Women aged 40 and older should have a screening mammogram every year. Between the ages of 20 and 39, women should have a clinical breast examination (CBE) by a health professional every 3 years. After age 40, women should have a CBE by a health professional every year. Breast self-exam (BSE) is an option for women starting in their 20’s. Women should report any breast changes promptly to their health care providers. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.  Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram.  Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Screening by mammography, clinical breast exam, or both may decrease breast cancer mortality. The NCI recommends women in their 40s and older have a mammogram done every one to two years. Women who are at higher than average risk for breast cancer should talk with their health care providers about whether or not to have mammograms before age 40 and how often to have them. Some women perform monthly breast self-exams to check for changes in their breasts. Women who notice anything unusual during a breast self-exam or at any other time should contact their health care provider promptly. Studies so far have not shown that BSE alone reduces the number of deaths from breast cancer. Studies have not shown that ultrasonography is of any proven benefit in detecting breast cancer. The role of the MRI in breast cancer screening has not yet been established.

Recommends against routine screening mammography in women aged 40-49 years. The decision to start regular, biennial screening mammography before the age of 50 should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. Recommends screening mammography every two years for women aged 50 to 74 years. Recommends against teaching breast self-examination (BSE). Concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) in women 40 years or older, screening mammography in women 75 years or older, and digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

Cervical cancer can usually be found early by having regular cervical cytology (Pap) tests. Women should begin having Pap tests about 3 years after beginning to have vaginal intercourse, but no later than 21 years of age. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test. At age 30, women who have had 3 normal Pap tests in a row may get screened every 2 to 3 years with either the regular or liquid-based Pap test. Women at increased risk for cervical cancer should continue to be screened every year. Women over age 30 may also get screened every 3 years with the regular or liquid-based Pap test, plus the HPV DNA test. Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screenings. Women at high risk for cervical cancer, however, should continue to have screenings done. Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, 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 above.

Studies suggest that the death rate of cervical cancer will decrease if women who are or have been sexually active or who are in their late teens or older have regular Pap tests. Screening is effective when started within 3 years after beginning vaginal intercourse and becomes much less effective in women ages 65 years and older who have had recent negative Pap tests. Women who do not have a cervix cannot benefit from screening for cervical cancer. The evidence is insufficient to determine the additional benefits or harms of new technologies for screening, including liquid-based cytology, compared with traditional Pap testing. Although not suitable as a primary screening test, testing for human papillomavirus (HPV) DNA is a promising technology for differentiating between women with atypical squamous cells of undetermined significance who would more likely benefit from colposcopy and women who would be unlikely to benefit.

Routine screening for cervical cancer is recommended for all women who are or have been sexually active and who have a cervix. Screening with cervical cytology (Pap smear) should begin within three years of the start of sexual activity or age 21 (whichever comes first), and should be repeated at least once every three years. The USPSTF recommends against routinely screening women older than age 65 if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. In addition, USPSTF recommends against routine screening in women who have had a total hysterectomy for benign (non-cancerous) disease. There is insufficient evidence to recommend for or against routine screening with new technologies such as liquid-based cytology (ThinPrep) in place of conventional Pap tests or for human papillomavirus (HPV) testing as a primary screening test for cervical cancer.

Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below.  The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests.  Talk to your doctor about which test is best for you.

Tests that find polyps and cancer

• Flexible sigmoidoscopy every 5 years*
• Colonoscopy every 10 years
• Double contrast barium enema every 5 years*
  
• CT colonography (virtual colonoscopy) every 5 years*

Tests that mainly find cancer

• Fecal occult blood test (FOBT) every year *, **
• Fecal immunochemical test (FIT) every year*, **
• Stool DNA test (sDNA), interval uncertain*

* Colonoscopy should be done if test results are positive.
** For FOBT or FIT used as a screening test, the take-home multiple sample method should be used.  A FOBT or FIT done during a digital rectal exam in the doctor’s office is not adequate for screening.

People should talk to their doctor about starting colorectal cancer screening earlier and/or being screened more often if they have any of the following colorectal cancer risk factors:

• A personal history of colorectal cancer or adenomatous polyps
• A personal history of chronic inflammatory bowel disease (Crohns disease or ulcerative colitis)
• A strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in 2 or more first-degree relatives of any age)
• A known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)

Studies show that a fecal occult blood test performed every 1 or 2 years in people between the ages of 50-80 years decreases the number of deaths due to colorectal cancer. Studies suggest that fewer people may die of colorectal cancer if they have regular screening by sigmoidoscopy after the age of 50 years. There is insufficient evidence to determine the most effective time-interval for such screening. The evidence available does not suggest that digital rectal examination is effective in decreasing mortality from colorectal cancer. Barium enema may be effective in detecting large polyps. Studies suggest that colonoscopy is a more effective screening method than barium enema. A colonoscopy is a procedure used to look inside the rectum and colon for polyps, abnormal areas, or cancer. Polyps or tissue samples may be taken for biopsy. A virtual colonoscopy is a procedure that uses a series of x-rays to make a series of pictures of the colon. This procedure is currently being studied in clinical trials to determine its effectiveness. Another procedure currently being studied in clinical trials is the DNA stool test. This is a test that checks DNA in stool cells for genetic changes that may be a sign of colorectal cancer.

