RECOMMENDATIONS for CANCER SCREENING
for persons at general population risk

and

RECOMMENDATIONS for CANCER SURVEILLANCE
for persons at increased cancer risk

The following recommendations are intended to guide both individuals and health care professionals about screening persons at general population risk¹ and surveillance plans for persons at increased risk² of developing several common types of cancer. These recommendations emphasize an evidence-based approach³ to guiding clinical recommendations.

Screening tests are used for the early diagnosis of disease in otherwise healthy persons. For example, breast cancer screening with mammography at regular intervals, is used to identify breast cancers among women in the general population not known to be at increased risk of developing breast cancer. This approach aids in the detection of early stage disease when treatment is most successful.

Surveillance refers to explicit strategies for assessment and/or examination at precise time intervals. For example, a person with a close relative (mother, father, brother, sister or child) who has been diagnosed with cancer of the colon or rectum needs surveillance with colonoscopy at specific intervals because of their increased risk of developing this cancer compared to others without this family history.

¹General Population Risk: refers to persons of a certain age, who are not known to have any medical conditions, family history of cancer or specific exposures that would increase the risk of developing certain type/s of cancer above that of the general population.

²Increased Risk: refers to persons who are known, or are suspected to be, at increased risk of developing a certain cancer(s) due to personal and/or family history of medical conditions, exposures, and/or prior cancers. Levels of increased risk are variable; talk with your doctor. Patients with a history of cancer should discuss the need for monitoring/on-going testing with their doctors.

³Evidence-based: refers to the use of current best evidence and is on based on a systematic review of published research findings that examine patient relevant outcomes (e.g., morbidity, mortality, quality of life).

In general, personal or family histories of cancer that may suggest increased susceptibility for certain type/s of cancer are:

• Two or more persons on the same side of the family (i.e., relatives related through either the mother's side or the father's side) with the same or related cancers (such as breast and ovarian cancers, or colon and uterine cancers);
• age of cancer diagnosis is earlier than the average age of onset in the general population (typically age 50 years) in at least one individual;
• presence of more than one primary cancer in an individual (this does not include metastases, the spread of cancer from its primary site);
• history of specific medical conditions associated with an increased risk of developing certain type/s of cancer.

Note: Persons and/or families having a history suggestive of increased susceptibility should consider evaluation by a genetics professional to determine the significance of this family history and specific recommendations for surveillance and/or cancer risk management.

Key Definitions for the Cancer Specific Guidelines (list on left hand side of page)

• First degree relatives are those persons with a direct, close blood relationship such as mother, father, brothers & sisters and children
• Second degree relatives are those persons with a less direct, but close blood relationship such as aunts, uncles, grandparents and grandchildren.
• Maternal relatives are those persons who share a blood relationship with the mother’s side of the family – sisters, brothers, children, grandchildren, nieces, nephews, maternal cousins, maternal aunts, maternal uncles, maternal grandmother, maternal grandfather.
• Paternal relatives are those persons who share a blood relationship with the father’s side of the family – sisters, brothers, children, grandchildren, nieces, nephews, paternal cousins, paternal aunts, paternal uncles, paternal grandmother, paternal grandfather.

Roswell Park Cancer Institute recommendations
for routine cancer screening¹

Selecting either a link below or on the left hand side of the page will give more detailed information about risk for that cancer.

Breast cancer	Females	Beginning at age 40 years: annual clinical breast examination mammography every year
Cervical cancer	Females	Beginning by age 21 years: annual pelvic examination and pap screening; start within three years of onset of sexual activity after age 30 years, women with three consecutive normal tests may extend screening to once every 2-3 years discontinue screening after age 65 years
Colorectal cancer	Females & Males	Beginning at age 50 years: screening colonoscopy every 10 years talk with your doctor for alternative screening strategies
Prostate cancer	Males	Beginning at age 50 years: discuss risks and benefits of prostate cancer screening with your physician. At this time there is no evidence that prostate specific antigen (PSA) screening or digital rectal examination (DRE) for the early detection of prostate cancer results in improvements in morbidity, mortality or quality of life after considering information about the known risks and potential benefits of prostate cancer screening, annual screening with PSA and digital rectal examination (DRE) should be available to those who request to be screened if elected, screening can be discontinued if life expectancy is <10 years
Lung cancer	Females & Males	at this time, screening for lung cancer is not recommended
Ovarian cancer	Females	at this time, screening for ovarian cancer is not recommended

The cancer screening tests listed above have a solid basis of evidence in terms of improved patient health (e.g., decreased morbidity, decreased mortality or improved quality of life). Unfortunately, we do not yet have

1. evidence of the effectiveness of all screening tests or
2. accurate screening tests available to detect all types of cancers. Use of other tests for the early detection of cancer is left to clinical discretion

Talk with your doctor about these screening tests and/or the need for surveillance for cancer. Specific recommendations may be individualized based on your personal medical history, including other medical conditions, and your family medical history. Other cancer screening tests are not recommended for use in the general population; although their use might be considered on an individual basis as recommended by your doctor.

Evidence to support continued cancer screening among persons of advanced age is limited, therefore, decisions regarding the need for cancer screening beyond age 70 or 75 years, or when life expectancy is < 10 years, is best determined based upon an individualized conversation with your primary care physician about your overall health status, including the presence and severity of other medical conditions, as well as your personal preferences.