Prevention and Screening

Early Detection

Hereditary Cancer Syndromes

Approximately 5-10% of all cancers are hereditary, which means that changes (or mutations) in specific genes are passed from one blood relative to another. Individuals who inherit one of these gene changes will have a higher likelihood of developing cancer within their lifetime. Currently, we have an understanding about mutations in several genes that increase the risk for developing several types of cancer; however, we have not yet identified genetic causes for all types of cancer.

Hereditary Breast & Ovarian Cancer Syndrome

The most common type of inherited breast cancer is hereditary breast and ovarian cancer syndrome (HBOC). HBOC is caused by mutations in the BRCA1 and BRCA2 genes. A woman with an inherited mutation in the BRCA genes has a higher chance to develop breast and ovarian cancer in her lifetime than a woman who does not carry a mutation. A man with an inherited mutation in the BRCA genes has a higher chance to develop breast and prostate cancer in his lifetime. Additionally, some families have higher incidence of pancreatic cancer, melanoma and other cancers.

Cowden Syndrome

Cowden syndrome (CS) is characterized by multiple tumor-like growths and an increased risk of certain cancers. The majority of patients with CS develop small, non-cancerous growths, or hamartomas, of the skin and mucous membranes, but these growths can also occur in the intestinal tract or brain. Individuals with CS also have an increased risk of developing benign and malignant tumors of the breast, uterus and thyroid. CS is associated with mutations in the PTEN gene.

Hereditary Non-polyposis Colorectal Cancer Syndrome (Lynch Syndrome)

Hereditary non-polyposis colorectal cancer syndrome (HNPCC) or Lynch Syndrome is characterized by early age onset colorectal cancer and endometrial (uterine) cancer as well as other extracolonic tumors. Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch Syndrome is caused by mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6 or PMS2). A variant of HNPCC-Lynch Syndrome called Muir Torre Syndrome is associated with increased risk for certain skin tumors. A second variant, called Turcot Syndrome, is associated with certain brain tumors (different than in FAP).

Familial Adenomatous Polyposis (FAP)

Familial adenomatous polyposis (FAP) or Gardner's Syndrome is a colon cancer predisposition syndrome in which hundreds to thousands of precancerous colon polyps (called adenomas) develop throughout the gastrointestinal tract (mostly in the colon and rectum but also in the stomach and small intestine). Attenuated FAP (AFAP) is a milder form of FAP and is associated with increased risk for colon cancer but fewer number of colon polyps. Gardner's Syndrome is associated with the typical number of polyps as in FAP, but also osteomas (benign tumors of the bone) and soft tissue tumors (called desmoids). A second variant, called Turcot Syndrome, is associated with certain brain tumors (different than in HNPCC-Lynch Syndrome). All forms of FAP are associated with mutations in the APC gene.

Li-Fraumeni Syndrome

Li-Fraumeni Syndrome (LFS) is a rare genetic condition characterized by increased risk to develop multiple types of cancer. The cancers that occur in LFS can be diagnosed during childhood, adolescence or adulthood. The most common types of cancer associated with LFS include: sarcomas of the soft tissue (tumor in fat, muscle, nerve, joint, blood vessel, bone or deep skin); breast cancer; leukemia; lung cancer; brain cancer; and cancer of the adrenal gland. Most individuals with LFS are found to have mutations in the TP53 gene.

Von Hippel-Lindau Disease

Von Hippel-Lindau Disease (VHL) is a multisystem disorder characterized by abnormal growth of blood vessels (called hemangioblastomas or angiomas). Hemagioblastomas may develop in the retina, certain areas of the brain, the spinal cord and other parts of the nervous system. Other types of tumors can develop in the adrenal gland, kidney and pancreas. Individuals with VHL also have a higher risk to develop certain types of cancer, especially kidney cancer. Nearly all individuals with VHL are found to have mutations in the VHL gene.

Multiple Endocrine Neoplasias

Multiple endocrine neoplasia (MEN) syndromes received their name because they predispose people to develop tumors of the endocrine glands. The endocrine system is comprised of glands that secrete hormones into the bloodstream that control numerous processes within the body. The endocrine system is instrumental in regulating mood, growth and development and metabolism, as well as sexual function and reproductive processes.

The major glands of the endocrine system affected by the MEN syndromes are the pituitary, thyroid, parathyroids, adrenals and pancreas. Currently, there are two distinct MEN syndromes: MEN1 and MEN2. In some ways, the two syndromes are similar, but there are important differences.

Cancer Risk Factors

Am I Likely to Develop Cancer?

According to the National Cancer Institute, a risk factor is anything that raises or lowers a person’s chance of developing a disease. Although doctors can seldom explain why one person develops the disease and another does not, researchers have identified specific factors that increase a person’s chances of developing certain types of cancers.

Cancer risk factors can be divided into four groups :

  • Behavioral risk factors are things you do, such as smoking, drinking alcohol, using tanning beds, eating unhealthy foods, being overweight and not getting enough exercise.
  • Environmental risk factors include things in the environment around you, such as UV radiation, secondhand smoke, pollution, pesticides and other toxins.
  • Biological risk factors are physical characteristics such as your gender, race or ethnicity, age and skin complexion.
  • Hereditary risk factors relate to specific mutated genes inherited from your parents. You have a higher likelihood of developing cancer if you inherit one of these mutated genes.

Most behavioral and environmental cancer risk factors can be avoided. Biological and hereditary risk factors are unavoidable, but it's important to be aware of them so you can discuss them with your doctor and get screened for cancer, if necessary.

What Can I Do?

To better understand your cancer risk factors, take a few minutes to complete our Cancer Risk Check. This short questionnaire will provide personalized suggestions for lifestyle changes and screening exams that may help you prevent cancer. Share your results with your doctor so he or she can determine what screening tests and regular checkups you need.

Remember, many people who develop cancer have no known risk factors, and most people who do have risk factors don't get the disease. So, it's important to see your doctor regularly for checkups and talk to him or her about which cancer screening tests are right for you.

What Risk Factors Exist for Different Types of Cancer?

