Screening Guidelines, Tests, and Symptoms

Screening Tests for Women

• Breast Cancer
• Cervical Cancer
• Uterine Cancer
• Pelvic Exams and Tests Explained

Breast Cancer

Screening Guidelines:

American Cancer Society (ACS)

• Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
• Clinical breast exams should be part of a periodic health exam, about every three years for women in their 20's and 30's and every year for women 40 and over.
• Women should report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20's.
• Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g. breast ultrasound or MRI), or having more frequent exams.

National Cancer Institute (NCI)
Screening by mammography, clinical breast examination, or both may decrease breast cancer mortality. The existence of benefit is uncertain due to the variable quality of the evidence and inconsistency of results across studies.

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

There is not enough evidence to recommend for or against routine mammography or clinical breast examination for women aged 40-49, or aged 70 and older.

There is not enough evidence to recommend for or against the use of screening examinations by a health professional alone, or the teaching of breast self examination.

Exams and Tests 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, any 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)
• Any dimpling, or puckering of the skin or change in the color or texture of the skin
• An abnormal discharge from the nipple
• Scaling of the nipple or nipple retraction

Cervical Cancer

Screening Guidelines:

American Cancer Society (ACS)

• All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
• Beginning at age 30, women who have had 3 normal Pap tests in a row, may get screened every 2 to 3 years with either regular or liquid based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.
• Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid based Pap test, plus the HPV DNA test.
• Women 70 years of age or older who have had 3 or ore normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

National Cancer Institute (NCI)

• The overall evidence is good that regular screening of appropriate women for cervical cancer with the Pap test reduces mortality from cervical cancer. Screening is effective when started within 3 years after beginning vaginal intercourse and becomes much less effective in women ages 65 years and older who have had recent negative Pap tests. These benefits assume that screening programs use quality control of testing and interpreting procedures and have good follow-up of abnormal results. Women who do not have a cervix cannot benefit from screening for cervical cancer.

U.S. Preventative Services Task Force

• The Task Force strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. Screening should begin within 3 years of onset of sexual activity or age 21 (whichever comes first). Screening should be done at least every 3 years.
• The Task Force recommends against routine screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap tests and they are not otherwise at high risk for cervical cancer.
• The Task Force recommends against routine Pap test screening in women who have had a total removal of the uterus for benign disease.

Symptoms to Report to Your Doctor:

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

Uterine (lining of the uterus) Cancer

Screening Guidelines:

• The American Cancer Society recommends that all women should be informed about the risks and symptoms of uterine cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary nonpolyposis colon cancer annual screening should be offered for uterine cancer with endometrial biopsy beginning at age 35.

National Cancer Institute (NCI)

• 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

• There is not enough evidence to establish whether a decrease in mortality from endometrial cancer occurs with screening by endometrial biopsy.

Symptoms to Report to Your Doctor:

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

Exams and Test 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 suck 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 procedure is typical.