Cancer screening & prevention.

1. Cancer screening & prevention. HussainHaideri, M.D. FOM : CAPS.

4. ■We recommend that women between the ages of 50 and 70 be screened with mammography (Grade 1A). Information about the risk of breast cancer and the benefits and harms of screening should be reviewed (figure 3A-B and table 5). (See 'Mammography' above.) ■We suggest discussion of the risks and benefits of mammography between women age 40 to 50 and their clinician; the decision to perform mammography should be determined by individual patient risk and values through shared decision making (Grade 2B). (See 'Women in their 40s' above and 'Trade-offs between benefits and harms' above.) ■We suggest that women over the age of 70 be screened with mammography if their life expectancy is at least 10 years (Grade 2B). Frameworks have been developed that may assist with decision making in older women (table 6). (See 'Older women' above.) ■The ideal interval for screening mammography is not known, but we suggest screening every one to two years (Grade 2C). We recommend that women being screened for breast cancer also undergo clinical breast examination (Grade 1B). Clinical breast examination may be particularly useful in older women. (See 'Clinical breast examination' above.) ■The efficacy of breast self-examination (BSE) is unproven. We suggest that BSE not be performed except by women who express a desire to do so and who have received careful instruction to differentiate normal tissue from suspicious lumps (Grade 2B). BSE should only be performed as an adjunct to mammography and clinical breast examination, not as a substitute for these screening methods. (See 'Breast self-examination'

8. Tests available for screening are as follows: Stool-based tests ■Guaiac-based fecal occult blood test (gFOBT) ■Immunochemical-based fecal occult blood test (iFOBT), also known as fecal immunochemical test (FIT) Endoscopic and radiologic examinations ■Flexible sigmoidoscopy (FS or FSIG) ■Optical colonoscopy ■Double-contrast barium enema (DCBE) ■CT colonography (CTC, formerly referred to as "virtual colonoscopy")

9. ■Offer screening beginning at age 50 years for average-risk patients. Colorectal cancer does occur in asymptomatic average-risk people under the age of 50, but infrequently enough that the costs and risks of screening outweigh the benefits [99]. ■Discontinue screening when the individual's estimated life expectancy is less than 10 years. ■No single test is of unequivocal superiority. Incorporating patient personal preferences may increase the likelihood that screening will occur. ■Screening should be supported by a program that assures proper follow-up of abnormal findings and ongoing testing at identified intervals.

10. •A personal history of CRC or adenomatous polyp •A genetic syndrome predisposing to CRC (ie, hereditary nonpolyposis colorectal cancer [HNPCC], familial adenomatous polyposis [FAP]) •One or more first-degree relatives with CRC •Two or more second-degree relatives with CRC •IBD causing pancolitis or longstanding (>8 to 10 years) active disease •A personal history of childhood cancer requiring abdominal radiation therapy