Cancer screening resident survival guide

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Cancer screening Resident Survival Guide Microchapters
Overview
Breast Cancer
Cervical Cancer
Colorectal Cancer
Endometrial Cancer
Esophageal Cancer
Lung Cancer
Ovarian cancer
Prostate cancer


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Synonyms and Keywords: Cancer screening guideline, Cancer screening in adults

Overview

Breast cancer screening starts at the age of 50 via a mammogram twice a year and discontinues at the age of 74. Cervical cancer screening starts at the age of 21 regardless of the onset of sexual activity via Papanicolaou test (Cervical cytology). Colorectal cancer screening starts among asymptomatic adults at the age of 50 with no family history of adenoma or colorectal cancer (CRC). It is preferably done via colonoscopy. There is insufficient evidence to recommend routine screening for endometrial cancer. Screening of barrett's esophagus-associated adenocarcinoma by endoscopy is a worldwide clinical practice. Squamous dysplasia is the precursor lesion of esophageal squamous cell carcinoma. There are no studies suggesting the endoscopic screening for squamous esophageal carcinoma among the population of western countries. Lung cancer screening starts among asymptomatic adults aged 55 to 80 years who have a 30 pack per year smoking history and currently smoke or have quit smoking within the past 15 years. There are no recommendations for screening ovarian cancer in asymptomatic women although better outcomes are associated with early diagnosis. Prostate cancer screening starts at the age of 55 via digital rectal exam and prostate specific antigen (PSA) blood test and discontinues at the age of 69. Screening for prostate cancer is controversial because it is not clear if the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.

Common Cancers

Breast Cancer

  • Breast cancer screening starts at the age of 50 via a mammogram twice a year and discontinues at the age of 74. [1]
  • According to the GLOBOCAN 2018 estimates of cancer incidence, mortality, and prevalence, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths among females (11.6% of total cancer deaths). [2]
Recommendations for Breast cancer screening:[1]
Population Screening recommendations
Age 50-74
Age 40
Age 75

The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older.

Cervical Cancer

Recommendations for Cervical cancer screening:[3]
Population Screening recommendations
Immunocompromised
  • Onset of sexual intercourse
Age under 21
  • Screening not recommended
Age 21-29
Age 30-65
Age 65 and Up

Discontinue cervical cancer screening

To view the detailed information on cervical cancer screening click here.

Colorectal Cancer

  • Colorectal cancer screening starts among asymptomatic adults at the age of 50 with no family history of adenoma or colorectal cancer (CRC). It is preferably done via colonoscopy. [4]
  • According to the GLOBOCAN 2018 estimates of cancer incidence, mortality, and prevalence, Colon cancer is the fourth commonly occurring cancer (6.1% for incidence). It is the third cause of death in cancer patients (9.2% of total cancer deaths).[2]
Recommendations for Colorectal cancer screening:[4]
Population Screening recommendations
Age 50 asymptomatic with no history of CRC or adenoma

Direct Visualization Tests

Stool-Based Tests

  • Guaiac-based fecal occult blood test (gFOBT) (every year)
  • Fecal immunochemical test (FIT) (every year)
  • Multitargeted stool DNA test (FIT-DNA) (every 1 year or 3 years)

Family history of CRC or adenomatous polyps

  • 1 First-degree relative age <60
  • Multiple first-degree relatives at any age
  • Colonoscopy at age 40 or 10 years before the age of diagnosis in affected relative (every 5 years)
Inflammatory bowel disease
  • Ulcerative colitis
  • Crohn disease with colonic involvement
  • Colonoscopy 8-10 years after diagnosis (every 1-3 years)
Hereditary nonpolyposis colorectal cancer
Familial adenomatous polyposis

Endometrial Cancer

Recommendations for Endometrial cancer screening:
Population Screening recommendations
Lynch syndrome
Perimenopausal and postmenopausal patients with abnormal vaginal bleeding

Esophageal Cancer

Esophageal Adenocarcinoma:

Recommendations for Esophageal adenocarcinoma screening:[7]
Population Screening recommendations in Barrett's Esophagus
Suspected low-grade dysplasia
  • Endoscopy (every 6-12 months) or endoscopy eradication therapy
Suspected high-grade dysplasia
  • Endoscopic Eradication therapy
No dysplasia

Esophageal squamous cell carcinoma:

Recommendations for Esophageal squamous cell carcinoma screening:[7]
Population Screening recommendations
Age 50
  • Endoscopy once in a lifetime among high-risk for cancer such as:
  • Geography such as: Southeastern Africa, Asia, Iran, South America
  • Alcohol
  • Smoking
  • Diet low in fruits and vegetables
Low-grade dysplasia
Intermediate grade dysplasia

To view the detailed information on esophageal cancer screening, click here.

