Cancer Screening, Adult

[2011 update]

Introduction to this self-study CME activity

Purpose

All adults should be screened for common cancers over a substantial period of their lives.  However, as screening methods evolve and evidence on effectiveness and cost-effectiveness, clinicians may be unaware or unsure of current screening recommendations.  This self-study activity provides current information on priority populations, initial screening, frequency of screening, and termination of screening for breast cancer, cervical cancer, colon cancer, and prostate cancer.  It also helps physicians implement these recommendations and address abnormal results.  New recommendations in this update include:

Breast cancer screening

  • Age to initiate: Some professional organizations recommend starting at age 40 for all women.  Others recommend starting at age 50, with individual decision-making for women age 40-49 that takes into account patient context (e.g. risk) and patients values regarding specific benefits and harms.
  • Frequency:  For average risk women, American Cancer Society and the National Comprehensive Cancer Network recommend screening every year and US Preventive Services Task Force recommends screening every 2 years. 
  • Consider continuing screening over age 74 if life expectancy is greater than 10 years.

Cervical cancer screening

  • Do not screen women under age 21.  
  • Consider co-test with human papillomavirus test and liquid-based cytology in routine screening for women over age 30.
  • HPV test remains a very useful tool for triaging cytologic abnormalities.

Colorectal cancer screening

  • Stop screening at age 75, though patient co-morbidity and life expectancy should be considered.
  • The preferred non-invasive test is fecal immunohistochemical (“high sensitivity”) testing rather than earlier types of fecal occult blood tests.

Prostate cancer screening

  • Key points to discuss with patients (Table 7) has been added.
  • Screening intervals of 1-4 years provide similar rates of detection of prostate cancer.
  • Stop prostate cancer screening at age 75, or when life expectancy is less than 10 years.

Objectives

Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for screening adults for cancers of the breast, cervix, colon, and prostate.

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers providing preventive health care for adults.

Authors

Team Leaders

  • Connie J. Standiford, MD
    General Internal Medicine

Team Members

  • Uche D. George-Nwogu, MD
    Family Medicine
  • Karl T. Rew, MD
    Family Medicine
  • R. Van Harrison, PhD
    Medical Education
  • Sandeep Vijan, MD
    General Internal Medicine

Consultants

  • Daniel F. Hayes, MD
    Breast Oncology
  • James E. Montie, MD
    Urology
  • Philip S. Schoenfeld, MD
    Gastroenterology
  • Mark A. Helvie, MD
    Breast Radiology
  • Anthony W. Opipari, MD
    Obstetrics & Gynecology

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant Greenberg, MD, MA, MHSA
  • R. Van Harrison, PhD
  • Connie J. Standiford, MD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This enduring material was released in December 2011 with credit available through November 2014.  The activity was reviewed for currency of content in September 2014 and availability of credit reauthorized  and extended through September 2017.  Continuation of credit from that date depends on a thorough review of the content currency and accuracy.

 

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.