Cancer screening resident survival guide

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.
• 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).

Recommendations for Breast cancer screening:
Population	Screening recommendations
Age 50-74	Mammogram (every 2 years) till age 74
Age 40	Mammogram is recommended only for population with risk factors of breast cancer such as: Early menarche Nulliparity First degree relative who has had breast cancer Known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome History of chest radiation at a young age
Age 75	Discontinue screening if no risk factor for breast cancer The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of screening mammography in women 75 years and older.

• To view the detailed information on breast cancer screening click here.

Cervical Cancer

• Cervical cancer screening starts at the age of 21 regardless of the onset of sexual activity via Papanicolaou test (Cervical cytology).
• According to the GLOBOCAN 2018 estimates of cancer incidence, mortality, and prevalence, cervical cancer ranks fourth for both incidence and mortality among females.

Recommendations for Cervical cancer screening:
Population	Screening recommendations
Immunocompromised	Onset of sexual intercourse
Age under 21	Screening not recommended
Age 21-29	Pap test (cytology) every 3 years
Age 30-65	Cytology every 3 years or Cytology and HPV testing (co-testing) every 5 years
Age 65 and Up	Discontinue cervical cancer screening Age 65 with no risk for cervical cancer (e.g., immunosuppression, high risk sexual activity, tobacco use, diethylstilbestrol exposure) or hysterectomy and No history of cervical intraepithelial neoplasia grade 2 or higher and 3 consecutive negative pap tests or 2 consecutive negative co-testing results

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.
• 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).

Recommendations for Colorectal cancer screening:
Population	Screening recommendations
Age 50 asymptomatic with no history of CRC or adenoma	Direct Visualization Tests Colonoscopy (every 10 years) Flexible sigmoidoscopy (every 5 years) Flexible sigmoidoscopy (every 10 years) with fecal immunochemical test (every year) CT colonography (every 5 years) 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	Colonoscopy at age 20-25 (every 1-2 years)
Familial adenomatous polyposis	Colonoscopy at age 10-12 (every year)

• To view the detailed information on colorectal cancer screening click here.

Endometrial Cancer

• There is insufficient evidence to recommend routine screening for endometrial cancer.
• Depending on access, histologic endometrial evaluation (endometrial biopsy) and transvaginal ultrasound are the preferred initial diagnostic investigations for patients with suspected endometrial cancer.

Recommendations for Endometrial cancer screening:
Population	Screening recommendations
Lynch syndrome	Extremely high risk for endometrial carcinoma Endometrial cancer screening with annual endometrial biopsy should begin at age 30-35
Perimenopausal and postmenopausal patients with abnormal vaginal bleeding	High risk for Endometrial cancer Cancer should be ruled out in the presence of excess estrogen stimulation of the endometrium such as: Long history of anovulation Obesity Menstrual irregularity Long-term use of unopposed estrogen Long-term use of Tamoxifen

Esophageal Cancer

Esophageal Adenocarcinoma:

• Screening of barrett's esophagus-associated adenocarcinoma by endoscopy is a worldwide clinical practice.
• According to current guidelines, random endoscopic biopsies should be collected in all four quadrants and each 2 cm of columnar epithelium. It is ideally performed with high-resolution endoscopes and NBI (narrow banding imaging).
• Barrett’s esophagus is the pre-neoplastic lesion preceding adenocarcinoma.
• People with chronic gastroesophageal reflux disease (GERD) symptoms and at least 1 risk factor for esophageal carcinoma (age> 50 years, male sex, white race, hiatal hernia, elevated body-mass index, intra-abdominal body-fat distribution, or tobacco use) are suitable for active endoscopic screening for barrett’s esophagus.

Recommendations for Esophageal adenocarcinoma screening:
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	Endoscopic screening (every 3-5 years)

Esophageal squamous cell carcinoma:

• Squamous dysplasia is the precursor lesion of esophageal squamous cell carcinoma.
• Esophageal squamous cell carcinoma is the predominant histologic subtype in Asia and the incidence and mortality are higher in China than in Japan.
• There are no studies suggesting the endoscopic screening for squamous esophageal carcinoma among the population of western countries.

Recommendations for Esophageal squamous cell carcinoma screening:
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	Endoscopic screening after 5 years of detecting low-grade dysplasia
Intermediate grade dysplasia	Endoscopic screening after 3 years of detecting 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).

Recommendations for lung cancer screening:
Recommended test	Low-dose chest CT
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.

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

Ovarian cancer

• There are no recommendations for screening ovarian cancer in asymptomatic women although the better outcome is associated with early diagnosis.
• 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.

Recommendations for Ovarian cancer screening:
Population	Screening recommendations
Lynch syndrome	Ovarian cancer risk is increased and may present at a relatively younger age.
BRCA1 and BRCA2 gene mutations	Women with family history and women with deleterious gene mutation are at risk for ovarian cancer.

• To view the detailed information on ovarian cancer screening click here.

Prostate Cancer

• 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.
• According to the GLOBOCAN 2018 estimates of cancer incidence, mortality, and prevalence, prostate cancer is the second cause of cancer deaths in males (7.1% of the total cancer deaths).

Recommendations for Prostate cancer screening:
Population	Screening recommendations
Age 55-69	The decision to be screened for prostate cancer should be an individual one. Clinicians should discuss the potential benefits and harms of screening. Screening could benefit population at risk for prostate cancer such as: Older age African American race family history of prostate cancer
Age 70	Discontinue screening for prostate cancer.

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

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