What cancer screenings are recommended for women?

Women have a 37% chance of developing invasive cancer during their lifetime, and a 19% chance of dying of cancer, according to American Cancer Society statistics.

Early detection dramatically increases the potential for treatment success, illustrating the importance of routine screenings that can detect cancer prior to symptom onset.

Screening recommendations for women vary based on age, family health history and other characteristics. Consequently, women should speak with their health care providers to determine which screening tests are most appropriate for them.

However, to help with the discussion, HemOnc Today compiled this guide to common cancer screening tests for women.

Breast cancer

Approximately one in eight women in the United States will develop invasive breast cancer in their lifetime, according to the American Cancer Society.

Women with an average risk for breast cancer should undergo annual screening mammography beginning at age 45 years, according to an updated guideline from the American Cancer Society. The society recommends women should transition to biennial screening at age 55 years, with an option to continue annual screening.

The guideline — issued last fall — was the society’s first guideline for breast cancer screening in average-risk women since 2003. At that time, the society recommended women undergo annual screening beginning at age 40 years.

The U.S. Preventive Services Task Force recommends no routine screening for women aged 45 to 49 years, and it recommends biennial screening for women aged 50 to 54 years.

Women at high risk for breast cancer due to family history or presence of BRCA mutations should be screened more frequently.

Clinical breast exams and breast self-exams are not recommended due to lack of evidence of a clear benefit, according to the American Cancer Society. However, experts suggest women be familiar with how their breasts look normally and report any changes to their physician.

Gynecologic cancers

No direct evidence supports the overall benefits or harms of one-time or periodic screening pelvic examinations for potential gynecologic conditions in asymptomatic women who are not pregnant, according to a draft recommendation statement from the U.S. Preventive Services Task Force.

The task force also found limited evidence for the diagnostic accuracy and harms of routine screening pelvic exams to guide practice in asymptomatic primary care populations.

The American Cancer Society recommends cervical cancer testing start at age 21 years. The society suggests women aged 21 to 29 years should have a Pap test done every 3 years, and that women aged 30 to 65 years have a Pap test plus an HPV test every 5 years.

Women aged older than 65 years who have undergone regular cervical cancer testing in the previous 10 years with normal results should not undergo additional cervical cancer tests, according to the society.

The society recommends that women who reach menopause be told about the symptoms and risks of endometrial cancer, and be encouraged to report unexpected bleeding or spotting to their physicians.

Colorectal cancer

Excluding skin cancers, colorectal cancer is the third most common malignancy diagnosed in the United States, according to the American Cancer Society.

An estimated 134,490 cases of colon or rectal cancers will be diagnosed nationwide in 2016, and 49,190 Americans will die of the disease this year, according to society statistics.

A man’s lifetime risk for developing colorectal cancer is 1 in 21, or approximately 4.7%.

Routine colorectal cancer screening should be performed among adults aged 50 to 75 years, according to an updated recommendation from the U.S. Preventive Services Task Force. The decision to screen adults aged 76 to 85 years should be based on a person’s overall health and prior screening history, the task force concluded.

The task force also found convincing evidence that several screening methods can accurately detect early-stage disease and adenomatous polyps. Most guidelines recommend colonoscopy every 10 years, sigmoidoscopy every 5 years and fecal occult blood test annually.

Despite growing evidence of the effectiveness of colorectal cancer screening, it “is a substantially underused preventive health strategy in the United States,” task force chair Kirsten Bibbins-Domingo, PhD, MD, MAS, and colleagues wrote in their recommendation statement.

Lung cancer

The U.S. Preventive Services Task Force recommends adults aged 55 to 80 years with a 30 pack-year smoking history who either still smoke or quit within the prior 15 years undergo annual screening with low-dose CT.

More than 8 million American adults meet these eligibility criteria.

Other entities — including the American Cancer Society, National Comprehensive Cancer Network and American Lung Association — recommend some form of lung cancer screening with low-dose CT.

The USPSTF guidelines are based in part on the results of the National Lung Screening Trial, which included 53,454 adults aged 55 to 74 years who were at high risk for lung cancer. Researchers randomly assigned participants to annual low-dose CT or single-view posteroanterior chest radiography for 3 years.

The results, published in 2011 in The New England Journal of Medicine, revealed a 20% (95% CI, 6.8-26.7) reduction in lung cancer mortality with low-dose CT.

Some clinicians have cautioned that the benefits of annual screening must be balanced with risks, which include the potential for overdiagnosis, a high frequency of false-positive results and increased radiation exposure.

Others suggest the decline in smoking rates will translate to fewer people qualifying for lung cancer screening, thereby potentially leading to higher rates of lung cancer mortality.

Melanoma/s kin cancer

Routine screening for skin cancer is not recommended due to a lack of data that suggest a benefit.

However, women are encouraged to perform regular self-exams to check for new or changing lesions that may be cancerous or precancerous.

Standard criteria include asymmetrical shape, irregular borders, presence of more than one color or even distribution of color, diameter of 6 mm or larger, or evolution of a mole.

The risk for melanoma/skin cancer is much higher for whites than blacks. White women with blonde or red hair, green or blue eyes, or fair skin that burns or freckles easily are at increased risk.

Physicians who perform physical examinations on patients for other reasons should look for skin abnormalities.

Additional information can be found by searching the following websites:

http://blogs.cdc.gov/cancer/2016/05/16/womens-cancer-screening-cheat-sheet/

http://www.cancer.org/cancer/news/features/cancer-screening-tests-all-women-should-know-about

http://www.cancer.org/cancer/news/features/understanding-tests-that-screen-for-colon-cancer

http://www.cancer.gov/about-cancer/understanding/statistics