Cancer Prevention: What You Need To Know

Screening Tests for Women

• Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.
• Women in their 20s and 30s should have a clinical breast exam as part of a periodic health exam by a health professional preferably every 3 years. After age 40, women should have a breast exam by a health professional every year.
• Breast self exam (BSE) is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any breast changes to their health professional right away.

National Cancer Institute (NCI)
Screening by mammogram, clinical breast exams or both decreases breast cancer deaths.

U.S. Preventative Services Task Force (USPSTF)
Routine screening for breast cancer every one to two years, with mammogram alone or mammogram and annual exams by a health professional is recommended for women ages 50-69.

Exams and Test Explained
Breast self-examination (BSE) is an examination by a woman of her breasts. This exam includes both feeling for lumps, as well as by looking at the breasts carefully to detect any changes in shape, size, and dimpling, puckering or changes in the color of the skin, or changes in the nipple.

A clinical breast exam is an examination by a physician or other health provider. The doctor palpates or feels the breasts for lumps and gently feels the lymph nodes above the collarbone and in the armpits.

A mammogram is an x-ray of the breast. A mammogram can often show tumors or changes in the breast before they can be felt or cause symptoms.

Symptoms to Report to Your Doctor

• A lump or thickening in the breast or armpit
• A change in the breast's size or shape
• A change in the color of the breast or the areola (area around the nipple)
• Scaling of the nipple or nipple retraction

Cervical/Uterine Cancer
Screening Guidelines

American Cancer Society (ACS)
Cervical
All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse. All women over age 21 should have regular cervical cancer screenings as well. Screening should be done every year with the regular Pap test or every 2 years using the new liquid based Pap test.

For women over age 30, who have had 3 or more normal Pap tests in a row and no abnormal Pap tests results in the last 10 years, may be tested every 2-3 years with conventional or liquid based Pap test.

National Cancer Institute (NCI)
Uterine
There is not enough evidence to establish whether a decrease in mortality for uterine cancer occurs with screening by endometrial biopsy or transvaginal ultrasound.

U.S. Preventative Services Task Force (USPSTF)
Uterine
There is not enough evidence to establish whether a decrease in mortality from endometrial cancer occurs with screening by endometrial biopsy.

Exams and Tests Explained
In a pelvic examination, the doctor checks the vagina, cervix, uterus, ovaries, fallopian tubes, and rectum. A speculum is inserted into the vagina so that the doctor can see the upper part of the vagina and cervix.

Regular or Conventional Pap Tests
For a Pap test, the doctor collects a sample of cells from the cervix and upper vagina. The cells are smeared onto a glass slide and sent to a laboratory to be checked for abnormal changes.

Liquid Based Pap Tests
Some centers are using liquid-based Pap testing. For this test, instead of smearing the sample onto a slide, the collection device is rinsed in a container of liquid that preserves the sample. When the vial arrives in the laboratory, a machine separates the cells and filters out any blood, mucus, and inflammatory cells. The remaining cells are placed on a slide in a thin layer. The Food and Drug Administration has recognized that liquid based Pap tests are "significantly more effective" than the conventional Pap test at detecting early signs of cervical abnormalities.

After the Pap test, the speculum is removed and the doctor inserts one or two gloved, lubricated fingers into the vagina while placing the other hand on the lower abdomen to feel the size and shape of the uterus and ovaries. The last part is a rectal exam in which the doctor inserts one gloved, lubricated finger into the rectum and another into the vagina to feel for any abnormalities.

An endometrial biopsy can be completed in a doctor's office. The doctor inserts a thin, flexible catheter through the vagina into the uterus. The catheter is used to gently scrape and take small amounts of tissue from the uterine lining. After the tissue is obtained, it is sent to a pathologist for examination. Women may experience cramping during the biopsy. Spotting for a few days after the exam is typical.

Symptoms to Report to Your Doctor

Cervical Cancer

• Abnormal vaginal bleeding or discharge
• Bleeding after intercourse
• Painful intercourse

Uterine Cancer

• Abnormal vaginal bleeding
• Pain in the pelvis, back or legs
• Change in bowel or bladder habits
• Weight loss

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