Cancer Screening, Early Detection and Prevention

Early detection of cancer not only saves lives, but also improves quality of life. To assist individuals in detecting cancer at its earliest stage, when treatment is most effective, the following information, based on national guidelines, is provided. Cancer prevention recommendations are also noted in areas where they apply. Please select from the cancer types listed below.

Brain
Breast
Cervical
Colon and Rectal
Endometrial (Uterine)
Liver
Leukemia and Lymphoma

Lung
Ovarian
Pancreatic
Prostate
Skin/Melanoma
Thyroid

Routine Cancer Checkups

For people aged 20 or older, the American Cancer Society recommends having periodic health examinations. Depending on a person's age and gender, these exams should also include cancer examinations and screenings, as well as screenings for non-malignant (non-cancerous) diseases. Special tests for certain types of cancer are recommended. Click on any of the above cancer types for more information.

Brain Cancer

There are currently no screening guidelines which have been approved for early detection of brain cancer.

Breast Cancer

Breast Cancer Screening (American Cancer Society)

Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
Clinical breast exam (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and over.
Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram.Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Hoag Breast Care Center offers the latest advances for the early detection of breast disease, including emerging technologies that may not be available elsewhere. Our highly specialized breast radiologists employ these technologies to diagnose breast cancer at its earliest stage, when it is easily treatable, often allowing breast preservation. Both screening mammography, and diagnostic mammography utilizing direct to digital technology are performed at the Hoag Breast Care Center, as well as dedicated Magnetic Resonance Imaging (MRI). MRI is recommended for breast screening in BRCA mutation carriers.

Hereditary Breast Cancer

It is estimated that up to 10% of all breast cancer occurs because of inheritance. People who are carriers of mutations in the BRCA1 and BRCA2 genes are at greatly increased risk for developing breast and ovarian cancer. Hoag Cancer Center’s Hereditary Cancer Program offers genetic counseling and genetic testing for BRCA1 and BRCA2 and other genetic mutations which are associated with hereditary breast cancer. Click here to learn more about Hoag Cancer Center’s Hereditary Cancer Program.

Cervical Cancer

Cervical Cancer Screening Recommendations (American Cancer Society)

All women should begin cervical cancer screening by 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
Beginning at age 30, women who have had 3 normal Pap test results in a row may reduce the frequency of screening to every 2 to 3 years. Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually.
Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having cervical cancer screening, unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a hysterectomy without removal of the cervix should continue to follow the guidelines above.

Hoag gynecologists routinely screen patients for cervical cancer through the use of Pap tests. To find a Hoag gynecologist, family practitioner or internist near you, click here to connect to Hoag’s physician referral website.

Cervical Cancer Prevention (Centers for Disease Control)

Human Papilloma Virus (HPV) infection is the leading cause of cervical cancer, as well as cancers of the vulva, vagina, anus and penis. HPV is the most common sexually transmitted infection in the United States with approximately 6.2 million persons infected each year. In June, 2006, a vaccine for HPV was licensed for use in females between the ages of nine and 26 years of age for the prevention of HPV infection.

The current recommendation from the Centers for Disease Control (CDC) is that all females be vaccinated between the ages of 11 and 12, and all females up to the age of 26 unless they have already acquired HPV. Hoag gynecologists and certain other primary care physicians are prepared to provide the vaccination which is administered in a series of three intramuscular injections. To find a Hoag pediatrician, family physician, or gynecologist near you, click here to connect to Hoag’s physician referral website section.

Colon and Rectal Cancer

Colon and Rectal Cancer Screening Recommendation (Hoag Cancer Center)

Each year, more than 250,000 Americans are diagnosed with gastrointestinal cancers, the most common of which is colorectal cancer, which is highly preventable with proper screening. The gold standard in colorectal cancer screening is colonoscopy, which is why Hoag Cancer Center recommends colonoscopy beginning at age 50 for both men and women, with subsequent intervals for retesting as determined by a physician.

Other physician recommendations may include one or more of the following alternatives: double contrast barium every five years, or virtual colonoscopy every 10 years.

Hoag Advanced Endoscopy Center provides complete screening and diagnostic testing, including colonoscopy, upper endoscopy, and endoscopic ultrasound (EUS).

According to the American Cancer Society, people should talk to their doctor about starting colorectal cancer screening earlier and/or undergoing screening more often if they have any of the following colorectal cancer risk factors:

A personal history of colorectal cancer or adenomatous polyps
A strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in 2 first-degree relatives of any age)
A personal history of chronic inflammatory bowel disease
A family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)

Colorectal Cancer Prevention

Most colorectal cancers arise from polyps, which can be visualized and removed during a colonoscopy.

Hereditary Colorectal Cancer

It is estimated that about six percent of all colon and rectal cancers occur because of inheritance. People who inherit mutations in certain cancer-preventing genes are at increased risk for colon, rectal, uterine and ovarian cancers. Hoag offers a genetics counseling program and genetic testing for HNPCC and FAP and certain other genes that are associated with these cancers. Click here for more information about Hoag’s Hereditary Cancer Program.