Recommends that adults age 50 to 75 be screened for colorectal cancer using annual fecal occult blood testing (FOBT), sigmoidoscopy every five years with FOBT between sigmoidoscopic exams, or colonoscopy every 10 years.  The risks and benefits of these screening methods vary.  The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age.  There may be considerations that support colorectal cancer screening in an individual patient.  The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.  Evidence is insufficient to assess the benefits and harms of CT colonography and fecal DNA testing as screening modalities for colorectal cancer.

Patients should be asked about their smoking history.  Patients who meet all of the following criteria may be candidates for lung cancer screening:  55 to 74 years old, in fairly good health,
have at least a 30 pack-year smoking history, and are either still smoking or have quit smoking within the last 15 years.

These criteria were based on what was used in the National Lung Screening Trial (NLST).

Doctors should talk to these patients about the benefits, limitations, and potential harms of lung cancer screening.  Screening should only take place at facilities that have the right type of CT scan and that have a great deal of experience in low-dose CT scans for lung cancer screening.  The facility should also have a team of specialists that can provide the appropriate care and follow-up of patients with abnormal results on the scans.

Several studies have shown that routine screening for lung cancer using chest x-ray and/or testing sputum (mucus coughed up from the lungs) did not decrease the number of lung cancer deaths. The NCI conducted clinical trials to examine the value of yearly chest x-rays to screen for lung cancer, and the effectiveness of low-dose helical computed tomography (LDCT) test in screening for lung cancer.  LDCT scans were better than chest x-rays at finding early-stage lung cancer. Screening with LDCT also decreased the risk of dying from lung cancer in current and former heavy smokers.  The NCI recommends that individuals consult with their doctor about their risk for lung cancer and their need for screening tests.  For more information on the National Lung Screening Trial (NLST), see the NCI website:  http://www.cancer.gov/.

Evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with either low dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a combination of these tests.  All patients should be counseled against tobacco use.

The American Cancer Society recommends routine cancer-related checkups, including a skin examination by a health professional. In addition, the ACS recommends individuals check their own skin once a month for changes in moles, blemishes, freckles, or other marks on the skin. Changes should be reported to a doctor.The ABCD rule can help tell a normal mole from a melanoma:
A: asymmetry – one half of the mole does not match the other half.
B: border irregularity – the edges of the mole are ragged or notched.
C: color – the color of the mole is not the same all over. There may be shades of tan, brown, or black, and sometimes patches of red, blue, or white.
D: diameter – the mole is wider than about ¼ inch or about the size of a pencil eraser (although doctors are now finding more melanomas that are smaller).

Other important signs of melanoma include changes in size, shape, or color of a mole. Some melanomas do not fit the descriptions above, and it may be hard to tell if the mole is normal or not, so you should show your doctor anything that you are unsure of.

Routine examination of the skin increases the chance of finding skin cancer early.

Insufficient evidence to recommend for or against routine screening by total-body skin examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer.

The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what is known and not known about the risks and possible benefits of testing and treatment. They recommend men starting at age 50, talk to their doctor about the pros and cons of testing so they can decide if testing is the right choice for them. African American men or men who have a father or brother who had prostate cancer before age 65, should have this talk with their doctor starting at age 45. If a man decides to be tested, he should have the PSA blood test with or without a rectal exam. How often a man is tested will depend on their PSA level.

Because unnecessary treatment due to false screening results could be harmful, research is being done to determine the most reliable method for prostate cancer screening. For example, scientists at the National Cancer Institute are studying the value of early detection by DRE and PSA on reducing the number of deaths caused by prostate cancer. Information on prostate cancer screening clinical trials can be found at the NCI website: http:www3.cancer.gov/prevention/plco.

Evidence is insufficient to recommend for or against routine screening for prostate cancer using the PSA test or DRE. Do not screen for prostate cancer in men age 75 years or older.

Recommends regular dental checkups that include an examination of the entire mouth. The ACS also recommends that primary care doctors examine the mouth and throat as part of a routine cancer-related checkup. Many dentists and doctors recommend that individuals perform monthly self-exams to check for signs and symptoms of oral cancer. Signs and symptoms include: a sore in the mouth that does not heal (most common symptom), pain in the mouth that does not go away (also very common), a persistent lump or thickening in the cheek, a persistent white or red patch on the gums, tongue, tonsil, or lining of the mouth, a sore throat or a feeling that something is caught in the throat that does not go away, difficulty chewing or swallowing, difficulty moving the jaw or tongue, numbness of the tongue or other area of the mouth, swelling of the jaw that causes dentures to fit poorly or become uncomfortable, loosening of the teeth or pain around the teeth or jaw, voice changes, a lump or mass in the neck, or weight loss. Many of these signs and symptoms may be caused by other cancers or by less serious, benign problems. It is important to see a medical doctor or dentist if any of these conditions lasts more than two weeks.

Screening for oral cancer may be done during a physical examination by the dentist or doctor. The areas of the mouth that are inspected for early detection are: floor of the mouth, front and sides of the tongue, and soft palate. However, it is not known if screening decreases the risk of dying from oral cancer.

There is insufficient evidence to recommend for or against routinely screening adults for oral cancer. All patients should be counseled to discontinue tobacco use and limit alcohol consumption. Clinicians should remain alert to signs and symptoms of oral cancer and premalignancy in persons who use tobacco or regularly use alcohol.