Cancer-related checkup. Questions? Cancer screening guidelines. Breast cancer. American Cancer Society guidelines for the early detection of cancer

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1 In compliance with the state of Missouri laws and regulations, we are pleased to provide you with the following notice about your health care coverage. Questions? Here s how to reach us. You can either: Go to your personal member website at coventryhealthcare.com Call us at Member Services, using the toll-free number on your ID card Forgot your user name or password? You can get help right away at coventryhealthcare.com, or call us at the toll-free number. Cancer screening guidelines We use guidelines from the American Cancer Society when we decide whether or not to recommend a service. If there isn t enough evidence from the guidelines to make a decision, we use other nationally recognized sources. We use the following guidelines: American Cancer Society guidelines for the early detection of cancer The following cancer screening guidelines are recommended for people at average risk for cancer (unless otherwise specified) who do not have any specific symptoms. People who are more at risk for certain cancers may need to follow a different screening schedule. They may have to: Start these screenings at an earlier age Be screened more often If you have symptoms that could be related to cancer, you should see your doctor right away. Cancer-related checkup If you are age 20 or older, a cancer-related checkup should include health counseling. Depending on your age and gender, the exams should look for cancers of the: Thyroid Mouth Skin Lymph nodes Testes Ovaries Your exams also should look for other nonmalignant (noncancerous) diseases. We recommend special tests for certain cancers listed below. Breast cancer Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health. Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over. Breast self-exam (BSE) for women starting in their 20s. Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Some women because of their family history, a genetic tendency or certain other factors should be screened with MRI in addition to mammograms. (The number of women who fall into this category is small: fewer than 2 percent of all women in the U.S.) Talk with your doctor about your history and whether you should have additional tests at an earlier age. For more information, call the American Cancer Society and ask for their document called Breast Cancer Early Detection. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health and Life Insurance Company and their affiliates (Aetna) MO A (3/18) 1

2 Colon and rectal cancer Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below. The tests designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests. Talk to your doctor about which test is best for you. Tests that find polyps and cancer Flexible sigmoidoscopy every 5 years* Colonoscopy every 10 years Double-contrast barium enema every 5 years* CT colonography (virtual colonoscopy) every 5 years* Tests that mainly find cancer Yearly guaiac-based fecal occult blood test (gfobt)** Yearly fecal immunochemical test (FIT)** Stool DNA test (sdna), every 3 years* You should talk to your doctor about starting colorectal cancer screening earlier and/or being screened more often if you have any of the following colorectal cancer risk factors: A personal history of colorectal cancer adenomatous polyps A personal history of chronic inflammatory bowel disease (Crohn s disease or ulcerative colitis) A strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative [parent, sibling, or child] younger than 60 or in two or more first-degree relatives of any age) A known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC) Cervical cancer Cervical cancer screening (testing) should begin at age 21. Women under age 21 should not be tested. Women between ages 21 and 29 should have a Pap test every 3 years. HPV testing should not be used in this group unless it is needed after an abnormal Pap test result. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called co-testing ) every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years. Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past age 65. A woman who has had both her uterus and cervix removed for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested. A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group. Some women because of their health history (HIV infection, organ transplant, DES exposure, etc.) may need to have a different screening schedule for cervical cancer. Talk to your doctor or nurse about your history. Endometrial (uterine) cancer The American Cancer Society recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary non-polyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35. *If the test is positive, a colonoscopy should be done. **Highly sensitive versions of these tests should be used with the take-home multiple sample method. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive. 2

3 Prostate cancer The American Cancer Society (ACS) recommends that men make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after they get information about the uncertainties, risks and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at: Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years. Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother or son) diagnosed with prostate cancer at an early age (younger than age 65). Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age). After this discussion, those men who want to be screened should be tested with the prostatespecific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening. If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient s general health preferences and values. Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test: Men who choose to be tested who have a PSA of less than 2.5 ng/ml may only need to be retested every 2 years. Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher. Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening. References Levin B, Lieberman DA, McFarland, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58. Saslow D, Boetes C, Burke W, et al for the American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57: Saslow D, Solomon D, Lawson H, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. CA Cancer J Clin May-Jun;62(3): Epub 2012 Mar 14. Smith RA, Brooks D, Cokkinides V, Salsow D, Brawley OW. Cancer screening in the United States, 2013: A review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin 2013, Mar-Apr;63: Accessed at onlinelibrary.wiley.com/ doi/ /caac.21174/full on April 23, Wender R, Fontham E, Barrera E, et al. American Cancer Society lung cancer screening guidelines: CA Cancer Journal for Clinicians Jan 11 [Epub ahead of print]. cancer.org/healthy/findcancerearly/cancerscreeningguidelines/ american-cancer-society-guidelines-for-the-early-detection- of-cancer. 3

4 Aetna complies with applicable Federal civil rights laws and does not unlawfully discriminate, exclude or treat people differently based on their race, color, national origin, sex, age, or disability. We provide free aids/services to people with disabilities and to people who need language assistance. If you need a qualified interpreter, written information in other formats, translation or other services, call the number on your ID card. If you believe we have failed to provide these services or otherwise discriminated based on a protected class noted above, you can also file a grievance with the Civil Rights Coordinator by contacting: Civil Rights Coordinator, P.O. Box 14462, Lexington, KY (CA HMO customers: PO Box Fresno, CA 93779), , TTY: 711, Fax: (CA HMO customers: ), CRCoordinator@aetna.com. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at or at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, or at , (TDD). Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health and Life Insurance Company and their affiliates (Aetna). 4

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