Breast Cancer

  • Age - most cases occur in women age 50 or older
  • Family History of breast or ovarian cancer before menopause (mother, sister or daughter)
  • Abnormal breast biopsy results
  • Lobular or ductal carcinoma in situ or atypical hyperplasia
  • First period before age 12
  • Menopause after age 55
  • Never being pregnant or having your first child after age 30
  • Higher education and socioeconomic status
  • Women in this group tend to have fewer children
  • Obesity or weight gain after menopause
  • Hormonal therapy
  • Inherited mutations in the BRCA1 or BRCA2 genes
  • Suspected risk factors include :
    • High-fat diet
    • Physical inactivity
    • More than one alcoholic drink per day
    • Oral contraceptives

Cervical Cancer

  • First intercourse at an early age
  • Multiple sex partners (either of the woman or her partner)
  • Cigarette smoking
  • Race – More cases occur in African American, Hispanic and American Indian women
  • Human Papillomavirus(HPV) infection
  • Diethylstilbestrol(DES) exposure before birth
  • HIV infection
  • Weakened immune system due to organ transplant, chemotherapy or chronic steroid use

Colorectal Cancer

  • Age – most common in people over age 50
  • Personal or family history of colorectal cancer (especially a parent or sibling)
  • Personal or family history of adenomatous polyps (especially a parent or sibling)
  • Personal history of inflammatory bowel disease
  • Diet high in fat (especially in red meat)
  • Diet low in fiber, fruits and vegetables
  • Physical inactivity
  • Cigarette smoking
  • Alcohol consumption
  • Obesity

Endometrial Cancer (also called Uterine Cancer)

  • Increasing age
  • Increased estrogen exposure
  • First period before age 12
  • Menopause after age 55
  • Hormonal therapy without the use of progestin
  • Never being pregnant
  • History of infertility
  • Personal history of hereditary non-polyposis colon cancer
  • Obesity
  • Use of tamoxifen

Lung Cancer

  • Cigarette, cigar or pipe smoking
  • Personal or family history of lung cancer
  • Recurring exposure to :
    • Radon or asbestos (especially for smokers)
    • Radiation
    • Arsenic
    • Air pollution
    • Secondhand smoke
  • Lung diseases such as tuberculosis (TB)

Ovarian Cancer

  • Age – most common in people over age 50
  • Family history of ovarian (mother, daughter, sister, grandmother, or aunt)
  • Inherited mutations in the BRCA1 or BRCA2 genes
  • Northern European and/or Ashkenazi Jewish heritage
  • Never being pregnant
  • Suspected risk factors include :
    • Fertility drugs
    • Exposure to talcum powder
    • Hormone replacement therapy
    • Obesity

Prostate Cancer

  • Age – men 50 and older are at greater risk
  • Family history of prostate cancer (especially father, brother, or son)
  • Race – African American men have nearly twice the incidence of white men
  • Diet high in saturated fat and low in fruits and vegetables

Skin Cancer

  • Exposure to ultraviolet (UV) radiation from the sun or tanning beds
  • Fair complexion
  • Family history, especially of melanoma
  • Living in the southern states or near the "Sun Belt"
  • Living in a sunny climate
  • Occupational exposure to :
    • Coal tar
    • Pitch
    • Creosote
    • Arsenic
    • Radium

Cancer Screening Guidelines

Cancer screening exams are medical tests done when you’re healthy, and you don’t have any signs of illness. They help find cancer at its earliest stage, when the chances for curing the disease are greatest.

Exams for colorectal and cervical cancer also find abnormal cells that may turn into cancer. Removing these cells can prevent cancer altogether.

MD Anderson has specific screening plans for men and women, based on their chances of getting cancer. The exam you get and how often you are tested depends on whether you are at average, increased or high risk for cancer. People at increased risk have a higher chance of getting cancer than those at average risk. Men and women at high risk for cancer have a higher chance of getting the disease than those at increased risk.

It’s important to know if people in your family have had cancer and if so, what type. This information, along with your personal health history, helps your health care provider find out if you’re at increased or high risk. You and your doctor can use this information to make a well-informed decision about cancer screening.

MD Anderson recommends screening exams for the following types of cancer :

  • Breast Cancer
  • Cervical Cancer
  • Colorectal Cancer
  • Lung Cancer
  • Ovarian and Endometrial Cancer
  • Prostate Cancer
  • Skin Cancer

The HPV Vaccination: What Have We Learned ?

It's been about four years since the Food and Drug Administration (FDA) approved the Human Papillomavirus or HPV vaccine. What have we learned about the vaccine during this time? Let’s take a look at what recent reports say.

Well-informed parents support the vaccine

Every parent has concerns about the safety of a new vaccine. But, what other thoughts do people have about the HPV vaccine? A study published in the August 2009 issue of Annals of Epidemiology shared the opinions of moms who had daughters ages 11 to 17. Of the 52 mothers interviewed, more than half had their daughters vaccinated.

Most moms with vaccinated daughters said they believe the odds of getting HPV are high. They had their daughters vaccinated because they wanted to :

  • Prevent their daughters from getting a future illness, such as cancer
  • Follow their doctor’s advice

Most moms who decided not have their daughters vaccinated said they :

  • Knew little about HPV
  • Had age-related concerns
  • Didn’t believe their daughters were likely to get HPV

Some teenage girls are still not getting the vaccine

The Centers for Disease Control and Prevention (CDC) reported that about a quarter of teenage girls got the first vaccine shot in 2007. Even though this number increased a little in 2008, not all teenage girls are getting the vaccine.

Several studies suggest the following as factors that may be preventing parents from vaccinating their daughters :

  • Concerns about the safety and effectiveness of the vaccine
  • Little knowledge about HPV and the vaccine
  • No insurance coverage or not being able to get help to pay for the vaccine
  • Their doctor did not recommend having the vaccine

Vaccine still works after four years

A big question is how long the vaccine will stay effective. Researchers know that the vaccine still works in girls and women who got the first available vaccination series. Doctors don’t yet know whether this group will eventually need a booster shot. However, they are still following the girls and women who were a part of the first studies to learn more about the long-term effectiveness of this vaccine.

