TABLE 1

Summary of Cancer Screening Recommendations for Low-Risk Patients

MARCH 15, 2001 / VOLUME 63, NUMBER 6 www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1103

 

Medical organization Screening recommendations

Breast cancer

MAMMOGRAPHY

AAFP              Every 1 to 2 years, ages 50 to 69; counsel women ages 40 to 49 about potential risks and benefits of mammography
                          and clinical breast examination.

ACOG             Every 1 to 2 years starting at age 40, yearly after age 50

ACS                Annually after age 40

AMA              Every 1 to 2 years in women ages 40 to 49; annually beginning at age 50

CTFPHC         Every 1 to 2 years, ages 50 to 59

NIH                 Data currently available do not warrant a universal recommendation for mammography for women in their
                        40s; each woman should decide for herself whether to undergo mammography.

USPSTF        Every 1 to 2 years, ages 50 to 69

CLINICAL BREAST EXAMINATION

AAFP         Every 1 to 2 years, ages 50 to 69; counsel women ages 40 to 49 about potential risks and benefits of
                    mammography and clinical breast examination.

ACOG         Yearly (or as appropriate) general health evaluation that includes examination to detect signs of premalignan
                    or malignant conditions

ACS             Every 3 years, ages 20 to 39; yearly after age 40; monthly breast self-examination beginning at age 20

AMA         Continuation of clinical breast examinations in asymptomatic women older than age 40

CTFPHC         Yearly, ages 50 to 69

USPSTF     Insufficient evidence to recommend for or against using clinical breast examination alone; optional every
                    1 to 2 years, ages 50 to 69

Cervical cancer

AAFP         Pap test at least every 3 years to women who have ever had sexual intercourse and who have a cervix

ACOG         Annual Pap test and pelvic examination beginning at age 18 or when sexually active; after 3 or more tests
                    with normal results, Pap test may be performed less frequently on physicianís advice.

ACS             Pap test annually starting at age 18 or when sexually active; after 2 to 3 normal (negative) tests, continue at
                       discretion of physician.

AGS             Pap test every 3 years until age 70; in women of any age who have never had a Pap test, screening with at
                    least 2 negative smears 1 year apart

AMA         Annual Pap test and pelvic examination starting at age 18 (or when sexually active); after 3 or more normal
                    annual Pap tests, the Pap test may be performed less frequently at the physicianís discretion.

CTFPHC     Pap test annually beginning at age 18 or following initiation of sexual activity; after 2 normal Pap results,
                       perform Pap tests every 3 years to age 69.

USPSTF     Pap test at least every 3 years in women who have ever had sexual intercourse and who have a cervix;
                       discontinue regular testing after age 65 if Pap test results have been consistently normal.

Colorectal cancer

AAFP         No published standards or guidelines for low-risk patients

ACOG         After age 50, annual FOBT (DRE should accompany pelvic examination); sigmoidoscopy every 3 to 5 years

ACS             After age 50, yearly FOBT plus flexible sigmoidoscopy and DRE every 5 years or colonoscopy and DRE every
                    10 years or double-contrast barium enema and DRE every 5 to 10 years

AMA         Annual FOBT beginning at age 50, and flexible sigmoidoscopy every 3 to 5 years beginning at age 50

AGA         FOBT beginning at age 59 (frequency not specified); sigmoidoscopy every 5 years, double-contrast barium
                    enema every 5 to 10 years or colonoscopy every 10 years.

CTFPHC     Insufficient evidence to recommend using FOBT screening in the periodic health examination of individuals
                        older than age 40; insufficient evidence to recommend sigmoidoscopy in the periodic health examination;
                        insufficient evidence to recommend screening with colonoscopy in the general population

USPSTF     After age 50, yearly FOBT and/or sigmoidoscopy (unspecified frequency for sigmoidoscopy)

Prostate cancer

AAFP                 No published standards or guidelines for low-risk patients

ACP-ASIM     Physicians should describe potential benefits and known harms of screening, diagnosis and treatment; listen
                            to the patientís concerns, then individualize the decision to screen.

ACS, AUA     Offer annual DRE and PSA screening, beginning at age 50, to men who have at least a 10-year life expectancy
                            and to younger men at high risk.

AMA                 Provide information regarding the risks and potential benefits of prostate screening.

CTFPHC, USPSTF         DRE and PSA tests are not recommended for the general population.

Skin cancer

ACS                 Cancer-related checkup, including skin examination every 3 years between ages 20 and 40, and every year
                            for anyone age 40 and older

AMA             Patients should talk to their physicians about the frequency of screening for skin cancer (those at modestly
                           increased risk should see a primary care physician annually); skin self-examination should be performed
                            monthly.

CTFPHC         Insufficient evidence to recommend for or against total-body skin examination or self-examination; counsel on
                            avoiding sun exposure and wearing protective clothing.

USPSTF         Insufficient evidence to recommend for or against routine screening for skin cancer by primary care clinicians
                            or counseling patients to perform periodic skin examination.

Testicular cancer

ACS                 Examine testicles as part of a cancer-related checkup.

CTFPHC            Insufficient evidence to recommend routine examination of testes by physician or by patient selfexamination

USPSTF             Insufficient evidence to recommend for or against routine screening of asymptomatic men in the general
                            population by physician examination or patient self-examination

 

 

 

DRE = digital rectal examination; FOBT = fecal occult blood testing; Pap = Papanicolaou; PSA = prostate-specific antigen.

ABBREVIATIONS FOR MEDICAL ORGANIZATIONS: AAFP = American Academy of Family Physicians; ACOG = American College of Obstetricians and

Gynecologists; ACP-ASIM = American College of Physicians-American Society of Internal Medicine; ACS = American Cancer Society; AGA

= American Gastroenterological Association; AGS = American Geriatrics Society; AMA = American Medical Association; AUA = American

Urological Association; CTFPHC = Canadian Task Force on Preventive Health Care; NIH = National Institutes of Health; USPSTF = U.S. Preventive

Services Task Force.