Drawing on years of experience in cancer research and patient care, The University of Texas M. D. Anderson Cancer Center released today the most comprehensive, risk-based screening guidelines publicly available to date for breast, cervical and colorectal cancers.
The new recommendations represent the first wave of an effort by M. D. Anderson to improve the effectiveness of efforts to prevent and detect cancer at its earliest, most treatable stage by reconstructing and expanding its screening, risk reduction and diagnostic guidelines across eight disease sites.
Available on M. D. Anderson's Web site, the recommendations translate best practices in cancer prevention employed at M. D. Anderson into accessible guidelines the public can follow, with risk categories identified and information about when to begin and discontinue screening exams.
According to the American Cancer Society, more than 40 percent 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 new cancer cases.
"Cancer screening is not one-size-fits-all," said 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 detailed guidance than what has previously been made available to the public here or by other cancer organizations."
Until now, cancer screening recommendations were targeted largely to individuals at average risk for developing cancer based on characteristics like age, family history or genetic predisposition. However, average risk was not previously defined and recommendations for individuals at increased or high risk were not outlined. The new screening guidelines define risk and offer recommendations for those at increased and high risk of developing cancer. For example, there are now five different sets of screening recommendations for those at increased risk for breast cancer; four categories of age-based risk recommendations for cervical cancer; and for colorectal cancer, there are three categories defining those at increased risk and three categories defining those at high risk.
The new guidelines build on established cancer screening practices and now more specifically offer the following recommendations:
Breast Cancer
Starting at age 20, women at all risk levels should practice breast self-awareness by being familiar with how their breasts look and feel and immediately reporting any changes to their doctor. Women aged 40 years 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 MRI - depend on factors putting them at increased risk, including:
- history of radiation treatment to the chest;
- genetic predisposition;
- diagnosis of lobular carcinoma in situ;
- Gail Model score of greater than 1.7 percent;
- or family history.
Cervical Cancer
For women at average risk, it is now recommended that women under age 21 get a liquid-based Pap test within three years of initiating vaginal intercourse. She should continue to have Pap tests annually until she has had three consecutive negative test results. After that, M. D. Anderson recommends screening every two years unless she is at increased risk of cervical cancer based on risk factors, including:
- history of cervical cancer or severe cervical dysplasia;
- persistently testing positive for Human Papilloma Virus (HPV);
- exposure to diethylstilbestrol (DES) before birth;
- Human Immunodeficiency Virus (HIV) infection;
- or an immune system that does not function properly.
Beginning at age 30, adding HPV testing is a preferred option to the Pap test, and if both are negative, a woman may go to every three years unless she is at increased risk based on the risk factors cited above or unless the optional HPV test was not done.
Colorectal Cancer