For people having periodic health exams, a cancer-related check-up should include health counseling and – depending on age – might include examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes or ovaries, as well as other non-malignant diseases. Specific tests include:
- Yearly mammograms starting at age 40 and continuing as long as a woman is in good health.
- Clinical breast exams as part of a periodic health exam every three years during a woman’s 20s and 30s and every year for women 40 and over.
- Any breast change should be reported promptly. Breast self-exam is an option for women starting in their 20s – please ask your provider how to do it properly.
- Women at increased risk should discuss earlier screening and other surveillance and risk management options such as a M.R.I. A March 2007 study sponosored by the National Cancer Institute and reported in the New England Journal of Medicine calls for greatly expanded use of M.R.I. scans in women who have breast cancer or are at high risk for it. The recommendations are not for healthy women who are only at average risk of developing breast cancer.
- For more information, see the Vanderbilt Breast Center website.
Beginning at age 50, men and women of average risk should begin the following:
- Yearly fecal occult blood test (FOBT) or fecal immunochemical test (FIT), flexible sigmoidoscopy every five years or a combination of annual FOBT or FIT with sigmoidoscopy every five years (preferred over ether alone)
- Double-contrast barium enema every five years
- Colonoscopy every 10 years
Any positive test should be followed up with a colonoscopy.
Discuss beginning earlier screening if you have a personal history of colorectal cancer or polyps, a strong family history of either, a personal history of chronic inflammatory bowel disease or a family history of a hereditary colorectal cancer syndrome.
- The U.S. Food and Drug Association recently approved a new vaccine that protects against infection by types of the human papilloma virus (HPV) that causes cervical cancer. The vaccine is recommended for girls and women between the ages of 9 and 26. If you are between these ages, or if you have a daughter who is between these ages, talk to your doctor or pediatrician about the HPV vaccine.
- All women should begin regular Pap tests by age 21 or within three years after onset of vaginal intercourse. Regular Pap tests should be done yearly; the newer liquid-based Pap test, every two years.
- Beginning at age 30, women who do not have certain risk factors such as a weakened immune system or DES exposure before birth and who have had three normal Pap test results in a row may be screened every two to three years.
- Women over 30 may also consider a Pap test plus the DNA test for infection with the human papilloma virus (HPV) every three years.
- Women over 70 who have had three normal Pap tests in a row and no abnormal Pap tests in the past 10 years may choose to stop having screening. Women with a history of cervical cancer or certain risk factors should continue screening.
Digital rectal examination and prostate-specific antigen (PSA) testing should be offered annually beginning at age 50 (or 45 for men at increased risk including African Americans and men with a strong family history of prostate cancer). Information about what is known and what is uncertain about the benefits and limitations of early detection and treatment of prostate cancer should be discussed so men may make an informed decision about screening.
As part of a routine cancer-related checkup, your health care professional should check your skin carefully and discuss any concerns you may have. It’s also important to check your own skin, preferably once a month. Learn the pattern of moles, blemishes, freckles, and other marks on your skin so that you’ll notice any changes. Any trouble spots should be seen by a doctor.
For melanoma, the most serious form, the “ABCD” rule is an easy guide:
- A is for ASYMMETRY: One half of a mole or birthmark does not match the other.
- B is for BORDER: The edges are irregular, ragged, notched, or blurred.
- C is for COLOR: The color is not the same all over and may include shades of brown or black, sometimes with patches of red, white, or blue.
- D is for DIAMETER: The spot is larger than 6 millimeters across (about the size of a pencil eraser) or is growing larger.
Other important signs of melanoma include changes in size, shape, or color of a mole or the appearance of a new spot. Some melanomas do not fit the ABCD rule described above, so it is particularly important for you to notice changes in skin markings or new spots on your skin.