Reported side effects are similar to those of other vaccines

Most people who got the shot reported the same symptoms you would have if you got any other vaccine. People had one or more of the following side effects at the site of the shot :

  • Swelling
  • Pain
  • Redness
  • Soreness of muscle

Very few people had serious side effects. The CDC reports that about 6% of people who received the shot had serious side effects (i.e., fainting, dizziness, nausea, headache and skin rash).

Boys and men can get the vaccine, too

In October 2009, the FDA approved the HPV vaccine for use in boys and men ages 9 to 26. They found that the vaccine safely protects males from genital warts caused by HPV types 6 and 11. Each year, doctors detect genital warts in about two out of every 1,000 men in the United States, says the CDC.

Help to cover vaccine costs does exist

Without insurance, the vaccine can be pricey. The retail price of the vaccine is about $125 per dose ($375 for the full series). While some insurance companies may cover the cost, others may not.

Kids and teens age 18 and younger may be able to get vaccines, including the HPV vaccine, for free through the Vaccines for Children program. They must be able to get Medicaid; be American Indian or Alaska Native; or not have insurance. Some states or counties provide free or low-cost vaccines at public health clinics for people without health insurance coverage for vaccines. The pharmaceutical companies who make the vaccines also may have programs to reduce vaccine costs.

Getting the vaccine is a personal decision

M.D. Anderson recommends that girls and women ages 11 to 26 receive the vaccine to prevent cervical cancer, precancerous genital lesions and genital warts. It’s important to remember that no vaccine is 100% effective, and the HPV vaccine does not cover all forms of the virus. But, it does cover the types that cause more than half of cervical cancers. Whatever the decision, to vaccinate or not, getting the vaccine is a personal decision that should be made based on facts.

Breast Cancer Screening : Increased Risk

Women at increased risk have a higher chance of getting breast cancer than women at average risk. The exams you get and how often you are tested depends on what puts you at increased risk for breast cancer.

Women at increased risk include those who have a :

  • History of radiation treatment to the chest
  • Genetic mutation, including an abnormality in the BRCA 1 or BRCA 2 genes, Li-Fraumeni Syndrome, CDH1, Cowden's Syndrome or Bannayan-Riley-Ruvalcaba Syndrome
  • History of lobular carcinoma in situ
  • Five-year risk of breast cancer 1.7% or greater at age 35 or older, as defined by a Gail Model calculation. Calculate your risk using the Gail Model
  • A life-time risk of breast cancer 20% or greater, as defined by models dependent on family history. Women with a strong family history of breast cancer should consider speaking with a genetic counselor to learn more about these models and have their risk determined.

If you fit one or more items from the list above, you should follow one of the screening schedules below. These guidelines are for women without any breast cancer symptoms. If you have symptoms, you should see your health care provider as soon as possible.

Radiation Treatment

Women who received radiation treatment to the chest during their teens or twenties should follow the guidelines below.

Age 24 and younger, you should :

  • Have a clinical breast exam every year

Age 25 and older, you should :

  • Have a mammogram every year and clinical breast exam every 6 to 12 months. You should begin these tests 8 to 10 years from the age you started radiation treatment but no later than age 40. For example, a woman who received radiation treatment at age 25 will begin testing between ages 33 and 35.
  • Consider breast MRI once a year as an additional test

Genetic Predisposition

Women with a genetic mutation, such as a BRCA 1 and BRCA 2 mutation, Li-Fraumeni Syndrome, CDH1, Cowden's Syndrome or Bannayan-Riley-Ruvalcaba Syndrome should follow the guidelines below.

Age 20 to 24, you should :

  • Get a clinical breast exam every year

Age 25 and older, you should :

  • Have a mammogram every year and clinical breast exam every 6 to 12 months. You should begin testing 5 to 10 years before the youngest person in your family with breast cancer or at age 25, whichever comes first. For example, a woman whose sister was diagnosed with breast cancer at age 35 would begin testing between ages 25 and 30.
  • Have a MRI once a year as an additional test

Lobular Carcinoma in Situ

Women who have been diagnosed with lobular carcinoma in situ should follow the guidelines below.

  • Have a mammogram every year and clinical breast exam every 6 to 12 months

Gail Model Greater Than 1.7%

Women age 35 and older, whose five-year risk of breast cancer is 1.7% or greater according to the Gail Model, should follow the guidelines below. This number is based on a Gail model calculation.

  • Get a mammogram every year and clinical breast exam every 6 to 12 months

Family History Based on Model Results Greater Than 20%

Women should follow the guidelines below if their chances of getting cancer in their lifetime is 20% or greater. This number is based on models that rely on a woman’s family history. Speak with a genetic counselor if you have a strong family history of breast cancer to learn more about these models and to have your risk determined.

  • Have a mammogram every year and clinical breast exam every 6 to 12 months
  • Consider breast MRI once a year as an additional test

These screening guidelines apply to women who are expected to live for at least another 10 years. The guidelines are not for women who have a health condition that would make it hard for a health care provider to diagnose or treat breast cancer.

Breast Cancer Screening: Average Risk

The following breast cancer screening guidelines are for women at average risk for breast cancer. They also are for women who do not have any breast cancer symptoms. If you have symptoms, you should see your health care provider as soon as possible.

Women at average risk of breast cancer are those who have :

  • No history of radiation treatment to the chest
  • No genetic mutations, including an abnormality in the BRCA 1 or BRCA 2 genes, Li-Fraumeni Syndrome, CDH1, Cowden's Syndrome or Bannayan-Riley-Ruvalcaba Syndrome
  • No history of lobular carcinoma in situ
  • A five-year risk of breast cancer less than 1.7% for women age 35 or older, as defined by a Gail Model calculation. Calculate your risk using the Gail Model
  • A life-time risk of breast cancer less than 20%, as defined by models dependent on family history. Women with a strong family history should consider speaking with a genetic counselor to learn more about these models and have their risk determined

If you fit this description, you should follow one of the screening schedules below.

Age 20 to 39, you should :

  • Have a clinical breast exam every 1 – 3 years

Age 40 and older, you should :

  • Have a clinical breast exam every year
  • Get a mammogram every year

These screening guidelines apply to women who are expected to live for at least another 10 years. The guidelines are not for women who have a health condition that would make it hard for a health care provider to diagnose or treat breast cancer.

