Screening for solid tumors in allogeneic hematopoietic cell transplant recipients vs the general population

General populationAllogeneic transplant recipients
Risk factorsScreening considerations
Skin cancersRoutine screening not recommendedAcute or chronic graft-vs-host disease
Prolonged immunosuppression
Human papillomavirus infection
Total body irradiation
Annual skin self-examination
Breast cancerYearly mammogram beginning at age 45aSame as in general population
Head and neck cancerRoutine screening not recommendedChronic graft-vs-host disease with prolonged immunosuppression
Reduced-intensity conditioning
Oral evaluation at 6 months, 1 year, then annually
Colorectal cancerColonoscopy every 10 years beginning at age 45bAbdominal radiationFor patients who received radiation: colonoscopy every 5 years beginning at age 35 or 10 years after radiation, whichever occurs last
Esophageal cancerRoutine screening not recommendedChronic graft-vs-host diseaseUpper endoscopy if persistent gastroesophageal reflux disease, symptoms of dysphagia
Thyroid cancerRoutine screening not recommendedNeck radiation; chronic graft-vs-host diseaseYearly thyroid examination
Lung cancerAnnual low-dose computed tomography for high-risk cigarette smokers beginning at age 50 cBusulfan and cyclophosphamide-based conditioning
Pretransplant smoking
Yearly chest imaging, smoking cessation
Prostate cancerDiscuss prostate-specific antigen screening at age 50Same as in general population
Cervical cancerPapanicolaou smear every 3 years beginning at age 25dAge > 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 3642.