Practice Guidelines

Cancer Screening Recommendations from the ACS: A Summary of the 2017 Guidelines

 

Am Fam Physician. 2018 Feb 1;97(3):208-210.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• The ACS recommends mammography starting at 45 years of age with annual screening until 54 years of age and biennial screening afterward.

• Vaccination against human papillomavirus infection should be given as a two-dose vaccine with a six- to 12-month interval in children who begin the series at nine through 14 years of age.

• Lung cancer screening with low-dose computed tomography should be performed in patients 55 through 74 years of age who meet the criteria based on smoking history and health status.

From the AFP Editors

Each year, the American Cancer Society (ACS) releases guidelines for health care professionals and patients on current cancer screening recommendations. The annual report updates previous recommendations, provides data on cancer screening rates, and discusses issues relating to early cancer detection. The 2017 guidelines cover screening recommendations for breast, cervical, colorectal, endometrial, lung, and prostate cancers (Table 1).

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TABLE 1.

American Cancer Society Recommendations for the Early Detection of Cancer in Average-Risk Asymptomatic Adults*

Cancer typePopulationTest or procedureRecommendation

Breast

Women, 40 to 54 years of age

Mammography

Women should undergo regular screening mammography starting at 45 years of age; women 45 to 54 years of age should be screened annually; women should have the opportunity to begin annual screening between 40 and 44 years of age

Women, 55 years or older

Mammography

Women 55 years or older should transition to biennial screening or have the opportunity to continue screening annually; women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more

Cervical

Women, 21 to 29 years of age

Pap test

Cervical cancer screening should begin at 21 years of age; for women 21 to 29 years of age, screening should be done every three years with conventional or liquid-based Pap tests

Women, 30 to 65 years of age

Pap test and HPV DNA test

For women 30 to 65 years of age, screening should be done every five years with both the HPV test and the Pap test (preferred) or every three years with the Pap test alone (acceptable)

Women, 66 years or older

Pap test and HPV DNA test

Women 66 years or older who have had three or more consecutive negative Pap tests or two or more consecutive negative HPV and Pap tests within the past 10 years, with the most recent test occurring in the previous five years, should stop cervical cancer screening

Women who have had a total hysterectomy

Pap test and HPV DNA test

Women who have had a total hysterectomy should stop cervical cancer screening

Colorectal

Men and women, 50 years or older, for all tests listed

Guaiac-based FOBT with at least 50% sensitivity for cancer, or fecal immunochemical test with at least 50% sensitivity for cancer or

Annual: Testing stool sampled from regular bowel movements with adherence to manufacturer's recommendation for collection techniques and number of samples is recommended; FOBT with the single stool sample collected on the clinician's fingertip during a digital rectal examination is not recommended; “throw in the toilet bowl” FOBTs also are not recommended; compared with guaiac-based tests for the detection of occult blood, immunochemical tests are more patient-friendly and are likely to be equal or better in sensitivity and specificity; there is no justification for repeating FOBT in response to an initial positive finding; patients should be referred for colonoscopy

Multitarget stool DNA test† or

Every three years, per manufacturer's recommendation

Flexible sigmoidoscopy† or

Every five years, flexible sigmoidoscopy can be performed alone, or consideration can be given to combining flexible sigmoidoscopy performed every five years with a highly sensitive FOBT or fecal immunochemical test performed annually

Double-contrast barium enema† or

Every five years

Colonoscopy or

Every 10 years

CT colonography†

Every five years

Endometrial

Women, at menopause

At the time of menopause, women should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians

Lung

Current or former smokers 55 to 74 years of age in good health with at least a 30 pack-year history

Low-dose helical CT

Clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about annual lung cancer screening with apparently healthy patients 55 to 74 years of age who have at least a 30 pack-year smoking history and who currently smoke or have quit within the past 15 years; a process of informed and shared decision making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose CT should occur before any decision is made to initiate lung cancer s

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.

 

 

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