Cervical Cancer Screening Exams

How often you get tested for cervical cancer depends on your chances for getting the disease.

Having one or more risks for cervical cancer does not mean you will definitely get the disease. It means that you may be more likely to get cervical cancer. If you are at increased risk for cervical cancer, you may need to begin testing earlier and/or be tested more often. Look at the lists below to find out if you are at average or increased risk for cervical cancer.

Increased Risk

Women at increased risk have a higher chance of getting cervical cancer than women at average risk. Women at increased risk include those who have :

  • History of cervical cancer or severe cervical dysplasia (pre-cancer)
  • Persistent Human Papilloma Virus (HPV) infection after age 30 (HPV testing not recommended in women younger than age 30)
  • An immune system that does not function properly
  • Been infected with Human Immunodeficiency Virus (HIV)
  • Diethylstilbestrol(DES) exposure before birth

Cervical Cancer Screening: Increased Risk

Women at increased risk have a higher chance of getting cervical cancer than women at average risk. The exams you get and how often you are tested depends on what puts you at increased risk for cervical cancer.

Women at increased risk include those who have :

  • History of cervical cancer or severe cervical dysplasia (pre-cancer)
  • Persistent Human Papilloma Virus (HPV) infection after age 30 (HPV testing not recommended in women younger than age 30)
  • An immune system that does not function properly
  • Been infected with Human Immunodeficiency Virus (HIV)
  • Diethylstilbestrol(DES) exposure before birth

If you fit one or more items from the list above, you should follow one of the screening schedules below. These guidelines are for women without any cervical cancer symptoms. If you have symptoms, you should see your health care provider as soon as possible.

History of Cervical Cancer or Severe Cervical Dysplasia

  • Get a liquid-based Pap test every year after treatment for cervical cancer or severe cervical dysplasia for at least 20 years

Persistent HPV Test

Women with persistent Human Papilloma Virus (HPV) tests should speak with their doctor about diagnostic testing for abnormal cells.

DES and Suppressed Immune Systems

Women with diethylstilbestrol exposure before birth, Human Immunodeficiency Virus (HIV) or an immune system that does not function properly should follow the screening schedule below :

  • Get a liquid-based Pap test every year

Human Immunodeficiency Virus (HIV)

Women with HIV should get a liquid-based Pap test twice in the first year after their diagnosis and then continue screening every year.

All women should continue annual well-woman check-ups with a health care provider even during years when a Pap test is not required. Women who have received the Human Papilloma Virus (HPV) vaccine also should follow the above screening guidelines.

These screening guidelines apply to women who are expected to live for at least another 10 years. The guidelines are not for women who have a health condition that would make it hard for a health care provider to treat cervical cancer or pre-cancer.

Average Risk

If you none of the above bullets apply to you, then you may be at average risk for cervical cancer.

Cervical Cancer Screening: Average Risk

The following cervical cancer screening guidelines are for women at average risk for the disease. They also are for women who do not have any cervical cancer symptoms. If you have symptoms, you should see your health care provider as soon as possible.

Women at average risk for cervical cancer include those who have :

  • Never had cervical cancer or severe cervical dysplasia (pre-cancer)
  • No persistent Human Papilloma Virus (HPV) infection after age 30 (HPV testing not recommended in women younger than age 30)
  • An immune system that functions properly
  • Not been infected with Human Immunodeficiency Virus (HIV)
  • No diethylstilbestrol (DES) exposure before birth

If you fit this description, you should follow one of the screening schedules below.

Age 20 and younger :

  • No screening recommended

Age 21 to 29, you should :

  • Get a liquid-based Pap test every two years

Age 30 to 65, you should :

  • Get a liquid-based Pap test and Human Papilloma Virus (HPV) test every three years as long as your results are negative
  • Speak with your doctor about a different testing schedule if your test results are positive

Age 65 and older :

  • If you have had three or more negative Pap tests, and no positive Pap test, in the last 10 years, speak with your doctor about whether you should continue screening. Women at increased risk for cervical cancer should continue the age 30 to 65 screening recommendations as long as they are in good health.

Age 30 and older, who have had a hysterectomy but have not had cervical cancer or severe cervical dysplasia, you should :

  • Speak with your doctor about whether you should continue screening if your hysterectomy included removal of the cervix.
  • Get a liquid-based Pap test and Human Papilloma Virus (HPV) test if your hysterectomy did not include removal of the cervix. Repeat these tests every three years if both test results are normal.

All women should continue annual well-woman check-ups with a health care provider even during years when a Pap test is not required. Women who have received the HPV vaccine also should follow the above screening guidelines.

These screening guidelines apply to women who are expected to live for at least another 10 years. The guidelines are not for women who have a health condition that would make it hard for a health care provider to treat cervical cancer or pre-cancer.

Colorectal Cancer Screening Exams

How often you get tested for colon cancer and rectal cancer depends on your chances for getting the disease.

Having one or more risks for colorectal cancer does not mean you will definitely get the disease. It means that you may be more likely to get colorectal cancer. If you are at increased or high risk for colorectal cancer, you may need to start screening exams at an earlier age or be tested more often. Look at the lists below to find out if you are at average, increased or high risk for colorectal cancer.

Average Risk

Men and women at average risk of colorectal cancer include those who have :

  • No personal history of colorectal cancer or precancerous colon polyps (adenomas)
  • No family history of colorectal cancer or precancerous colon polyps (adenomas)
  • No personal history of inflammatory bowel disease (chronic ulcerative colitis or Crohn’s disease)
  • No personal history of Familial Adenomatous Polyposis or suspected Familial Adenomatous Polyposis without yet having undergone genetic testing
  • No personal history of Hereditary Nonpolyposis colorectal cancer or a family history of Hereditary nonpolyposis colorectal cancer

Colorectal Screening: Average Risk

The following colorectal cancer screening guidelines are for people at average risk for the disease. They also are for men and women without any colorectal cancer symptoms. If you have symptoms, you should see your health care provider as soon as possible.

