Internal Medicine
Curricular Elements:
  Return to Internal Medicine Home Page

  Case I
  Case II 
  Case III 
  Adult Vaccination
  Cancer Screening
  Diabetes Screening





Roughly 16,000 new cases are diagnosed each year, and about 4,800 patients die annually from cervical cancer. The 5 year survival of advanced cervical cancer (Stage IV) is 14%, making early detection and treatment essential. In one major report of over 1.8 million women, the cumulative incidence of invasive cervical cancer was reduced 91% by performing regular Pap tests on 3 year intervals. The use of an endocervical brush and “Thin Prep” smears increase the utility of the screening maneuver.

RECOMMENDATION: Regular Pap tests are recommended for all women who are or have been sexually active and have a cervix. Testing should begin when the woman first engages in sexual activity. Low risk women should receive testing every 3 years after 2 negative exams.

High risk women (early onset of intercourse, multiple partners, history of STD’s, unprotected intercourse) with no previous abnormal tests should be tested annually. Regular testing after age 65 may not be necessary for low risk women with previous normal smears.


Colorectal cancer is the second most common form of cancer. It accounts for approximately 140,000 new cases and 55,000 deaths each year. Five year survival is 60% with regional spread and 6% with distant metastases. A digital rectal exam (DRE) is of limited value because only 10% of colorectal cancer can be felt by an examining finger. Fecal occult blood testing (FOBT) is best done with 3 separate stool specimens. FOBT can reduce mortality by 3 1-57%.

RECOMMENDATION: Colon Cancer screening is recommended for all adults over age 50. FOBT can be done on an annual basis. Sigmoidoscopy can be done as an alternative to FOBT on a 3-5 year basis. Many experts consider colonoscopy at 5-10 year intervals a superior screening test (vs. sigmoidoscopy & FOBT) with increased sensitivity, specificity, and cost effectiveness. Nevertheless, colonoscopy has increased complication rates


In 1995 there were 182,000 new cases and 46,000 deaths from breast cancer. Breast cancer is the leading cause of cancer death in women aged 15-54. The sensitivity of mammography exceeds 75% for breast cancer and is generally 10-15% lower for women in the 40’s. For women over age 50, mammography lowers mortality 20-30%.

RECOMMENDATION: Screening for breast cancer is recommended every year with mammography (+1- clinical breast exam) for women aged 50-69. For women 40-49 there is disagreement between the various screening organizations as to when to offer mammography for women under 50.


Insufficie evidence to recommend for or against routine exam by physicians or patients. Referral of high risk individuals (dysplastic nevi, family history of melanoma, severe childhood sunburns) may be made on other clinical grounds.


Insufficient evidence to recommend for or against. Persons who use alcohol or tobacco are at increased risk. Clinicians may wish to perform regular oral exams on high risk patients with lack if direct evidence.


There is insufficient evidence to recommend for or against physician exam or patient self examination. Patients with increased risk (cryptorchidism, atrophic testes) should be informed of their risk and screening options.


Routine screening for prostate cancer with DRE, PSA, or transrectal ultrasound is not recommended by the U.S. Preventive Task Force. If screening is to be performed, it should be limited to men with a life expectancy of 10 years or greater. PSA screening of high risk individuals (family history, African. Americans) may be made on clinical grounds.

• Recommendations taken primarily from the Report of the U.S. Preventive Services Task Force, Guide to Clinical Preventive Services, 1996

Updated 2002 version can be viewed online at