The following recommendations are for the early detection of cancer in asymptomatic persons on an individual basis. The recommendations are intended to help individual providers and their patients determine the most appropriate early cancer detection tests to meet their individual needs.
Guidelines for the early detection of cancer in people without symptoms are recommended by the American Cancer Society as follows:
A cancer-related checkup by a physician every three years for persons aged 20-39 and annually for those aged 40 and older. Some persons at particular risk for certain cancers may need tests more often and should discuss this with their doctor. The checkup should always include exams for cancer of the breast, uterus, cervix, colon, rectum, prostate, mouth, skin, testes, thyroid, and lymph nodes, as well as health counseling (how to quit smoking, etc.).
In 1989 and 1990, Congress passed legislation mandating Medicare coverage for cervical and breast cancer screening, respectively. For women over age 65, Medicare currently covers a Pap smear once every three years and a mammogram every two years. Although this policy does not strictly conform to ACS screening recommendations, it does begin to address the benefits of early detection.
The American Cancer Society recommends that screening mammography begin by age 40. Women aged 40-49 should get a mammogram every 1-2 years, depending on physical and mammographic findings. Women aged 50 and older should get a mammogram yearly. The ACS recommends the monthly practice of breast self-exam (BSE) by women 20 years and older as a routine good health habit. Examination of the breast by a health care professional should be done every three years from ages 20-40 and then every year.
The American Cancer Society recommends three tests for the early detection of colon and rectum cancer in people without symptoms. A digital rectal examination by a physician during an office visit should be performed every year after the age of 40; the stool blood test is recommended every year after age 50; and sigmoidoscopy, preferably flexible, should be performed every 3 to 5 years after age 50.
For cervical cancer, women who are or who have been sexually active, or have reached age 18, should have an annual Pap test and pelvic examination. After a woman has had three or more consecutive satisfactory normal annual examinations, the Pap test may be performed less frequently at the discretion of her physician.
Women at high-risk for endometrial cancer (those who have a history of infertility, obesity, failure to ovulate, abnormal uterine bleeding, or unopposed estrogen or tamoxifen therapy) should have an endometrial tissue sample taken at menopause and thereafter at the discretion of her physician.
Men who have reached 40 years of age and older should have a digital rectal examination (DRE) annually as part of their general cancer checkup. After age 50, DRE should be performed for the detection of prostate cancer. Annual prostate-specific antigen blood testing should be performed on men aged 50 and older.
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