The following cancer screening guidelines are recommended for those
people at average risk for cancer (unless otherwise specified) and
without any specific symptoms.
People who are at increased risk for certain cancers may need
to follow a different screening schedule, such as starting at an
earlier age or being screened more often. Those with symptoms that
could be related to cancer should see their doctor right away.
For people aged 20 or older having periodic health exams, a
cancer-related checkup should include health counseling, and depending
on a person's age and gender, might include exams for cancers of the
thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well
as for some non-malignant (non-cancerous) diseases.
Special tests for certain cancer sites are recommended as
mammograms are recommended starting at age 40 and continuing for as
long as a woman is in good health.
- Clinical breast exam (CBE) should be part of a periodic
health exam, about every 3 years for women in their 20s and 30s and
every year for women 40 and over.
- Women should know how their breasts normally feel and
report any breast change promptly to their health care providers.
Breast self-exam (BSE) is an option for women starting in their 20s.
- Women at high risk (greater than 20% lifetime risk) should
get an MRI and a mammogram every year. Women at moderately increased
risk (15% to 20% lifetime risk) should talk with their doctors about
the benefits and limitations of adding MRI screening to their yearly
mammogram. Yearly MRI screening is not recommended for women whose
lifetime risk of breast cancer is less than 15%.
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 that are 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
- fecal occult blood test (FOBT) every year*,**
- fecal immunochemical test (FIT) every year*,**
- stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are
**For FOBT or FIT used as a screening test, the take-home multiple sample
method should be used. A FOBT or FIT done during a digital rectal exam in the
doctor's office is not adequate for screening.
People should talk to their doctor about starting colorectal
cancer screening earlier and/or being screened more often if they have
any of the following colorectal cancer risk factors:
- a personal history of colorectal cancer or adenomatous
- a personal history of chronic inflammatory bowel disease
(Crohns 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 2 or more first-degree relatives of any
- a known family history of hereditary colorectal cancer
syndromes such as familial adenomatous polyposis (FAP) or hereditary
non-polyposis colon cancer (HNPCC)
- All women should begin cervical cancer screening about 3
years after they begin having vaginal intercourse, but no later than
when they are 21 years old. Screening should be done every year with
the regular Pap test or every 2 years using the newer liquid-based Pap
- Beginning at age 30, women who have had 3 normal Pap test
results in a row may get screened every 2 to 3 years. Another
reasonable option for women over 30 is to get screened every 3 years
(but not more frequently) with either the conventional or liquid-based
Pap test, plus the HPV DNA test. Women who have certain risk factors
such as diethylstilbestrol (DES) exposure before birth, HIV infection,
or a weakened immune system due to organ transplant, chemotherapy, or
chronic steroid use should continue to be screened annually.
- Women 70 years of age or older who have had 3 or more
normal Pap tests in a row and no abnormal Pap test results in the last
10 years may choose to stop having cervical cancer screening. Women
with a history of cervical cancer, DES exposure before birth, HIV
infection or a weakened immune system should continue to have screening
as long as they are in good health.
- Women who have had a total hysterectomy (removal of the
uterus and cervix) may also choose to stop having cervical cancer
screening, unless the surgery was done as a treatment for cervical
cancer or pre-cancer. Women who have had a hysterectomy without removal
of the cervix should continue to follow the guidelines above.
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.
Both the prostate-specific antigen (PSA) blood test and
digital rectal examination (DRE) should be offered annually,
beginning at age 50, to men who have at least a 10-year life
expectancy. Men at high risk (African-American men and men with a
strong family of one or more first-degree relatives [father, brothers]
diagnosed before age 65) should begin testing at age 45. Men at even
higher risk, due to multiple first-degree relatives affected at an
early age, could begin testing at age 40. Depending on the results of
this initial test, no further testing might be needed until age 45.
Information should be provided to all men about what is known
and what is uncertain about the benefits, limitations, and harms of
early detection and treatment of prostate cancer so that they can make
an informed decision about testing.
Men who ask their doctor to make the decision on their behalf
should be tested. Discouraging testing is not appropriate. Also, not
offering testing is not appropriate.
American Cancer Society. Cancer
Facts & Figures 2008. Atlanta, Ga: American Cancer
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. Published online March 5, 2008. 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.