Comprehensive screening guidelines issued for breast, cervical and colorectal cancers

At least half of all new cancers can be prevented or detected earlier with screening, according to the American Cancer Society. Researchers from The University of Texas M.D. Anderson Cancer Center are spearheading efforts to help identify those patients at highest risk with the release of new comprehensive, risk-based screening guidelines.

“Cancer screening is not one-size-fits-all,” Therese Bevers, MD, medical director at the facility’s Cancer Prevention Center, said in a press release. “Our new risk-based recommendations are markedly more personalized and precise, offering more detailed guidance than what has previously been made available to the public here or by other cancer organizations.”

A multidisciplinary panel that includes experts in medical and surgical oncology, cancer prevention and imaging are currently developing cancer-specific risk categories and screening intervals for eight types of cancer. Recommendations for breast, cervical and colorectal cancer are now available.

Breast cancer

Physicians should encourage all women to practice breast self-awareness beginning at age 20 and to report any noticeable changes at first sign. A clinical breast exam is recommended every one to three years for women at average risk for breast cancer aged 20 to 39 years; women aged 40 and older should receive annual exams accompanied by a mammogram.

Screening recommendations for women at increased risk — defined as a history of radiation treatment to the chest, genetic predisposition, lobular carcinoma in situ diagnosis, Gail model score of greater than 1.7% or a family history — vary depending on the age of the patient and the specific risk factor. Annual mammograms, a clinical breast exam every six to 12 months and an optional annual MRI are recommended for the following:

• Women 25 and older who have had chest radiation treatment eight to 10 years after the start of radiation, but no later than age 40.
• Women 25 and older with a genetic predisposition five to 10 years before the age of the youngest family member at onset of cancer or at age 25.
• Women 35 and older who have a five-year breast cancer risk of 1.7% or greater on the Gail model.
• Women with a 20% or greater chance of developing breast cancer as determined using a family-based model.

Women who have been diagnosed with in situ lobular carcinoma should also receive a breast exam every six to 12 months and an annual mammogram.

Cervical cancer

Health care providers should begin liquid-based Pap tests for women aged younger than 21 who have an average risk for cervical cancer within three years of vaginal intercourse initiation. Pap tests should be performed annually until three consecutive negative results are obtained, and then every two years thereafter.

Adding HPV testing is recommended for women aged 30 and older. If both are negative, testing is recommended every three years for women at average risk.

Annual Pap tests are recommended for the following high-risk patients:

• Those with a history of cervical cancer or severe cervical dysplasia.
• Those with persistent, positive HPV test results.
• Those with exposure to diethylstilbestrol before birth.
• Those who are immunocompromised or who have HIV.

Colorectal cancer

M.D. Anderson Cancer Center recommends initiating one of three screening options among men and women aged 50 and older who are at average risk for colorectal cancer. These include colonoscopy once every 10 years, a virtual colonoscopy every five years or a yearly fecal occult blood test.

The type and frequency of testing for patients at increased or high risk vary depending on the following factors:

• Personal history of adenomatous polyps.
• Personal history of colorectal cancer.
• Family history of colorectal cancer or adenomatous polyps.
• Genetic diagnosis of familial adenomatous polyposis.
• Genetic or clinical history of hereditary nonpolyposis colorectal cancer.
• Inflammatory bowel disease, including ulcerative colitis or Crohn’s disease.

“For colorectal cancer screenings, patients need to be proactive about obtaining results from their screenings,” Bevers said. “For example, if a colonoscopy reveals polyps, it is critical for the patient to know what kind, how many and what size, since this information factors heavily into what risk category they fall into for colorectal cancer.”

Colorectal cancer screening for patients aged 76 to 85 should be determined on a patient-by-patient basis. Screening recommendations for each of the previously mentioned cancers should be applied to patients expected to live for at least another 10 years.

“Because of the research being conducted in laboratories and clinics at M.D. Anderson and around the world, our understanding of how cancer develops and spreads is steadily increasing,” said Ernest T. Hawk, MD, MPH, vice president for the center’s Cancer Prevention and Population Sciences.