Endometrial (Uterine) Cancer

Endometrial Cancer Screening (American Cancer Society)

The American Cancer Society recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with, or at high risk for hereditary non-polyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.

Women taking hormonal treatment with tamoxifen should be aware that there is an increased incidence of uterine cancer with tamoxifen use. If vaginal bleeding is experienced, see your gynecologist immediately. To find a Hoag gynecologist near you, click here to connect to Hoag’s Physician Referral Website.

Hoag’s Hereditary Cancer Program offers genetic counseling and genetic testing for HNPCC which is associated with hereditary uterine cancer. Click here for more information about Hoag’s Hereditary Cancer Program.

Liver Cancer Screening

There are no recommendations for screening for liver cancer. However, Hepatitis B and C, hemochromatosis, cirrhosis and diabetes are known risk factors for liver cancer.

Liver Cancer Prevention (Advisory Committee on Immunization Practices)

Hepatitis B is one of the most common causes of liver cancer. The Advisory Committee on Immunization Practices (ACIP) recommends the following immunization strategy for elimination of Hepatitis B transmission in the United States:

Universal vaccination of infants beginning at birth
Prevention of perinatal Hepatitis B Viral (HPV) infection through:
-Routine screening of all pregnant women for Hepatitis B surface antigen (HBsAg) and
-Routine vaccination of previously unvaccinated children and adolescents
-Vaccination of previously unvaccinated adults at risk for HBV infection

At risk adults include:

Those at risk for infection by sexual exposure
-Injection drug users
-Household contacts of persons with chronic HBV infection
-Developmentally disabled persons in long-term-care facilities
Persons at risk for occupational exposure to HBV (Healthcare workers and public safety workers)
-Persons with chronic liver disease
-Travelers to HBV endemic regions
-HIV positive persons

Vaccination for Hepatitis B is accomplished through a three-injection series. To find a Hoag physician near you, click here to connect to Hoag’s Physician Referral Website.

For more information, visit the Advisory Committee on Immunization Practices.

Other causes of liver cancer include:

Hepatitis C is a known cause of liver cancer. Currently there is no vaccine for Hepatitis C.
Alcoholic cirrhosis of the liver is a cause of liver cancer.

Leukemia and Lymphoma

There are currently no screening guidelines which have been approved for early detection of hematologic malignancies such as leukemia and lymphoma. However, as part of a regular cancer-related checkup, routine blood tests may show early signs of these cancers.

Lung Cancer

Screening for Lung Cancer

There are currently no screening guidelines which have been approved for early detection of lung cancer. However, it has longed been known that the best way to cure lung cancer is to detect it early. For those who are concerned about their risk for lung cancer due to a smoking history, exposure to second hand smoke or environmental exposures, Hoag provides the Lung Cancer Early Detection Program. Click here to learn more about the early detection of lung cancer.

Prevention of Lung Cancer

The most important risk factor for lung cancer is smoking. Therefore, the most effective prevention for lung cancer is to never smoke, or for smokers, to quit smoking. It is also known that second-hand smoke increases the risk of developing lung cancer, especially among children raised in a home in which parents smoke. Hoag Hospital offers several options for those who wish to stop smoking. Click here to learn about Hoag’s Freedom From Smoking program.

Ovarian Cancer

Ovarian Cancer (National Cancer Institute)

Each year, more women die in the United States from ovarian cancer than from cervical and endometrial cancers combined. That’s why it’s important to understand the risk factors for ovarian cancer. Risk Factors for Ovarian Cancer include:

Genetic Factors: Women who have inherited certain altered (mutated) genes have a much higher risk of developing ovarian cancer. These mutations may be found in BRCA1, BRCA2, or hereditary nonpolyposis colon cancer (HNPCC) genes. For more information on groups that are at high risk for ovarian cancer due to inherited genetic factors, see the National Cancer Institute’s PDQ summary on the Genetics of Breast and Ovarian Cancer.

Hoag’s Hereditary Cancer Program offers genetic counseling and genetic testing for Hereditary Breast and Ovarian Cancer Syndrome. Click here to learn more about the Hereditary Cancer Program.

Family History of Ovarian Cancer: A woman who has a first-degree relative (mother or sister) or a cluster of two or more relatives with ovarian cancer has a higher than average risk of developing ovarian cancer.

Age: The risk of developing ovarian cancer increases as a woman gets older.

Obesity: Having excess body fat as measured by body mass index, including during the teen years, increases the risk of ovarian cancer. Diet and nutrition during the teen years may play a role in prevention.

Risk Reduction Factors

Oral Contraceptives: Studies show that the use of oral contraceptives reduces the risk of developing ovarian cancer. The longer you use oral contraceptives, the lower your risk might be. The decrease in risk may last up to 25 years after the use of oral contraceptives has ended. This lower risk is seen both in women who have given birth and in women who have not. Oral contraceptives may also protect against ovarian cancer in women who are at higher risk because they have inherited an altered version of BRCA1 and BRCA2 genes.

