Hosted by Ray Shields, MD

The American Cancer Society (ACS) recommends early detection of cancer in average-risk asymptomatic people.  As part of comprehensive diabetes care, patients should be offered cancer screening based on national recommendations, family history and increased risk. Further recommendations and guidelines for cancer screening may be found in the references section.

Cervical Cancer

• Pap Smear and pelvic exam annually or according to ACS guidelines

Breast Cancer

• Clinical breast examination according to ACS guidelines  

• Counseling to raise awareness of breast cancer symptoms

• Mammogram every 1-2 years in women ages 40-49, yearly thereafter.

Prostate Cancer

• Digital rectal exam (DRE) and prostate-specific antigen test (PSA) should be offered annually, starting at age 50, for men who have a life expectancy of at least 10 more years.  The provider should discuss with the patient the potential benefits, limitations, and harms associated with PSA testing.

Colorectal Cancer (CRC)

Potential CRC screening options are numerous.  However, within the Indian Health Service setting, access to care and cost constraints may limit provider options.  As a result, the IHS recommends the following:  

1. Renewed emphasis on CRC screening
2. Improved patient education on CRC screening
3. Fecal occult blood testing (FOBT) (three samples gathered at home) every year if possible; every 2 years at a minimum starting at age 50 years.
4. Appropriate follow-up for positive FOBT results

Additional screening options if available:

1. Flexible sigmoidoscopy every 5 years starting at age 50 years
2. Annual FOBT plus flexible sigmoidoscopy every 5 years, starting at age 50 years
3. Double contrast enema every 5 years, starting at age 50 years
4. Colonoscopy every 10 years, starting at age 50 years  

If the patient is at risk for earlier onset CRC (e.g., first degree relative with onset of CRC before age 50 years) screening should begin earlier and be more frequent.