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Cancer: Screening Methods
Cancer: Screening Methods(i)
Anal cancer
| Person |
MSM and TW age > 35y, men who have sex with women (MSW) and CisW age >45y or previous vulvar HSIL or cancer |
|---|---|
| Procedure | Digital rectal exam, anal cytology and HPV16/High-risk HPV |
| Evidence of benefit | Reduces incidence of anal cancer |
| Screening interval | 1 (up to 2 years if both cytology and (HR-HPV or HPV16) neg) |
| Comments | Positive cytology or HPV should be followed up with high resolution anoscopy |
Breast cancer
| Person | Women 50-74 years(ii) |
|---|---|
| Procedure | Mammography |
| Evidence of benefit | ↓ Breast cancer mortality |
| Screening interval | 1-3 years |
Cervical cancer
| Person |
Women > 21 years |
|---|---|
| Procedure | PAP smear or liquid based cervical cytology test |
| Evidence of benefit | ↓ Cervical cancer mortality |
| Screening interval | 1 year (or every 3 years if 3 consecutive negative PAP and CD4 ≥ 350/µl and HIV-RNA <200 cp/ml or, in women>30 years, 1 negative PAP/HPV co-testing) (iii) |
| Comments |
HPV genotype testing may aid PAP/liquid based cervical screening, but this is only recommended in women >30 years |
Colorectal cancer
| Person |
Persons 50-75 years or with a life expectancy > 10 years |
|---|---|
| Procedure |
According to local screening programme practice. Colonoscopy every 10 years if willing/ able. If unable, annual faecal immunochemistry test (FIT) for occult blood, or multitarget stool DNA (MT-sDNA) testing every 3 years, or computed tomography colonography (CTC) every 5 years |
| Evidence of benefit | ↓ Colorectal cancer mortality |
| Screening interval | Depending on screening method used |
HepatoCellular Carcinoma (HCC)
| Person |
HCC screening should follow current EASL guidelines*, see: Assessment of PLWH, Liver Cirrhosis: Management and General Recommendations for Persons with Viral Hepatitis/HIV Co-infection |
|---|---|
| Procedure |
Ultrasound (and alpha-foetoprotein) |
| Evidence of benefit | Earlier diagnosis allowing for improved ability for surgical eradication. The clinical management of nodules should be in line with EASL treatment strategy guidelines |
| Screening interval | Every 6 months |
| Comments | *(iv) Risk factors for HCC in this population include family history of HCC, ethnicity (Asians, Africans), HDV and age > 45 years. EASL guidelines propose using the PAGE-B score in Caucasians to assess the HCC risk |
Prostate cancer
| Person |
Men > 50 years with a life expectancy >10 years |
|---|---|
| Procedure |
PSA(v) |
| Evidence of benefit | Use of PSA is controversial |
| Screening interval | 1-2 years |
| Comments | Pros: ↑ early diagnosis and modest ↓ prostate cancer specific mortality. Cons: overtreatment, adverse effects of treatment on quality of life |
Lung cancer
| Person | Age 50-80 years old who are at high risk of lung cancer (at least a 20 pack-year smoking history, and are either current smokers or former smokers having quit within the past 15 years) |
| Procedure | Low-dose helical CT (where local screening programs are available) |
| Evidence of benefit | ↓ Lung cancer related mortality |
| Screening interval | Every year |
| Comments | Evidence confirmed in large RCT, but persons with HIV not included |
- Screening recommendations derived from the general population. These screenings should preferably be done as part of national general population screening programmes.
Careful examination of skin should be performed regularly to detect cancers such as Kaposi’s sarcoma, basal cell carcinoma and malignant melanoma. - US and Australian national Guidelines recommend an upper age limit of 74 years, whilst some other national Guidelines suggest 70 years. Most US guidelines encourage shared decision-making for women in their 40s because of trade-offs between benefits and harms, whilst some European screening guidelines recommend starting screening at age 45.
- Adapted from https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/human and modified according to expert opinion
- HCC screening is indicated in all cirrhotic HBV or HCV co-infected persons (even if HCV infection has been cured and HBV replication is medically suppressed) in a setting where treatment for HCC is available. Although the cost-effectiveness of HCC screening in persons with F3 fibrosis is uncertain, surveillance may be considered based on an individual risk assessment (easl.eu/publication/easl-clinical-practice-guidelines-management-of-hepatocellular-carcinoma/). In HBV-positive non-cirrhotics, HCC screening should follow current EASL guidelines. See Liver Cirrhosis: Management and Viral Hepatitis Co-infection in PLWH
- Whilst prostate cancer screening with PSA can reduce prostate cancer specific mortality, the absolute risk reduction is very small. Given limitations in the design and reporting of the randomized trials, there remain important concerns that the benefits of screening are outweighed by the potential harms to quality of life, including the substantial risks for over-diagnosis and treatment complications.