Lung Cancer

  • Lung cancer screening starts among asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years.
  • According to the GLOBOCAN 2018 estimates of cancer incidence, mortality, and prevalence, Lung cancer is the most commonly diagnosed cancer (11.6% of the total cases) and the leading cause of cancer death in both males and females (18.4% of the total cancer deaths).[2]
Recommendations for lung cancer screening:[11]
Recommended test
Recommended Interval
  • Annual screening (every year)
Age for screening
  • 55-80
Eligibility for screening based on smoking history
  • Patient has 30 or greater than 30-pack-year smoking history and patient is a current smoker or quite smoking within the last 15 years.
Discontinuation of screening
  • Age greater than 80 or
  • Patient successfully quit smoking for 15 years and beyond or
  • Patient has other medical problems that significantly limit life expectancy or ability/willingness to undergo lung cancer surgery.

Ovarian cancer

  • There are no recommendations for screening ovarian cancer in asymptomatic women although the better outcome is associated with early diagnosis. [12][13]
  • Transvaginal ultrasound and serum cancer antigen 125 testings are readily available procedures that are commonly used to evaluate women with signs or symptoms of ovarian cancer and have been evaluated in screening studies. [14]
Recommendations for Ovarian cancer screening:[14]
Population Screening recommendations
Lynch syndrome
  • Ovarian cancer risk is increased and may present at a relatively younger age.
BRCA1 and BRCA2 gene mutations

Prostate Cancer

Recommendations for Prostate cancer screening:[15]
Population Screening recommendations
Age 55-69
Age 70


Cancer screening recommendations developed and modified according to the United States Preventive Services Task Force (USPSTF) Guidelines.

References

  1. 1.0 1.1 "Recommendation: Breast Cancer: Screening | United States Preventive Services Taskforce".
  2. 2.0 2.1 2.2 2.3 2.4 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018). "Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries". CA Cancer J Clin. 68 (6): 394–424. doi:10.3322/caac.21492. PMID 30207593.
  3. 3.0 3.1 "Recommendation: Cervical Cancer: Screening | United States Preventive Services Taskforce".
  4. 4.0 4.1 US Preventive Services Task Force. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW; et al. (2016). "Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement". JAMA. 315 (23): 2564–2575. doi:10.1001/jama.2016.5989. PMID 27304597.
  5. "Endometrial Cancer Screening".
  6. 6.0 6.1 "No. 291-Epidemiology and Investigations for Suspected Endometrial Cancer - Journal of Obstetrics and Gynaecology Canada".
  7. 7.0 7.1 7.2 7.3 Domper Arnal MJ, Ferrández Arenas Á, Lanas Arbeloa Á (2015). "Esophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries". World J Gastroenterol. 21 (26): 7933–43. doi:10.3748/wjg.v21.i26.7933. PMC 4499337. PMID 26185366.
  8. 8.0 8.1 Lao-Sirieix P, Fitzgerald RC (2012). "Screening for oesophageal cancer". Nat Rev Clin Oncol. 9 (5): 278–87. doi:10.1038/nrclinonc.2012.35. PMID 22430857.
  9. Spechler SJ, Souza RF (2014). "Barrett's esophagus". N Engl J Med. 371 (9): 836–45. doi:10.1056/NEJMra1314704. PMID 25162890.
  10. 10.0 10.1 Yang J, Wei WQ, Niu J, Liu ZC, Yang CX, Qiao YL (2012). "Cost-benefit analysis of esophageal cancer endoscopic screening in high-risk areas of China". World J Gastroenterol. 18 (20): 2493–501. doi:10.3748/wjg.v18.i20.2493. PMC 3360447. PMID 22654446.
  11. "Recommendation: Lung Cancer: Screening | United States Preventive Services Taskforce". Retrieved 8/3/2020. Check date values in: |accessdate= (help)
  12. Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D; et al. (2017). "Cancer screening in the United States, 2017: A review of current American Cancer Society guidelines and current issues in cancer screening". CA Cancer J Clin. 67 (2): 100–121. doi:10.3322/caac.21392. PMID 28170086.
  13. Galea M, Gauci G, Calleja-Agius J, Schembri-Wismayer P (2017). "Peritoneal biomarkers in the early detection of ovarian cancer". Minerva Ginecol. 69 (1): 84–99. doi:10.23736/S0026-4784.16.03943-5. PMID 27284942.
  14. 14.0 14.1 "Recommendation: Ovarian Cancer: Screening | United States Preventive Services Taskforce".
  15. 15.0 15.1 "Recommendation: Prostate Cancer: Screening | United States Preventive Services Taskforce".