereditary colorectal cancer syndrome (such as familial adenomatous polyposis or hereditary non-polyposis colon cancer).

Cervical Cancer

All women should begin cervical cancer screening about three years after they begin having vaginal intercourse, and no later than 21 years of age. Screening should be done every year with the regular Pap test, or every two years using the new liquid-based Pap test.

Beginning at age 30, women who have had three normal Pap tests in a row may get screened very two to three years with either the conventional (regular) Pap test or liquid-based Pap test. Women who have certain risk factors, such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use, should continue to be screened annually.

Another reasonable option for women over 30 is to get screened very three years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test.

Women 70 years of age or older who have had three or more normal Pap tests in a row and have had no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screenings. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune sysem should continue to have screenings as long as they are in good health.

Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screenings, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines.

Endometrial (Uternine) Cancer

The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer. If any woman experiences unexptected bleeding or spotting, they should report it 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.