Ministry of Health Guidelines on prevention and early detection of malignant diseases
Genetic tests for identification of high risk of becoming ill with malignant diseases:
- In cases of suspicion of a genetic high prevalence of malignant disease in the family, for example in a case of multiple cases of the same kind of cancer in a family, large number of relatives with a malignancy; early-onset cancer morbidity. In some of the cases it is possible to conduct tests to screen for genetic mutations which are responsible for the occurrence of malignant diseases and on condition that the genetic test might enable prevention or early detection of the malignant disease or to change a treatment decision. In these cases, genetic counseling is recommended (from a qualified geneticist or from a specialist doctor). The consultation process will include recommendations regarding relatives.
- Examples of diseases and genetic syndromes which cause high risk of malignant disease morbidity, and for which a genetic test may enable early diagnosis or even prevention of the malignant disease:
|Disease / genetic syndrome||The relevant gene|
|Familial Adenomatous Polyposis ||APC|
|Von Hippel Lindau Syndrome||VHL|
|Medullary Thyroid Carcinoma||RET|
Early detection of breast cancer
- Mammography test once every two years, at ages 50-74 is recommended for women in the general public (who are not at high risk).
- Mammography test once a year, from age 40, is recommended for women with a first-degree family relationship to another woman who has been diagnosed as suffering from breast cancer, for women with benign breast cancer with atypia cells in a biopsy of for women who are in a high-risk group for other reasons and according to the discretion of their caregiving physician.
Early detection of colorectal cancer
- Between ages 50-74, it is recommended once a year to perform a high sensitivity screening occult blood test.
- For patients with a with a first-degree family relationship to another person who has been diagnosed as suffering from colorectal cancer, a colonoscopy is recommended every five years from age 40.
- Patients with a first-degree relative with HNPCC/Lynch Syndrome, an annual colonoscopy is recommended from age 25.
- Patients with a first-degree relative with HNPCC/Lynch Syndrome, an annual colonoscopy is recommended from age 15.
- Patients with IBD, a periodic colonoscopy is recommended as per the caregiving physician’s recommendation.
Early detection of lung cancer
- An annual X-ray of the lungs is recommended for anyone who has had occupational asbestos exposure.
Early detection of endometrial carcinoma
- It is recommended that women belonging to any of the following groups obtain genetic consultation:
- A personal or family history of breast cancer, which was diagnosed before age 50.
- A family history of endometrial carcinoma.
- A personal or family history of colorectal cancer or endometrial carcinoma, which was diagnosed before age 50. For women who, following genetic counseling, have been defined as belonging to a high-risk group for endometrial carcinoma, it is recommended that beginning at age 25, they undergo a periodic (every 6 months) test, including a gynecological test and an ultrasound test.
Early detection of cervical cancer
- It is recommended that women undergo a Pap smear test every three years, from age 25 to age 65.
- The Pap smear test is included in the health basket for women aged 35-54.
In addition to the early detection, it is possible to receive primary prevention by receiving an immunization for the prevention of cervical cancer.
In December 2012, the medication basket committee approved the inclusion of immunization against HPV in the health basket. The papilloma virus is transmitted in sexual relations and may cause cervical cancer several years after the infection. The infection with this virus usually occurs between adolescence and age 25.
Starting with the next school year, the immunization will be given nationwide in schools, to girls in the eighth grade. This is expected to reduce the morbidity from cervical cancer.
Early detection of skin cancer and melanoma
- For persons at high risk of skin cancer or melanoma, it is important that they report to their family physician, and monitor themselves periodically for moles and dermal naevi, and to undergo a periodic skin inspection by a dermatologist or plastic surgeon.
- High-risk groups for skin cancer or melanoma:
A. Exposure to ionizing radiation from childhood treatment of Scalp Ringworm.
B. Existence of a first-degree relative who has become ill with melanoma.
C. Existence of 20 or more melanocytic moles over the entire body surface after age 17.
D. Existence of dysplastic nevi (atypical moles) in a patient or in a first-degree relative.
E. Regular exposure of more than two hours per day to the sun between 10:00 am and 4:00 pm.
- Stop smoking
- Avoidance of smoking near people who do not smoke, especially avoidance of smoking in the presence of children.
In addition, the Ministry of Health is promoting policy and research activities, which yield collaboration with the Ministry of Environmental Protection on reducing exposure ti harmful environmental impacts, which may cause cancer, including air pollution, radiation and other exposures to chemicals.