Men and women at average risk of colorectal cancer include those who have :

  • No personal history of colorectal cancer or precancerous colon polyps (adenomas)
  • No family history of colorectal cancer or precancerous colon polyps (adenomas)
  • No personal history of inflammatory bowel disease (chronic ulcerative colitis or Crohn’s disease)
  • No personal history of Familial Adenomatous Polyposis or suspected Familial Adenomatous Polyposis without yet having undergone genetic testing
  • No personal history of Hereditary Nonpolyposis Colorectal Cancer or a family history of Hereditary Nonpolyposis Colorectal Cancer

If you fit this description, you should follow ONE of the guidelines below.

Age 50 and older, you should :

  • 1. Get a colonoscopy every 10 years. This test is preferred by MD Anderson to find colorectal cancer and prevent the disease by removing polyps. Polyps are abnormal growths that may become cancer.
  • 2. Have a virtual colonoscopy (also called Computed Tomographic Colonography) every five years. A colonoscopy will be performed if polyps are found.
  • 3. Take a Fecal Occult Blood Test (FOBT) every year. This take-home test finds hidden blood in the stool. This may be a sign of cancer. The FOBT may not prevent colorectal cancer. If the doctor finds blood in your stool, you will need a colonoscopy to look for the cause of the blood in your stool.

If you choose a virtual colonoscopy, check with your insurance provider before scheduling an exam. Not all insurance providers cover the cost of this exam.

MD Anderson does not recommend colorectal cancer screening for men and women age 85 and older. Screening for adults ages 76 to 85 should be considered on an individual basis after a review of the risks and benefits with a health care provider.

These screening guidelines apply to men and women who are expected to live for at least another 10 years. The guidelines are not for men and women who have a health condition that would make it hard for a health care provider to find and treat colorectal cancer.

Increased Risk

Men and women at increased risk have a higher chance of getting colorectal cancer than those at average risk. Men and women at increased risk include those who have a :

  • Personal history of precancerous colon polyps (adenomas)
  • Personal history of colorectal cancer
  • Family history of colorectal cancer or precancerous polyps (adenomas), meaning that a family member had or has colorectal cancer or precancerous polyps

Colorectal Screening: Increased Risk

Men and women at increased risk have a higher chance of getting colorectal cancer than those at average risk. The exams you get and how often you are tested depends on what puts you at increased risk for colorectal cancer.

Men and women at increased risk include those who have a :

  • Personal history of precancerous colon polyps (adenomas)
  • Personal history of colorectal cancer
  • Family history of colorectal cancer or precancerous polyps (adenomas), meaning that a family member had or have colorectal cancer or precancerous polyps

If you fit one or more items from the list above, you should follow one of the screening schedules below. These guidelines are for men and women without any colorectal cancer symptoms. If you have any symptoms, you should see your doctor as soon as possible.

History of Precancerous Polyps

Men and women, whose doctor found precancerous (adenomatous) colon polyps during a past colonoscopy, should follow one of the screening schedules below. Each is based on the size and number of polyps found. Speak with your doctor if you do not know the size or number of polyps found in your colon.

One or two adenomatous polyps less than 1 cm with low-grade dysplasia (abnormal cells), you should :

  • Get a colonoscopy every five years after your polyps were removed (polypectomy)

Three to 10 adenomatous polyps or 1 adenomatous polyp greater than 1 cm, or any polyps with villous features or high-grade dysplasia (abnormal cells), you should :

  • Get a colonoscopy three years after your polyps were removed (polypectomy)
  • Get a colonoscopy at five years if your three-year exam was normal or shows no more than one or two small tubular polyps

More than 10 adenomatous polyps during a single exam, you should :

  • Get a colonoscopy less than three years after your polyps were removed (polypectomy)

Polyps not raised on a stalk (sessile adenomas) that were removed piecemeal, you should :

  • Get a colonoscopy two to six months after your polyps were removed (polypectomy) to verify complete removal

Personal History

Men and women who have had colorectal cancer and received treatment should follow the screening schedule below.

Received insufficient testing before treatment to find all possible cancers in the colon and rectum, you should :

  • Get a colonoscopy three to six months after your cancer treatment is complete

Received complete testing before treatment to find all possible cancers in the colon and rectum, you should :

  • Get a colonoscopy one year after cancer surgery (or one year after clearing colonoscopy)
  • Get a colonoscopy at three years if your one-year exam was normal
  • Get a colonoscopy at five years if your three-year exam was normal
  • Consider an examination of the rectum every three to six months for the first two to three years after rectal cancer surgery

Family History

Men and women with a family history of colorectal cancer or precancerous polyps should follow one of the screening schedules below. Each schedule is based on your family member’s age at diagnosis. Family history means that a family member had or has colorectal cancer or precancerous polyps.

First-degree relative (parent, brother, sister, daughter or son) with colorectal cancer or precancerous polyps before age 60 or two or more first-degree relatives with colorectal cancer or precancerous polyps at any age, you should :

  • Get a colonoscopy every five years. You should begin this testing at age 40 if your family member was 50 or older when diagnosed. If they were younger than 50, subtract 10 years from their age at diagnosis. This is the age you should begin testing. For example, if they were 42 years old at diagnosis, you should begin testing at age 32.

First-degree relative with colorectal cancer or precancerous polyps age 60 or older , or two second-degree relatives (grandparents, aunts, uncles or cousins) with colorectal cancer, you should choose ONE of the following options :

  • 1. Get a colonoscopy every 10 years beginning at age 40
  • 2. Have a virtual colonoscopy (Computed Tomographic Colonography) every five years beginning at age 40
  • 3. Take a Fecal Occult Blood Test (FOBT) every year beginning at age 40

If you choose a virtual colonoscopy, check with your insurance provider before scheduling an exam. Not all insurance providers cover the cost of this exam.

MD Anderson does not recommend colorectal cancer screening for men and women age 85 or older. Screening for adults ages 76 to 85 should be considered on an individual basis by a health care provider.

These screening guidelines apply to men and women who are expected to live for at least another 10 years. The guidelines are not for men and women who have a health condition that would make it hard for a health care provider to find and treat colorectal cancer.