Childbearing and Breastfeeding: Women who have had at least one child are less likely to develop ovarian cancer than women who have never had children. Studies have also shown that women who breastfeed are less likely to develop ovarian cancer.

Tubal Ligation or Hysterectomy: Studies have shown that women who have undergone tubal ligation (sterilization) or a hysterectomy are at decreased risk of developing ovarian cancer.

Prophylactic Oophorectomy: Sometimes women with a very strong family history of ovarian cancer decide to have prophylactic oophorectomy (removal of both ovaries) and salpingectomy (removal of the fallopian tubes). This greatly reduces the risk of ovarian cancer in women who have inherited an altered version of BRCA1 and BRCA2 genes or hereditary nonpolyposis colon cancer (HNPCC) genes. With prophylactic removal of the ovaries, there is still a small chance that ovarian cancer may develop in nearby abdominal and pelvic tissue. It is important to have a cancer risk assessment and counseling before making this decision.

Hormone Replacement Therapy/Hormone Therapy: Hormone replacement therapy, also called hormone therapy, is associated with an increased risk of ovarian cancer in postmenopausal women. The risk increases with the length of use, and may be different for estrogen-only therapy (ERT) and estrogen-progestin replacement therapy (EPRT).

Some studies show an increased risk of ovarian cancer in women who have used fertility drugs, especially in those who do not become pregnant. Other risk factors that have been suggested for ovarian cancer are the use of talcum powder in the area between the vagina and the anus, or eating a high fat or high lactose diet. The exact relationship remains unclear.

Ovarian Cancer Screening

There currently is no recommendation for screening for ovarian cancer. However, in women who are BRCA 1 or 2 mutation carriers, CA125 blood test and pelvic ultrasound are used to enhance the potential for early detection.

Early signs of ovarian cancer often go unrecognized because symptoms are ignored or go unrecognized by healthcare professionals. Now, in an attempt to increase recognition of symptoms of ovarian cancer early, the American Cancer Society, the Society of Gynecologic Oncologists and the Gynecologic Cancer Foundation have written a consensus statement which defines the following symptoms as being much more likely to occur in women with ovarian cancer than in the general population:

Abdominal bloating
Pelvic or abdominal pain
Difficulty eating or feeling full quickly
Urinary urgency or frequency

If you experience these symptoms and are concerned about your risk for ovarian cancer, see your gynecologist. To find a Hoag gynecologist near you, please click here. For more information about ovarian cancer, visit the Women’s Cancer Foundation Website.

Pancreatic Cancer

There are currently no screening guidelines which have been approved for early detection of pancreatic cancer. However, carriers of mutations in the BRCA1 and 2 genes (Hereditary Breast/Ovarian Cancer Syndrome) also have an elevated risk of developing pancreatic cancer. Hoag’s Hereditary Cancer Program offers genetic counseling and genetic testing for Hereditary Breast and Ovarian Cancer Syndrome. Click here to learn more about the Hereditary Cancer Program.

Prostate Cancer

Screening for Prostate Cancer (American Cancer Society)

Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. Men at high risk (African-American men and men with a strong family history of one or more first-degree relatives [father, brothers] diagnosed before age 65) should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.

It's important to note that it is not appropriate for physicians to discourage, or not offer, prostate cancer screenings to their patients. Information should be provided to all men about what is known and what is uncertain about the benefits, limitations, and harms of early detection and treatment of prostate cancer so that they can make an informed decision about testing.

Early Detection of Prostate Cancer

Indications for diagnostic testing for early detection of prostate cancer include elevated PSA and abnormality detected by digital rectal examination.

Prevention of Prostate Cancer

Currently there are no known strategies for prevention of prostate cancer.

Skin Cancer

Skin Cancer (American Cancer Society)

More than one million people are diagnosed with skin cancer each year. These cancer types include: basal cell, squamous cell and melanoma.

Skin Cancer Prevention

The major cause of skin cancers including basal cell, squamous cell and melanoma is exposure to ultra-violet rays from sun exposure and other sources including tanning beds. Light-skinned individuals are more prone to cancer-causing damage caused by ultra-violet rays. Ultra-violet ray exposure can be decreased by limiting the time spent in the sun, wearing protective clothing and hats, and applying sunscreen. To learn more about ultra-violet rays and skin cancer, please visit the American Cancer Society Website.

Skin Cancer Screening

There are currently no screening guidelines which have been approved for early detection of skin cancer. However, as part of a regular cancer-related checkup, your doctor should check your skin carefully for abnormal areas. It’s also important to be aware of changes which may develop in your skin by doing skin self-examination once monthly. For more information how to perform skin self-examination, please visit the American Cancer Society Website.

Thyroid Cancer

There are currently no screening guidelines which have been approved for early detection of thyroid cancer. However, as part of a regular cancer-related checkup, your doctor should check your neck area carefully for any nodules in the thyroid area.

Treatment/Diagnostic Capabilities:

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