Cancer treatment, screening guidelines restructured by M.D. Anderson

The University of Texas M.D. Anderson Cancer Center in Houston has released new screening guidelines for breast, cervical and colorectal cancers based on redefined risk-based categories for the public to follow.

Developed by a panel of disease-site experts in areas such as medical oncology, surgical oncology, cancer prevention and imaging, the new guidelines offer criteria for individuals at both average and high-risk groups for developing the three forms of cancer.

"Cancer screening is not one-size-fits-all," said Therese Bevers, MD, medical director of M.D. Anderson's Cancer Prevention Center. "Our new risk-based recommendations are markedly more personalized and precise, offering detailed guidance than what has previously been made available to the public here or by other cancer organizations."

According to the cancer center, individuals are considered average risk for cancers based on age, family history or genetic predisposition. For those who are considered to be in a high-risk category for the cancers, the new guidelines offer recommendations for screenings.

The guidelines for individuals at average risk for breast cancer are as follows: women of average risk age 40 and older should receive annual mammograms; and women of all risk levels should practice breast self-awareness beginning at age 20.

    For individuals at high risk, the frequency of mammograms, breast MRI and clinical breast exams vary according to:
    • History of radiation treatment to the chest;
    • Genetic predisposition;
    • Diagnosis of lobular carcinoma in situ;
    • Gail Model score of greater than 1.7 percent; and
    • Family history.

    The guidelines for individuals at average risk for cervical cancer are as follows:
    • Women under age 21 should receive liquid-based Pap tests within three years of initiating vaginal intercourse. Having been tested each of those three years, and after having three consecutive negative test results, further screening is recommended on a two-year basis.
    • Women age 30 and older may add HPV testing to the Pap test.   If both are negative, a woman may go every three years unless she is at increased risk.

    Screening should continue on a yearly basis for those who are considered high risk for cervical cancer.  High risk is determined by:
    • History of cervical cancer or severe cervical dysplasia;
    • Persistently testing positive for Human Papilloma Virus;
    • Exposure to diethylstilbestrol before birth;
    • Human Immunodeficiency Virus infection; and
    • Weak or improperly functioning immune system.

    The guidelines for individuals at average risk for colorectal cancer are as follows: a colonoscopy is recommended every 10 years for individuals age 50 and older; a virtual colonoscopy is recommended every five years; or an annual fecal occult blood test for individuals aged 50 and older.

      For individuals at high risk, the frequency of colonoscopy testing varies according to:
      • Personal history of precancerous (adenomatous) polyps;
      • Personal history of colorectal cancer;
      • Family history of colorectal cancer or adenomatous polyps;
      • Genetic diagnosis of familial adenomatous polyposis;
      • Genetic history of hereditary nonpolyposis colorectal cancer or a clinical history suggesting such; and
      • Inflammatory bowel disease (ulcerative colitis or Crohn's disease).

      By early 2010, M.D. Anderson plans to release additional screening guidelines for prostate, liver, skin, endometrial and ovarian cancers.

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