Cancer Screening

First establish that the patient is asymptomatic and is being considered for preventive screening rather than diagnostic evaluation. Organ-specific symptoms, an abnormal examination, or prior abnormal screening findings require a diagnostic pathway; for colorectal testing, blood or cancer-associated DNA detected in stool warrants visual evaluation, usually colonoscopy, rather than serial stool testing.fda+1fdaColorectal CancerfdaColorectal Cancer: What You Should Know About Screening | FDA

Before ordering any screening modality, verify that the patient can complete its downstream steps. For colorectal screening, selection should account for required test frequency, access, bowel-preparation tolerance, ability to undergo sedation or anesthesia when relevant, and the risks of follow-up procedures after abnormal findings.fdafdaMCGP May 23, 2024 FDA Presentation For lung screening, use a program with diagnostic accuracy, defined follow-up protocols for positive results, and criteria for invasive procedures rather than ordering an isolated low-dose CT scan.NEJMNEJMUSPSTF Finalizes Recommendation for Lung Cancer Screening | NEJM Clinician

Separate average-risk screening from risk-directed surveillance. Earlier colorectal screening may be needed with inflammatory bowel disease or a family history of colorectal cancer; average-risk intervals should not be applied automatically to these populations.fda+1fdaColorectal CancerfdaColorectal Cancer: What You Should Know About Screening | FDA

Colorectal cancer screening is recommended for average-risk adults beginning at age 45 who have no signs or symptoms of colorectal cancer.fda+2fdaMCGP May 23, 2024 FDA PresentationfdaColorectal Cancer: What You Should Know About Screening | FDAWileyColorectal cancer screening: An update to the American Cancer Society guideline, 2026 Screening detects colorectal cancer and precursor polyps; colonoscopy can biopsy suspicious lesions and remove polyps during the procedure.fdafdaColorectal Cancer

Use annual FIT or high-sensitivity guaiac fecal occult blood testing when a noninvasive annual strategy is most likely to be completed. FIT is commonly interpreted at a quantitative cutoff of 20 micrograms hemoglobin per gram of stool in the United States; in a meta-analysis of asymptomatic average-risk adults, one-time FIT sensitivity and specificity for colorectal cancer were 79% and 94%, respectively. A negative FIT does not reliably exclude advanced adenoma or sessile serrated lesions, for which one-time test sensitivity is substantially lower.Wolters KluwerWolters KluwerACG Clinical Guidelines: Colorectal Cancer... : American Journal of Gastroenterology

Use colonoscopy every 10 years when direct whole-colon visualization, biopsy capability, and same-procedure polypectomy are desired and bowel preparation plus sedation or anesthesia are acceptable.fda+1fdaMCGP May 23, 2024 FDA PresentationfdaColorectal Cancer Stool DNA-FIT is an alternative every 1 to 3 years; CT colonography is repeated every 5 years; flexible sigmoidoscopy is repeated every 5 years; and flexible sigmoidoscopy every 10 years can be paired with annual FIT.fdafdaMCGP May 23, 2024 FDA Presentation

After any abnormal stool-based test, arrange diagnostic colonoscopy or another visual evaluation as clinically appropriate. Do not treat a positive stool test as a completed screening encounter: its value depends on completion of the diagnostic examination that identifies the bleeding source, cancer, or precancerous lesion.fda+1fdaColorectal CancerfdaColorectal Cancer: What You Should Know About Screening | FDA

Annual low-dose CT is recommended for eligible adults with a substantial smoking history in the age range and pack-year criteria specified by the applicable USPSTF recommendation. The cited USPSTF summary describes annual screening for adults aged 55 to 80 years with at least a 30-pack-year smoking history who currently smoke or quit within the prior 15 years.NEJMNEJMUSPSTF Finalizes Recommendation for Lung Cancer Screening | NEJM Clinician

Stop low-dose CT screening after 15 years of smoking abstinence and do not screen patients with medical conditions that limit life expectancy.NEJMNEJMUSPSTF Finalizes Recommendation for Lung Cancer Screening | NEJM Clinician These stopping rules prevent screening from proceeding when a detected cancer is unlikely to yield meaningful benefit from curative evaluation or treatment.

Order low-dose CT through an established screening program, not as an unstructured imaging request. False-positive results and overdiagnosis are recognized harms; programs should have high diagnostic accuracy, formal protocols for positive findings, and explicit thresholds for invasive diagnostic procedures.NEJMNEJMUSPSTF Finalizes Recommendation for Lung Cancer Screening | NEJM Clinician A meta-analysis of lung screening trials reported a pooled lung cancer mortality relative rate of 0.84 (95% CI, 0.76-0.92) with low-dose CT screening.The LancetThe LancetLung cancer mortality reduction by LDCT screening: UKLS ...

For men aged 55 to 69 years, make PSA-based screening an individualized decision after discussion of benefits and harms.fdafdaProstate Cancer Symptoms, Tests and Treatments | FDA The discussion should include the possibility that PSA testing detects slow-growing prostate cancer that may never require treatment, creating risk of overtreatment.fdafdaProstate Cancer Symptoms, Tests and Treatments | FDA

Interpret PSA in clinical context rather than as an isolated cancer diagnosis. Factors that may affect risk assessment include age, race, family history, prostate size, urinary tract infection or irritation, medications, and PSA rate of rise.fdafdaProstate Cancer Symptoms, Tests and Treatments | FDA An abnormal PSA therefore requires diagnostic risk assessment rather than automatic treatment.

Do not routinely offer PSA-based screening to men age 70 years or older under USPSTF recommendations because screening harms outweigh expected benefit in this group.fdafdaProstate Cancer Symptoms, Tests and Treatments | FDA Screening-related harms include false-positive findings, anxiety, biopsy, and treatment complications for cancers that may never have affected health.acpjournalsacpjournalsScreening for Prostate Cancer: Recommendation and Rationale | Annals of Internal Medicine

Do not screen asymptomatic adults for thyroid cancer using neck palpation or thyroid ultrasound.NEJM+1NEJMUSPSTF Finalizes Recommendation Against Thyroid Cancer Screening | NEJM ClinicianJAMAScreening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement The USPSTF concluded that potential benefit is no greater than small, citing thyroid cancer rarity, apparent lack of outcome differences between treatment and monitoring for the most common tumor types, and observational evidence showing no mortality change after a mass screening program.JAMAJAMAScreening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement

Do not order thyroid ultrasound solely to screen an asymptomatic adult without a clinical indication. Screening exposes patients to downstream diagnostic and treatment harms without established health-outcome benefit.JAMAJAMAScreening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement

For clinician visual skin examination in asymptomatic adolescents and adults, the USPSTF found insufficient evidence to determine the balance of benefits and harms.JAMAJAMAScreening for Skin Cancer: US Preventive Services Task Force Recommendation Statement This is an I statement rather than a recommendation for or against examination; use diagnostic skin evaluation when a lesion or symptom creates a clinical indication, rather than labeling the encounter routine population screening.