Screening Guidelines, Tests, and Symptoms
Screening Tests for Men and Women
Creation Date: February 2004
Last Revision Date: July 2005
Peer Review Status: Reviewed by Cancer Information Service
Colorectal Cancer
Screening Guidelines:
American Cancer Society (ACS)
Beginning at age 50, both men and women should follow one of these five testing schedules:
- Yearly fecal occult blood test (FOBT)*
- Flexible sigmoidoscopy every 5 years
- Yearly fecal occult blood test plus flexible sigmoidoscopy every 5 years **
- Double-contrast barium enema every 5 years
- Colonoscopy every ten years
*For FOBT, the take-home multiple sample method should be used.
**The combination of FOBT and flexible sigmoidoscopy is preferred over either of these two tests alone.
All positive tests should be followed up with colonoscopy.
People should begin colorectal cancer screening earlier and/or under go screening more often if they have any of the following colorectal cancer risk factors.
- A personal history of colorectal cancer or adenomatous polyps
- A strong family history of colorectal cancer of polyps (cancer or polyps in a first degree relative younger than 60 or two first degree relatives of any age)
- A personal history of chronic inflammatory bowel disease
- Families with hereditary colorectal cancer syndromes (familial adenomatous polyposis and hereditary non-polyposis colon cancer)
National Cancer Institute (NCI)
The NCI states that guaiac-based fecal occult testing (FOBT), either annually or twice yearly in people ages 50-80, decreases morality (death) from colorectal cancer. Regular screening by sigmoidoscopy in people over the age of 50 may decrease mortality from colorectal cancer. There is not enough evidence to determine how often this screening should be offered.
U.S. Preventative Services Task Force
The US Preventive Services Task Force strongly recommends that men and women 50 years or older be screened for colorectal cancer. The USPSTF found good evidence that periodic fecal occult blood testing (FOBT) reduces mortality from colorectal cancer. It found fair evidence that sigmoidoscopy alone or in combination with FOBT reduces mortality of colorectal cancer.
The American College of Gastroenterology
The American College of Gastroenterology recommends that African Americans should have colon screening for cancer at age 45, instead of 50. The recommendation is because African Americans are diagnosed with colorectal cancer at a younger age than whites. African American who develop colorectal cancer have decreased survival, compared with whites. They further recommend colonoscopy to be the preferred screening procedure for colorectal cancer for African Americans rather than flexible sigmoidoscopy because of the high overall risk as well as evidence that African American have more right sided cancer and polyps. The right side of the colon cannot be reached with flexible sigmoidoscopy.
Exams and Tests 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 examination.
The stool test for blood (FOBT) checks for hidden or occult blood in the stool. Sometimes colorectal cancers can cause bleeding that cannot be seen. For this test, a small amount of stool is placed on a plastic slide or on special paper. The stool may be tested in the doctor's office or sent to a lab.
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, where they would be missed by sigmoidoscopy. However, it is not known whether this benefit outweighs the risks of colonoscopy, which include possible bleeding, and puncturing 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 narrower 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)
For individuals undergoing periodic health examinations, a cancer related check-up should include health counseling, and depending on a person's age, might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some nonmalignant disease.
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. Preventive Services Task Force
The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for skin cancer using a total body skin examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer.
Exams Explained:
For a self skin examination, in a brightly lit room with a full-length mirror, look at all areas of the skin, including 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 area on the skin that becomes itchy or painful, that may bleed or ulcerate
Oral Cancer
Screening Guidelines:
American Cancer Society
Many cancers of the oral cavity and oropharynx can be found early, during routine screening examinations by a doctor or dentist, or by self-examination. 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
There is not enough evidence to recommend for or against routine screening of asymptomatic persons (those with no symptoms) for oral cancer by primary care clinicians. All patients should be counseled to stop the use of all forms of tobacco and to limit consumption of alcohol.
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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