Cancer Screening Guidelines

Early detection improves your chances of beating cancer. Here’s what you should know about the major cancer screening guidelines.

Screening increases the early chances of detecting — and beating — many cancers when they are most curable. Cancer screenings are preventive and, in many cases, covered by most health insurance. Here are the major cancer screening guidelines, when you should have them, and why.

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Breast cancer

Women with an average risk of breast cancer — those without a known genetic or family history of breast cancer — should have the option for annual mammograms between the ages of 40 and 44, according to the American Cancer Society (ACS). Women between the ages of 45 and 54 should be screened every year.

Women 55 and older can continue with yearly mammograms or opt to have the screening test every other year. ACS guidelines also advise women to continue having regular mammograms as long as they are in good health and are expected to live at least another 10 years.

The guidelines for breast self-exams have changed in recent years. There is little evidence that physical breast exams conducted by women themselves or by their healthcare provider help find breast cancer early, the ACS points out.

That does not mean these exams shouldn’t happen. If women are at higher-than-average risk of breast cancer, their doctor may offer clinical breast exams along with mammograms and other imaging, if needed. It’s also important for women to be familiar with how their breasts normally feel and report any changes in size, shape, or sensation to their healthcare provider.

If you have an elevated risk for breast cancer, screening recommendations may be different, depending on your specific risk.

For example, a breast MRI (magnetic resonance imaging) is not recommended as a screening test by itself because it can miss some cancers that a mammogram finds, the ACS explains. For certain women at high risk for breast cancer, however, a screening MRI is recommended along with a yearly mammogram.

Breast cancer risk is 20 percent to 25 percent in women who have a family history of the disease or a known BRCA1 or BRCA2 gene mutation (based on genetic testing). Radiation therapy to the chest between the ages of 10 and 30 also raises the risk of breast cancer.

Cervical cancer

Screening for cancer of the cervix (the lower, narrow end of a woman’s uterus) using the Pap test has significantly decreased deaths from cervical cancer since 1950. By revealing pre-cancerous cells that can then be treated, Pap tests have also helped prevent many cases of cervical cancer.

Infection with the human papillomavirus (HPV), spread primarily through sexual contact, is the major risk factor for cervical cancer, according to the National Cancer Institute. That’s why testing for HPV is an important part of cervical cancer screening.

The ACS recommends beginning cervical cancer screening at age 25. Women between the ages of 25 and 65 should have an HPV test every five years. Pap tests combined with HPV tests can be used for screening and repeated every two years. If a Pap test isn’t combined with HPV test, you should have a Pap test every three years.

Women over age 65 who have had regular screenings over the past decade with normal results and no history of cervical cancer or pre-cancerous cells within the past 25 years can stop having cervical cancer screening. Likewise, women who have had a total hysterectomy (which includes removal of the cervix) don’t need Pap and HPV tests, unless their surgery was performed to treat cancer or a serious pre-cancerous condition, the ACS explains.

Women who have had a supra-cervical hysterectomy — which does not involve removal of the cervix — should continue cervical cancer screening, according to the ACS guidelines.

Women who are vaccinated against HPV still need to follow guidelines for their ages.

The ACS emphasizes that typical cervical cancer screening guidelines do not apply to all women.

• Women who have been diagnosed with cervical cancer or cervical pre-cancer should have follow-up testing and cervical cancer screening as recommended by their healthcare team.
• Any woman with a history of a serious pre-cancer should be tested for at least 25 years after that condition was found, even if the testing goes past age 65.
• Women who are at high risk for cervical cancer because their immune system is suppressed (for example, from HIV infection, organ transplant, or long-term steroid use), or who were exposed to DES in utero, may need screening more often and should follow the recommendations of their healthcare provider.

Colon (colorectal) cancer

In recent years, the ACS has lowered the age for beginning colon cancer screening in people with average risk for the disease. Regular screening is now recommended at age 45, and people who are in good health with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75. Colorectal cancer screening is not recommended for men and women over the age of 85.

It’s important to note these recommendations apply only to people at average risk of colorectal screening, which means they do not have:

• A personal history of certain types of polyps linked to cancer risk
• A personal history of ulcerative colitis or Crohn's disease
• A family history of colorectal cancer
• A confirmed or suspected hereditary colorectal cancer syndrome
• A personal history of radiation treatment to the abdomen or pelvic area to treat a prior cancer

If you have a parent, sibling, or child who was diagnosed with colorectal cancer, your risk is two to four times higher than the risk for someone without that history, the American Cancer Society reports. Your doctor may recommend that you have a colonoscopy starting at age 40, or 10 years before that age if an immediate family member was diagnosed with cancer. You might need more frequent screening and genetic counselling.

The most common types of screening tests are colonoscopies, which examine the rectum and colon using a tube-like scope with a tiny video camera attached, and stool-based tests that check stool samples for signs of occult (hidden) blood or changes in DNA associated with cancer.

Talk to your doctor about your risk factors and the best colorectal screening test for you.

Lung cancer

Smoking is the number one risk factor for lung cancer in the U.S., the Centers for Disease Control and Prevention (CDC) points out. In fact, cigarette smoking is linked to about 80 percent to 90 percent of lung cancer deaths.

The CDC advises smokers and former smokers follow these U.S. Preventive Services Task Force guidelines for lung cancer screening with low-dose computed tomography.

Anyone with a 20 pack-year (meaning one pack a day for 20 years or two packs a day for 10 years) or more smoking history who is between the ages of 50 and 80 and smokes — or who quit smoking within the past 15 years — should be screened yearly.

Caught early, lung cancer is far more likely to be curable than at later stages when symptoms are present.

Prostate cancer

Research has not proven that the potential benefits of testing for prostate cancer outweigh the harms of testing and treatment. You should talk to your doctor about what’s right for you, starting at age 50. If you are African American, or your father or brother had prostate cancer before age 65, you should talk to your doctor at age 45. Men who decide to be tested for prostate cancer should have a PSA blood test every 2 to 4 years.

Other cancer screenings

People 20 and older should have periodic checkups or counseling for the following cancers:

• Thyroid
• Oral
• Lymph nodes
• Testes
• Ovaries
• Skin

Talk to your doctor about when it’s best to have these tests.

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