Redefining Cancer Screening Guidelines

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By Laura Prus, Staff Writer

FA3_screening.jpgThe risk for developing cancer varies from person to person. However, until recently, screening guidelines were targeted only to those at average risk.

To provide comprehensive recommendations, M. D. Anderson released risk-based screening guidelines for breast, cervical and colorectal cancers.

These recommendations, available on M. D. Anderson's Web site, are part of an extensive push to improve the effectiveness of efforts to prevent and detect cancer at its earliest, most treatable stage. M. D. Anderson's screening, risk-reduction and diagnosis guidelines will be reconstructed and expanded across eight different disease sites.

According to the American Cancer Society, more than 40% of Americans will develop cancer during their lifetime, and cancers that can be prevented or detected earlier by screening account for at least half of all cancer cases.

Beyond the average risk

Screening guidelines constructed for those at average risk were based on characteristics such as age, family history or genetic predisposition. However, new guidelines define risk through various categories and offer recommendations for those at increased and high risk of developing cancer. They also provide information about when to begin and discontinue screening exams.

"Cancer screening is not one-size-fits-all," says Therese Bevers, M.D., medical director of M. D. Anderson's Cancer Prevention Center. "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."

The new recommendations expand on earlier guidelines and offer more specific regimens for cancer screening.

Breast cancer

Starting at age 20, all women should practice breast self-awareness by being familiar with how their breasts look and feel. Any changes should be immediately reported to a doctor. Women 40 and older at average risk should get annual mammograms and breast exams.

For women at increased risk, the type and frequency of exams, including clinical breast exams, mammograms and breast magnetic resonance imaging (MRI), depend on the extent of a patient's risk factors. Such factors include:
•    History of radiation treatment to the chest
•    Genetic predisposition
•    Diagnosis of lobular carcinoma in situ (a condition in which abnormal cells are found only in the lobules)
•    Gail risk assessment score of 1.7% or greater in women 35 years or older (an explanation of the Gail risk assessment tool:
•    Lifetime risk of 20% or greater based on family history

Cervical cancer

It is now recommended that women at average risk under age 21 get a liquid-based Pap test within three years of initiating vaginal intercourse. Testing should continue annually until the results are negative three consecutive times.

M. D. Anderson recommends further screening every two years unless a woman is at increased risk of cervical cancer based on one or more risk factors, in which case she should continue with annual screening, including:
•    History of cervical cancer or severe cervical dysplasia
•    Persistently testing positive for human papilloma virus (HPV)
•    Exposure to diethylistilbestrol (DES) before birth
•    Human immunodeficiency virus (HIV) infection
•    A dysfunctional immune system

In addition to the Pap test, HPV testing is the preferred option beginning at age 30. If both are negative, a woman may be retested at three-year intervals unless she is at increased risk or an optional HPV test was not done.

Colorectal cancer

For men and women at average risk who are 50 years and older, M. D. Anderson recommends a colonoscopy every 10 years (preferred screening), and either a virtual colonoscopy every five years or a yearly fecal occult blood test (FOBT).

For men and women at increased or high risk, the type and frequency of exams, including colonoscopy and flexible sigmoidoscopy, depend on the following factors:
•    Personal history of precancerous (adenomatous) polyps
•    Personal history of colorectal cancer
•    Family history of colorectal cancer or precancerous (adenomatous) polyps
•    Genetic diagnosis of familial adenomatous polyps
•    Genetic history of hereditary nonpolyposis colorectal cancer, or clinical history suggesting such
•    Inflammatory bowl disease (ulcerative colitis or Crohn's disease)

The risk categories and related guidelines were developed by multidisciplinary panels of M. D. Anderson disease site experts across several areas. These included medical oncology, surgical oncology, radiation oncology, cancer prevention, imaging and others.

Risk-based screening guidelines for prostate, liver, skin, endometrial and ovarian cancers are currently in development. A new online risk assessment tool that will integrate the new screening guidelines is set to launch on the M. D. Anderson Web site in early 2010.

Adapted by Laura Prus from an M. D. Anderson news release.

Related articles:
M. D. Anderson Updates Screening Guidelines With a Focus on Risk

M. D. Anderson resources:
Cancer screening guidelines

New screening guidelines for cervical cancer

New screening guidelines for breast cancer

New screening guidelines for colorectal cancer

M. D. Anderson Cancer Prevention Center

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