Practice Guidelines

ACS Guidelines for Early Detection of Cancer

Am Fam Physician. 2004 Apr 15;69(8):2013.

The American Cancer Society (ACS) has released its annual recommendations for the early detection of cancer. The report was published in the January/February 2004 issue of CA: A Cancer Journal for Clinicians and is available online at: http://caonline.amcancersoc.org/cgi/content/full/54/1/41.

Recommendations

Breast Cancer Screening

The ACS no longer recommends monthly breast self-examination (BSE) beginning at age 20, and instead recommends that women be informed of potential benefits, limitations, and harms associated with BSE. Clinical breast examination should be performed every three years in women 20 to 39 years of age, then annually beginning at age 40. Women at average risk for breast cancer should begin regular mammography at age 40 and should be informed of the benefits, limitations, and potential harms associated with screening. A “baseline” mammogram at age 35 is no longer recommended. The importance of adhering to a schedule of annual mammograms should be stressed.

Cervical Cancer Screening

Cervical cancer screening should begin approximately three years after the onset of vaginal intercourse but no later than age 21. Screening should be performed annually until age 30 with conventional cervical cytology, or every two years until age 30 using liquid-based cytology. After age 30, screening should continue every two to three years in women who have had three consecutive, technically satisfactory smears with normal/negative results.

Women 70 years and older with an intact cervix may choose to cease screening if they have had three or more documented, consecutive, technically satisfactory smears with normal/negative results and no abnormal/positive results within the preceding 10 years. Women with a history of cervical cancer or in utero exposure to diethylstilbestrol or who are immunocompromised should continue screening for as long as they are in reasonably good health.

Cervical cancer screening is not indicated for women who have had a total hysterectomy for benign gynecologic disease. However, women who have had a subtotal hysterectomy should be screened according to the recommendations for women at average risk.

The ACS recommends that, as an alternative to cytologic examination alone, cervical cancer screening with human papillomavirus DNA testing and conventional or liquid-based cytology be performed every three years.

Colorectal Cancer Screening

The ACS recommends that adults at average risk begin colorectal cancer screening at age 50, using one of the following five screening tests: annual fecal occult blood test (FOBT), flexible sigmoidoscopy every five years, annual FOBT plus flexible sigmoidoscopy every five years, double-contrast barium enema every five years, or colonoscopy every 10 years. More intensive surveillance is recommended for patients with a history of adenomatous polyps, curative-intent resection of colorectal cancer, or inflammatory bowel disease of significant duration; or a family history of one of two hereditary syndromes, colorectal cancer, or colorectal adenomas diagnosed in a first-degree relative before age 60.

Endometrial Cancer Screening

Women with an average or increased risk should be informed of the risks and symptoms of endometrial cancer at the onset of menopause and should be encouraged to report any unexpected bleeding or spotting to their physician. However, screening should begin at 35 years of age in women at high risk for endometrial cancer because of known hereditary nonpolyposis colon cancer–associated genetic mutation carrier status, substantial likelihood of being a mutation carrier, or absence of genetic testing results in families with a possible autosomal dominant predisposition to colon cancer.

Prostate Cancer Screening

Prostate-specific antigen (PSA) testing and digital rectal examination should be offered annually beginning at age 50 for men with a life expectancy of at least 10 years. Men who ask their physician to make the decision for them should be tested. Men who request screening tests at an earlier age should not be discouraged from testing.

Men at high risk, including men of sub-Saharan African descent and men with a first-degree relative with the disease diagnosed before age 65, should begin testing at age 45. Men with more than one first-degree relative with prostate cancer diagnosed before age 65 should be screened beginning at age 40. If the PSA level is less than 1 ng per mL, no additional testing is needed until age 45. If the PSA level is greater than 1 ng per mL but less than 2.5 ng per mL, annual testing is recommended. If the PSA level is 2.5 ng per mL or greater, further evaluation with biopsy is indicated.


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