Tumour | Screening recommendation |
ACC | Abdominal USS 3–4 monthly birth:18 years Biochemistry (17 OH-progesterone, total testosterone, DHEAS, androstenedione) should only be performed where there is an unsatisfactory USS. |
Breast cancer (women only) | Annual dedicated MRI from age 20–70 years Consider risk-reducing mastectomy from age 20 years |
Brain tumour | Annual dedicated brain MRI from birth (first MRI with contrast)* |
Sarcoma | Annual WB-MRI† from birth* |
Haematological | Routine FBC are not indicated due to lack of evidence that these detect haematological malignancy at an early stage. |
Colon | Colonoscopy only indicated when family history of colorectal cancer or polyposis‡; consider investigation for, possibly coinherited, causes if strong family history of colorectal cancer or polyposis The presence of microcytic anaemia should prompt investigation for a gastrointestinal tract malignancy (routine FBC not advised). |
Gastric | Recommend Helicobacter pylori testing and eradication if required Endoscopy not indicated due to lack of evidence |
Skin | Annual dermatology review from 18 years (general practitioner or dermatology) General advice on use of high protection factor sunscreen and covering up in sun |
Physical examination | Full physical examination 3–4 monthly in children (including blood pressure, anthropometric measurements, signs of virilisation and neurological exam) Routine physical examination not recommended in adults; advise detailed discussion of ‘red flag’ symptoms and low threshold for fast track referral of persistent or unusual symptoms |
Other | Recommend detailed discussion of red flag symptoms in both children and adults and provide information on relevant resources. Discuss importance of making positive lifestyle choices (eg, not smoking, eating a healthy diet, limiting alcohol consumption, sun protection, keeping physically active and providing appropriate resources). |
Notes: (1) Currently on most scanners, arms are not covered adequately, and these should be evaluated clinically; (2) patients to be recalled for detailed imaging to evaluate uncertain lesions; (3) units wanting to do WB-MRI have to opt in (ie, self-certify quality for WB-MRI); (4) a minimum number of scans per year in a unit have not been specified; (5) optional sequences can be performed at the discretion of the unit; (5) radiology should be informed of any current clinical symptoms to inform interpretation of scan.
*Children weighing less than 20 kg need sedation, examination without anaesthetic may be possible from the age of 5 years with help from a dedicated play specialist. Feed and wrap approach may also be possible in the first year.
†Recommended core minimum sequence for WB-MRI (adults): T1, T2 fat sat/STIR or diffusion and non-fat sat T2; images can be acquired in axial or coronal planes or mixture; slice thickness (including gap) not greater than 10 mm; coverage vertex to feet; optional sequences at the discretion of the unit. Radiology should be informed of any current clinical symptoms to inform interpretation of scan.
‡For individuals with a family history of colorectal cancer, we would suggest reference to the recently published British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland/United Kingdom Cancer Genetics Group guidelines for hereditary colorectal cancer.21
FBC, full blood count.