Cancer Screening Jog Chart For Patients
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1Cancer Screening Jog Chart for Patients
Designed for Patients to keep in their own medical record.
Name: __________________________________
Age:__________
WOMEN:
Breast Cancer Screening:
At age 20, you should start yearly Breast Self Exams (BSE) and Clinical Breast Exams (CBE) every 3 years.
At age 40, you should start yearly Mammograms and Clinical Breast Exams. Mark boxes with ‘X’ if completed.
Yr1
Yr2
Yr3
Yr4
Yr5
Yr6
Yr7
Yr8
Yr9
Yr10
Breast Cancer
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Screening Tests
Mammogram
(Age 40 - yearly)
CBE
(Age 40 - yearly)
Yr1 Date:
Yr4 Date:
Yr7 Date:
Yr 10:
CBE
(Age 20 – every 3 yrs)
Cervical Cancer Screening:
Yearly Pap tests should begin 3 years after the start of vaginal intercourse or no later than age 21. At age 30,
if had 3 normal Pap tests in a row, screen every 2-3 years. Women 70 years of age or older who have had no
abnormal Pap test in the last 10 years may choose to stop. Mark boxes with ‘X’ if completed.
Yr1
Yr2
Yr3
Yr4
Yr5
Yr6
Yr7
Yr8
Yr9
Yr10
Cervical Cancer
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Screening Tests
Pap Test
(yearly)
MEN & WOMEN:
Colorectal Cancer Screening:
You should complete at least one of the following tests on a regular basis starting at age 50. Mark boxes with
‘X’ if completed.
Yr1
Yr2
Yr3
Yr4
Yr5
Yr6
Yr7
Yr8
Yr9
Yr10
Colorectal Cancer
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Screening Tests
FOBT/FIT
(yearly)
Yr1 Date:
Yr6 Date:
Flex. Sigmoidoscopy
(every 5 years)
Yr1 Date:
Yr6 Date:
DC Barium Enema
(every 5 years)
Yr1 Date:
Colonoscopy
(every 10 years)
MEN:
Prostate Cancer Screening:
Start at age 45 for African Americans and age 50 for average risk men. Digital Rectal Exam (DRE) and
Prostate-Specific Antigen should be offered every year. Mark boxes with ‘X’ if completed.
Yr1
Yr2
Yr3
Yr4
Yr5
Yr6
Yr7
Yr8
Yr9
Yr10
Prostate Cancer
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Screening Tests
PSA
(yearly)
DRE
(yearly)
At time of check-up, ask your health provider about examinations for cancer of
the thyroid, oral cavity, skin, lymph nodes, and testes or ovaries.
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Parent category: Medical