Cancer Prevention: What You Need To Know

Screening Tests for Men and Women

• Fecal occult blood test (stool test for blood) every year
• Flexible sigmoidoscopy every five years
• Fecal occult blood test every year and flexible sigmoidoscopy every five years
• Colonoscopy every 10 years
• Double contrast barium enema every five years

If you are at an increased risk, or higher than average risk, of colorectal cancer, you should begin colorectal cancer screening earlier and/or be screened more often. The following conditions place you at higher than average risk:

• Personal history of colorectal cancer or adenomatous polyps
• Personal history of chronic inflammatory bowel disease
• Strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative which is parent sibling or child, younger than 60, or in 2 first degree relatives of any age)
• Known family history of hereditary colorectal cancer syndromes (familial adenomatous polyposis or hereditary nonpolyposis colon cancer)

National Cancer Institute (NCI)
There are five exams that detect colorectal cancer. The National Cancer Institute supports screening for colorectal cancer. People should talk with their health care provider about when to begin screening for colorectal cancer, what tests to have, the benefits and risks of each test and how often to schedule appointments.

U.S. Preventative Services Task Force (USPSTF)
The USPSTF strongly recommends that men and women 50 years or older be screened for colorectal cancer. The USPSFT found good evidence that periodic fecal occult blood testing reduces death from colorectal cancer. It found fair evidence that sigmoidoscopy alone or in combination with fecal occult blood testing reduces death of colorectal cancer.

The American College of Gastroenterology
The American College of Gastroenterology recommends:

• For normal risk individuals, screening tests begin at age 50 and the preferred approach is a screening colonoscopy every 10 years. An alternative strategy consists of annual stool test for blood and a flexible sigmoidoscopic exam every 3 to 5 years.
• Colonoscopic surveillance (also called screening colonoscopy) needs to be available at more frequent intervals for individuals at high risk for colon cancer (for instance, those with a personal history of colorectal cancer, nonhereditary polyposis, colorectal cancer, or a predisposing condition such as inflammatory bowel disease). (Medicare provides for surveillance colonoscopy no more frequently than once every two years for those at high risk).
• For both average and high risk individuals, all potential precancerous polyps must be removed.

Exams and Test Explained
For a digital rectal exam, the doctor gently inserts a gloved, lubricated finger into the rectum and feels for abnormal areas. Fifteen percent of colorectal cancers can be detected by digital rectal exams.

There are two stool tests to check for hidden blood in the stool. These tests are the FOBT (fecal occult blood test) and FIT (fecal immunochemical test). Stool tests for blood checks for hidden or occult blood in the stool. Sometimes colorectal cancers can cause bleeding that cannot be seen. For the FOBT a small amount of stool is placed on a slide or special paper. The stool is tested in the doctor's office or sent to a lab. FOBT can sometimes be affected by food or vitamins ingested in the days surrounding the stool test. The FIT test is a new kind of stool blood test. It checks for a substance in blood. It is done the same way as FOBT. It is felt that this test will cut down the number of false positive results.

A sigmoidoscopy exam allows the doctor to visualize up to 25 inches of the lower bowel. For this exam, the doctor gently inserts a small flexible, lighted tube into the rectum and lower colon. Approximately 72% of all colorectal cancers occur in this area.

A colonoscopy is an examination of the rectum and entire colon using a lighted instrument called a colonoscope. Colonoscopy can find precancerous or cancerous growths throughout the colon, including the upper part of the colon. This area would be missed by sigmoidoscopy. However, it is not known whether this benefit outweighs the risk of colonoscopy. These include possible bleeding, and puncture of the lining of the colon. More research is needed to address these issues.

Symptoms to Report to Your Doctor

• A change in usual bowel habits (constipation, diarrhea, or both)
• Stools that are more narrow than usual
• Blood in or on the stool
• General stomach discomfort, such as bloating, fullness and/or cramps
• Frequent gas pains
• A feeling that the bowel does not empty completely
• Weight loss with no known reason
• Constant tiredness

Skin Cancer
Screening Guidelines
American Cancer Society (ACS)
Part of a routine cancer related check up should include a skin exam by a health care professional qualified to diagnose skin cancer. Your doctor should be willing to discuss any concerns you might have about this exam.

National Cancer Institute (NCI)
There is not enough evidence to establish whether a decrease in mortality (death) occurs with routine examination of the skin.

U.S. Preventative Services Task Force (USPSTF)
The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for skin cancer using a total body examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer.

Exams Explained
For a self skin examination, it should be done in a brightly lit room. A full length mirror is needed to look at all areas of the skin. This should include the scalp, inside the mouth, between the toes and the bottoms of the feet. Use a hand mirror to view the back and other hard to see places.

During a skin physical exam, the doctor checks your skin from head to toe for any suspicious looking changes.

Symptoms to Report to Your Doctor

• Any sore or mark on the skin that changes in size, height, color or shape
• Any on the skin that becomes itchy or painful, that may bleed or ulcerate

Oral Cancer
Screening Guidelines
American Cancer Society (ACS)
Many cancers of the oral cavity and oropharynx can be found early, during routine screening exams by a doctor or dentist, or by self-exam. Some early cancers have symptoms that cause patients to seek medical or dental attention. Unfortunately, others may not cause symptoms until after reaching an advanced stage or may cause symptoms that appear to be due to a disease other than cancer.

National Cancer institute (NCI)
There is not enough evidence to establish that screening results in a decrease in mortality (death) from oral cancer.

U.S. Preventative Services Task Force (USPSTF)
The US Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routinely screening adults for oral cancer.

Exams Explained
During an oral physical examination a dentist examines both the internal and external parts of the mouth for any sores, swellings or changes in tissue.

Symptoms to Report to Your Doctor

• A sore in the mouth that does not heal
• A lump or thickening in the cheek
• A white or red patch on the gums, tongue, or lining of the mouth
• Soreness or a feeling that something is caught in the throat
• Difficulty chewing or swallowing
• Difficulty moving the jaw or tongue
• Numbness of the tongue or other area of the mouth
• Swelling of the jaw that causes dentures to fit poorly or become uncomfortable

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