Screening for solid tumors in allogeneic hematopoietic cell transplant recipients vs the general population
| General population | Allogeneic transplant recipients | ||
|---|---|---|---|
| Risk factors | Screening considerations | ||
| Skin cancers | Routine screening not recommended | Acute or chronic graft-vs-host disease Prolonged immunosuppression Human papillomavirus infection Total body irradiation | Annual skin self-examination |
| Breast cancer | Yearly mammogram beginning at age 45a | Same as in general population | |
| Head and neck cancer | Routine screening not recommended | Chronic graft-vs-host disease with prolonged immunosuppression Reduced-intensity conditioning | Oral evaluation at 6 months, 1 year, then annually |
| Colorectal cancer | Colonoscopy every 10 years beginning at age 45b | Abdominal radiation | For patients who received radiation: colonoscopy every 5 years beginning at age 35 or 10 years after radiation, whichever occurs last |
| Esophageal cancer | Routine screening not recommended | Chronic graft-vs-host disease | Upper endoscopy if persistent gastroesophageal reflux disease, symptoms of dysphagia |
| Thyroid cancer | Routine screening not recommended | Neck radiation; chronic graft-vs-host disease | Yearly thyroid examination |
| Lung cancer | Annual low-dose computed tomography for high-risk cigarette smokers beginning at age 50 c | Busulfan and cyclophosphamide-based conditioning Pretransplant smoking | Yearly chest imaging, smoking cessation |
| Prostate cancer | Discuss prostate-specific antigen screening at age 50 | Same as in general population | |
| Cervical cancer | Papanicolaou smear every 3 years beginning at age 25d | Age > 34 Chronic graft-vs-host disease | Papanicolaou smear annually posttransplante |
↵a Patients at high risk may require earlier or more frequent screening.
↵b Patients at high risk, including those with inflammatory bowel disease (Crohn disease or ulcerative colitis), family history of colorectal cancer, or a genetic syndrome, may require earlier or more frequent screening.
↵c Current smokers or those who quit within the past 15 years with a 20-pack-year history.
↵d Starting at age 30—cotesting with human papillomavirus every 5 years or Papanicolaou testing alone every 3 years. Discontinue at age 65 if certain criteria are met.
↵e Cotesting preferred, but cytology-only acceptable. If cytology-only is done, if 3 consecutive tests are negative, can increase the interval to every 3 years. If initial cotesting with human papillomavirus is done and negative, can increase interval to every 3 years. Continue past age 65.
Based on information in references 18 and 36–42.