High Risk

Men and women at high risk for colorectal cancer have a greater chance of getting the disease than those at increased risk. This includes those who have a :

  • Personal history of Familial Adenomatous Polyposis or suspected Familial Adenomatous Polyposis without yet having undergone genetic testing
  • Personal history of Hereditary Nonpolyposis Colorectal Cancer or family history of Hereditary Nonpolyposis Colorectal Cancer
  • Inflammatory bowel disease (chronic ulcerative colitis or Crohn’s disease)

Colorectal Screening: High Risk

If you are at high risk for colorectal cancer, you are at higher risk of getting the disease than someone at increased risk. MD Anderson recommends different screening schedules for each type of high risk group. These guidelines are for men and women without any colorectal cancer symptoms. If you have any symptoms, you should see your health care provider as soon as possible.

Personal history of Familial Adenomatous Polyposis or suspected of having Familial Adenomatous Polyposis without having undergone genetic testing, you should :

  • Get a flexible sigmoidoscopy every year beginning at age 10 to 12 to determine if you are developing polyps
  • Talk to a genetic counselor and consider genetic testing. If a genetic test is positive, talk to your health care provider about when surgery to remove the colon (colectomy) should be considered.

Personal history of Hereditary Nonpolyposis Colorectal Cancer or you have a family history of Hereditary Nonpolyposis Colorectal Cancer, you should :

  • Get a colonoscopy every one to two years beginning at age 20 to 25, or 10 years before the youngest case in the immediate family (parent, brother, sister, son or daughter). For example, if the youngest case in your family was someone age 23, you should begin testing at age 13.
  • Talk to a genetic counselor about genetic testing if there is a family history of Hereditary Nonpolyposis Colorectal Cancer

Crohn’s disease (inflammatory bowel disease), you should :

  • Get a colonoscopy every one to two years with biopsies to find dysplasia (abnormal cells)
  • Begin colonoscopy 12 to 15 years after colitis begins in the left side of the colon

Chronic ulcerative colitis (inflammatory bowel disease), you should :

  • Get a colonoscopy every one to two years with biopsies to find dysplasia (abnormal cells)
  • Begin colonoscopy eight years after colitis begins in the entire colon

MD Anderson does not recommend colorectal cancer screening for men and women age 85 or older. Screening for adults ages 76 to 85 should be considered on an individual basis by a health care provider.

These screening guidelines apply to men and women who are expected to live for at least another 10 years. The guidelines are not for men and women who have a health condition that would make it hard for a health care provider to find and treat colorectal cancer.

Lung Cancer Screening

Recent results from the National Lung Screening Trial (NLST) show that computerized tomography (CT or CAT scan) can detect lung cancer at an early stage and reduce your risk of dying from the disease. The NLST compared low dose CT scanning of the lungs with chest X-rays in people at risk for lung cancer (men and women age 55 to 75, who smoked an equivalent of a pack of cigarettes a day for 30 years).

The study results demonstrate a 20% reduction in lung cancer deaths among those screened yearly with CT scans. These encouraging results support the value of screening with low dose CT for a select population of current and former smokers.

Lung cancer screening with CT is not yet a standard recommendation. National agencies that develop screening guidelines are still working on their recommendations, which will affect whether Medicare and private insurance companies cover lung screenings in the future, how often and for whom.

Who should be screened for lung cancer ?

People who are eligible for lung cancer screening :

  • Are current or former smokers 50 years of age or older and
  • Have smoked the equivalent of one pack of cigarettes a day for at least 20 years

Current evidence does not support screening people who have not been heavy smokers or who have only been exposed to second-hand smoke. Screening everyone may cause more harm than good because lung cancer screening has certain risks. For example, doctors find a lung nodule suspicious for lung cancer in about 25% of patients who get a screening CT scan. All of these abnormalities require further testing to determine if they are cancer, but only a few (less than 4%) are actually lung cancer.

Ovarian and Endometrial Cancer Screening Exams

Getting tested for endometrial and ovarian cancers depends on your chances of getting the disease and is only recommended for women at increased risk.

Having one or more risks for endometrial or ovarian cancer does not mean you will definitely get the disease. It means that you may be more likely to get endometrial or ovarian cancer. Look at the lists below to find out if you are at average or increased risk for endometrial or ovarian cancer.

Average Risk

Women at average risk include those who have :

  • No history of Hereditary Nonpolyposis Colorectal Cancer
  • No history of Hereditary Ovarian Cancer Syndrome

The benefits of testing for women at average risk of endometrial and ovarian cancers have not been proven. Screening is not recommended.

Increased Risk

Women at increased risk have a higher chance of getting endometrial and/or ovarian cancer than those at average risk. Women at increased risk include those who have a history of :

  • Hereditary Nonpolyposis Colorectal Cancer
  • Hereditary Ovarian Cancer Syndrome

If you fit one or more items from the above list, you should consider following one of the screening schedules below.

Hereditary Nonpolyposis Colorectal Cancer, you should :

  • Have an endometrial biopsy every year beginning at age 35

Hereditary Ovarian Cancer Syndrome, you should :

  • Have a pelvic exam every six to 12 months
  • Get a CA-125 blood test every six to 12 months
  • Ask your health care provider about a transvaginal ultrasound every six to 12 months

These guidelines are for women without any ovarian cancer or endometrial cancer symptoms. If you have any symptoms, you should see your health care provider as soon as possible.

These screening guidelines apply to women who are expected to live for at least another 10 years. The guidelines are not for women who have a health condition that would make it hard for a health care provider to diagnose treat endometrial or ovarian cancer.

Prostate Cancer Screening Exams

How often you get tested for prostate cancer depends on your chances for getting the disease.

Having one or more risks for prostate cancer does not mean you will definitely get the disease. It means that you may be more likely to get prostate cancer. If you are at increased risk for prostate cancer, you may need to start screening exams at an earlier age. Look at the lists below to find out if you are at average or increased risk for prostate cancer.

The guidelines below are for men without any prostate cancer symptoms. If you have any symptoms, you should see your health care provider as soon as possible.

