All women should have a general health evaluation annually or as appropriate that should include evaluation for cancer and examination, as indicated, to detect signs of premalignant or malignant conditions. Here are the types of cancer we will screen for:
Mammography should be performed every 1-2 years beginning at age 40 years and yearly beginning at age 50 years. All women should have an annual clinical breast examination as part of the physical examination. Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended.
Cervical cytology should be performed annually beginning at age 21 years. Cervical cytology screening can be performed every 2-3 years after three consecutive negative test results if the patient is aged 30 years or older with no history of cervical intraepithelial neoplasia 2 or 3, immunosuppression, human immunodeficiency virus (HIV) infection, or diethylstilbestrol exposure in utero. Annual cervical cytology also is an option for women aged 30 years and older. The use of a combination of cervical cytology and HPV DNA screening is appropriate for women aged 30 years and older. If this combination is used, women who receive negative results on both tests should be rescreened no more frequently than every 3 years.
Beginning at age 50 years, one of five screening options should be selected:
- Yearly patient-collected fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT)*
- Flexible sigmoidoscopy every 5 years.
- Yearly patient-collected FOBT or FIT* plus flexible sigmoidoscopy every 5 years
- Double-contrast barium enema even 5 years
- Colonoscopy every 10 years
Screening asymptomatic women for endometrial cancer and its precursors is not recommended at this time.
Available screening techniques are not cost-effective and have not been shown to reduce mortality from lung cancer. Accordingly, routine lung cancer screening is not recommended.
Currently, there are no effective techniques for the routine screening of asymptomatic, low-risk women for ovarian cancer. It appears that the best way to detect early ovarian cancer is for both the patient and her clinician to have a high index of suspicion of the diagnosis in the symptomatic woman, and both should be aware of the symptoms commonly associated with ovarian cancer. Persistent symptoms such as an increase in abdominal size, abdominal bloating, fatigue, abdominal pain, indigestion, Inability to eat normally, urinary frequency, pelvic pain, constipation, back pain, urinary incontinence of recent onset, or unexplained weight loss should be evaluated with ovarian cancer being included in the differential diagnosis.
Evaluate and counsel regarding exposure to ultraviolet rays. Examine any moles or skin lesions for change or suspicious appearance with biopsy or referral.
*Both FORT and FIT require two or three sample of stool collected by the patient at home and returned for analysis. A single stool sample FOBT or FIT obtained by digital rectal examination is not adequate for the detection of colorectal cancer.