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INTRODUCTION

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American Cancer Society (ACS) Recommendations for the Early Detection of Cancer in Average-Risk, Asymptomatic People1
Cancer Site Population Test or Procedure Frequency
Breast Women >20 years Breast self-examination (optional) Monthly, starting at age 20
Clinical breast examination

Every 3 years from ages 20–39

Annually, starting at age 40

Mammography Annually, starting at age 40
Colorectal Men and women, age 50+ years Fecal occult blood test (FOBT) or Annually, starting at age 50
Stool DNA test (sDNA) or Interval uncertain, starting at age 50
Flexible sigmoidoscopy or Every 5 years, starting at age 50
Fecal occult blood test (FOBT) and flexible sigmoidoscopy or Annual FOBT and flexible sigmoidoscopy every 5 years, starting at age 50
Double-contrast barium enema (DCBE) or Every 5 years, starting at age 50
Colonoscopy or Every 10 years, starting at age 50
CT colonography Every 5 years starting at age 50
Prostate Men >50 years Digital rectal examination (DRE) and prostate-specific antigen test (PSA) The PSA test and the DRE should be offered annually, starting at age 50, for men who have a life expectancy of at least 10 years§

CervixImage not available.

Women age <21 None  
Women age 21–29 Cytology alone Every 3 years. HPV testing for screening should not be used
Women age 30–65 Preferred: HPV and cytology contesting Every 5 years. HPV testing for screening not recommended for most clinical settings
Acceptable: Cytology alone Every 3 years
Women age 65+ None following adequate prior negative screening History of CIN2 or greater diagnosis should continue screening for 20 years
Women following hysterectomy and NO history of CIN2 or greater diagnosis None Applies only to women with:
  • No cervix

  • Without a history of CIN2 or greater diagnosis in the past 20 years

  • No history of cervical cancer

Women following hysterectomy and history of CIN2 or greater diagnosis Continue age specific screening for at least 20 years  
Women HPV vaccinated Continue to follow age specific guidelines above for non-vaccinated women
Cancer-related checkup Men and women age 20+ years   On the occasion of a periodic health exam, the cancer-related check-up should include examination for cancers of thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures

Beginning at age 40, annual clinical breast examination

FOBT or FIT as sometimes done in the physician's office, with the single stool sample on fingertip during a DRE is NOT recommended. Toilet bowl FOBT tests also are not recommended. In comparison with guaiac-based tests for the detection of occult blood, immunochemical tests are more patient-friendly and are likely to be equal or better in sensitivity and specificity. There is no justification for repeating FOBT in response to an initial positive finding

Flexible sigmoidoscopy together with FOBT is preferred compared with FOBT or flexible sigmoidoscopy alone

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