Average Risk

Men at average risk include those who :

  • Have no family history of prostate cancer
  • Are not African American

If you fit this description, you should follow the screening schedule below.

Age 50 and older, you should :

  • Discuss screening risks and benefits with a health care provider
  • If screening is desired, get a digital rectal exam and prostate-specific antigen (PSA) blood test every year

Increased Risk

Men at increased risk have a higher chance of getting prostate cancer than those at average risk. Men at increased risk include those who :

  • Have a family history (especially father, brother, son) of prostate cancer
  • Are African American

If you fit one of the items in the list above, you should follow the screening schedule below.

Age 45 and older, you should :

  • Discuss screening risks and benefits with a health care provider
  • If screening is desired, get a digital rectal exam and prostate-specific antigen (PSA) blood test every year

These screening guidelines apply to men who are expected to live for at least another 10 years. The guidelines are not for men who have a health condition that would make it hard for a health care provider to diagnose or treat prostate cancer

Skin Cancer Screening Exams

Having one or more risks for skin cancer does not mean you will definitely get the disease. It means that you may be more likely to get skin cancer. Persons at increased risk for skin cancer include those who :

  • Have red or blond hair, fair skin, freckles, and blue or light-colored eyes
  • Live in sunny climates
  • Have a family history of skin cancer, especially melanoma
  • Have a personal history of skin cancer
  • Work around coal, tar, arsenic compounds, creosote, pitch and paraffin oil
  • Have damaged skin, such as a major scar or burn
  • Have actinic keratosis, a precancerous condition of thick, scaly patches of skin. It may also appear as a cracking or peeling lower lip that does not heal with lip balm.

MD Anderson recommends that everyone pay close attention to his or her skin. Promptly show your health care provider any :

  • Suspicious skin area
  • Sore that doesn’t heal
  • Change in a mole or freckle

Healthy Living & Aging

Chemoprevention

Chemoprevention is a way to prevent or delay the development of cancer by taking medicines, vitamins or other agents.

Tamoxifen, the first chemoprevention drug to receive FDA approval, is the most well-known chemopreventive agent. Studies have shown that tamoxifen reduces a high-risk woman’s chances of developing breast cancer by as much as one-half.

Some chemopreventive drugs can have severe side effects in some patients, which is an issue when considering long-term administration of a drug to healthy people who may or may not develop cancer. For this reason, most chemopreventive drugs are recommended solely for people at high risk of developing cancer because they are most likely to benefit from treatment. Persons at high risk of developing cancer include those with :

  • A family history of the disease
  • An inherited genetic mutation, such as Familial Adenomatous Polyposis (FAP)
  • Other factors that increase cancer risk (ethnicity, obesity, smoking, etc.)

Speak with your doctor about your risks for developing cancer, as well as the potential harms and benefits associated with taking chemopreventive agents. Your doctor can help decide if chemoprevention is right for you.

Quit Smoking

Susan Barry tried to stop smoking several times. But she didn’t kick the habit for good until she made it her New Year's resolution.

Health-wise, it was the best resolution Barry could have made — and kept. According to the American Cancer Society, people who stop smoking before age 50 cut their risk of dying in the next 15 years by 50%. And all smokers reap benefits — including improved circulation and lung function — within weeks of quitting.

Six years after becoming smoke-free, Barry enjoys these perks and others. "I don't stink, I don't cough all the time, and I'm not controlled by cigarettes," she says.

Ready to kick the tobacco habit for the New Year? Try these tips. Beware, though: No quit-smoking strategy is one-size-fits-all, so you’ll need to adapt these strategies to your smoking personality.

1. Set a date.

Whether you quit on January 1 or another date, it’s smart to plan ahead.

"Picking a quit date, particularly at a time when you know your motivation is high and there will be less stress or distraction, is generally a good idea," says Paul M. Cinciripini, Ph.D, director of MD Anderson's Tobacco Treatment Program and professor in the Department of Behavioral Science.

"Success at quitting smoking may require some change or adjustment to your daily routine and more broadly to your lifestyle,” Cinciripini says. “Think about how you can arrange your life to give you the best possible chance at success, before you make a quit attempt and then follow through."

2. Get help.

Few people quit for good on their first try. So get all of the support you can. "By using medication and getting help from a behavioral counselor or psychologist, you’ll boost your chances of success," says Vance Rabius, Ph.D., instructor in MD Anderson's Department of Behavioral Science and former senior scientist at the American Cancer Society Quitline.

Don’t have the time or money to get professional help? You can get free counseling by calling one of these free quit lines :

"A counselor can help you identify what triggers you to smoke and determine what’s most likely to work for you," Rabius says. That may include using a nicotine replacement product like the patch, gum or nasal spray, and cleaning out your car and home so you’re not constantly reminded of cigarettes.

3. Swap habits.

Before quitting, identify the moods or situations that lead you to smoke. Then, remove those smoking triggers from your environment and replace them with activities or habits that help you avoid tobacco.

Smoke because you like to chew on something? You may be able to get your fix by drinking water or chewing lozenges. Light up when you’re anxious? You’ll need to find new ways to cope with stress.

Susan Barry knew she couldn’t resist a cigarette when she was drinking alcohol. So, she avoided alcohol for three months after she quit smoking. Others have given up coffee or soda to succeed in their non-smoking resolve.

"This is one of the areas where a behavioral counselor can really help," Rabius says. "He or she can help you figure out how you're going to deal with situations when you’d normally smoke."

4. Distract yourself.

When you first quit smoking, you may spend a lot of time thinking about it. So, it helps to create positive distractions.

Barry did this by inventing a game. "I had to do one thing every day that I had never done before. It could be something small, like drinking hot milk, or big, like taking trapeze lessons," Barry says. "The time spent researching and doing new things helped take my mind off not smoking."

5. Take it one day at a time.

"Never again" can seem daunting during your first days without a cigarette. Focus instead on short-term goals.

"I told myself every day that I could smoke tomorrow if I wanted to, but today I wasn't smoking," Barry says. "The idea that I just had to last through the day was really helpful."

6. Reward yourself.

Rewarding yourself for even small successes can reinforce that you’ll benefit from quitting very soon.

"I set milestones for rewards," Barry says. "After the first week, I bought myself a jar of body cream. After a month, I got a cashmere scarf."

And with a healthier body, she's still earning rewards six years later. "I look back and see a different person!" Barry says of her old self.

Cancer Prevention Diet & Nutrition

You can reduce your risk of cancer significantly by making healthier food choices. In fact, some foods can actually help protect against certain cancers. Eating a plant-based, healthy diet (fruits, vegetables, whole grains and beans) and being physically active is your best insurance to reduce your risk of cancer, as well as heart disease and diabetes.

Healthy Diet Tips

Eat five to nine servings of fruits and vegetables. It’s easier than you think – just aim for one or two servings at every meal and snack. Suggestions :

  • Grate vegetables into spaghetti sauce and casseroles
  • Keep bite-sized vegetables as snacks
  • Make smoothies with non-fat milk, fruit and ice
  • Order meatless pizza with veggies

Eat a low-fat diet. High-fat diets are associated with colorectal, prostate and endometrial cancers.

Eat low-fat or nonfat dairy products every day. Calcium, found in low-fat and nondairy products may protect against colorectal cancer.

Drink alcoholic beverages in moderation. Drinking has been linked to colon, breast and liver cancers and when combined with smoking, greatly increases the risk of head and neck cancer.

A healthy diet can help you maintain a healthy weight throughout life. Overweight adults are at greater risk for colon, endometrial, breast (post-menopausal), esophageal, pancreatic and kidney cancers.

Exercise and Health

Exercising is one of the best things you can do for your overall health and to lower your risk for many types of cancer, as well as other diseases like diabetes and heart disease.

Physical activity in any form can prevent cancer by helping you maintain a healthy weight and burn belly fat. Plus, it keeps hormones at a healthy level, reduces stress, gets your blood flowing to help your immune system prevent infections and keeps the digestive system healthy, according to the American Institute for Cancer Research (AICR).

Best of all, just 30 minutes of moderate physical activity every day can make a difference. If you can pack in 60 minutes a day, that's even better.

What Counts as Exercise?

You don't have to go to the gym every day or do sprints to get your 30-60 minutes of physical activity. In fact, everyday activities can count as exercise, but only if you do them with at least a moderate intensity. You should be working enough to raise your heart rate and increase your breathing.

Try these strategies to work more physical activity into your day :

  • Get on or off the bus or train one stop early and walk briskly the rest of the way
  • Take the stairs instead of the elevator or escalator
  • Park on the far end of the parking lot so you have to walk further to reach your destination
  • Go dancing with your partner or friends
  • Walk briskly around the mall two or three times before you begin shopping
  • Mow your lawn
  • Wash your car

What Types of Exercise are Most Beneficial ?

To reap the rewards of exercise, it's best to alternate everyday activities that increase your heart rate with cardio and strength training workouts.

Cardiovascular activities like jogging, brisk walking or some types of yoga get your heart pumping and your blood flowing, while strength training, like lifting weights, can prevent muscle loss, build bone density and help your body burn calories faster so you stay at a healthy weight.

The AICR recommends doing cardio workouts every day and strength training three times a week. If you have trouble motivating yourself to workout or just want to mix things up, try MD Anderson's 7-day exercise plan, which includes options for beginners as well as more advanced exercisers. Or try group exercise classeslike spinning, yoga or strength training.

No matter what kind of exercise you do, be sure to stretch the muscles you're working. Stretching your legs, arms and back can help reduce soreness and help prevent muscle tears and injuries.

I Haven't Worked Out in Awhile. What Can I Do ?

If you're new to exercise or haven't exercised in awhile, start slowly. Gradually work up to exercising for 30 minutes. Try doing your exercise in 10-minute intervals throughout the day. Studies suggest this approach may be as good as 30 continuous minutes of moderate intensity exercise.

It's normal to be sore at first, but the soreness shouldn’t last more than a day or so.

After you’ve made it to 30 minutes, increase your exercise time to 60 minutes a day or rev up the intensity of your 30-minute workout.

How Can I Get My Kids to be More Active ?

By encouraging your children to exercise every day, you can help them maintain a healthy weight and lead a healthy lifestyle that will help prevent diseases like cancer later in life.

As soon as your children can walk, they should be up and moving. Kids under six should enjoy natural, daily physical activity like running, jumping and skipping. And, kids ages six to 17 should exercise at an intensity high enough to raise their heart rate for at least 60 minutes a day, five days a week.

Try these tips to encourage your kids to get moving :

Be a role model : If your kids see you being physically active and having fun, they are more likely to be active and stay active throughout their lives.

Use exercise as transportation : Walk or bike with your kids to school, to visit friends or to the park.

Involve the whole family in activities : Invite everyone to go hiking, biking, roller skating, or to play basketball or soccer.

Focus on fun : Pack in lots of walking during trips to the zoo, park or miniature-golf course.

Use competition as a motivator : Kids love to compete. So, make it a contest between you and the kids to see who can run faster, do more push-ups, sit-ups or jumping jacks and give the winner non-food-related prizes. And remember, winning often motivates kids, so don't be afraid to "lose" once in a while.

Include kids in household activities : Many household chores are also great opportunities to sneak in a little physical activity. Encourage physical activity by having your kids help out with washing the dog or the car, or mowing the lawn.

Give gifts that promote physical activity : Rollerblades, bicycles, ice skates, soccer balls and even the Wii Fit make great gifts for birthdays and holidays. Even better, they encourage your kids to get moving.

Limit TV and computer time : Offer them active options, like joining a local recreation center or after-school program, or taking lessons in a sport they enjoy. When your family does watch TV together, get everyone moving during commercial breaks by doing jumping jacks, hula-hooping or jumping rope.

Am I Overweight ? Is My Child Overweight ?

Exercise can help prevent cancer regardless of how much you weigh. But it's particularly important for obese adults and children, who may face a higher risk of many cancers.

Use the Body Mass Index (BMI) calculator to determine whether you are at a healthy weight. Check your child’s BMI with the CDC's child and teen BMI calculator.