The Centers for Disease Control and Prevention (CDC) and the U.S. Preventative Services Task Force (USPSTF) recommend that women 50 to 74 years of age have a screening mammogram every two years; and a decision to begin screening before this age should be made with a doctor, and should take into account the woman’s values regarding specific benefits and harms. Although the USPSTF believes the decision to screen before age 50 is an individual one, they specifically recommend against routine screening mammography in women aged 40 to 49.
The American Cancer Society gives a more conservative recommendation: yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
The screening recommendations are for average-risk women only. If a woman is experiencing breast symptoms or has a strong family history of breast cancer, they should see a doctor and screening may be done.
Although the leading health organizations differ somewhat in their recommendations regarding the frequency of routine screening, they all agree that women should begin screening at age 21, and continue screening through age 64.
The ACS, USPSTF, and American College of Gastroenterology (ACG) recommend both men and women begin colorectal cancer screening at age 50. After age 75, the USPSTF recommends talking to a doctor about screening. People at high risk should begin screening earlier - ACG specifically recommends that African Americans begin screening at age 45 – and get tested more frequently.
A colonoscopy, done every 10 years, is the preferred screening method. In addition to detecting cancer, it can find and remove pre-cancerous polyps (a growth on the surface of the colon). A colonoscopy may not be available inevery clinical setting; in which case, a flexible sigmoidoscopy should be performed every five years (five to 10 according to the ACG). This test can detect most polyps, but does not check the entire colon. According to the ACS, if the test is positive, a colonoscopy should be done. The USPSTF also recommends having a fecal occult blood test every three years along with the flexible sigmoidoscopy. A possible alternative to the flexible sigmoidoscopy is a computed tomography (CT) colonography, which should be done every five years.
A non-invasive screening option is a fecal test; however, fecal tests only find cancer, not pre-cancerous polyps, and a colonoscopy may still be needed if a test is positive. The tests, a fecal occult blood test (FOBT) or a fecal immunochemical test (FIT), should be done every year and involve multiple stool samples taken at home.
The USPTF does not recommend for or against lung cancer screening. They do not know if the benefits outweigh the potential harm, especially for people who do not smoke. The ACS recommends against screening for average risk people; however, screening may be beneficial for high risk people. The ACS and American Lung Association (ALA) define a high risk person as:
- A current or former smoker,
- 55 to 74 years of age,
- Having at least a 30 pack-year smoking history (this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.) ,
- AND either still smoking or has quit smoking within the last 15 years.
The ALA recommends that high risk people get screened with a low dose CT scan. Chest X-rays are not recommended.
The USPSTF recommends against prostate cancer screening for men who do not have symptoms. The harms of screening outweigh the benefits, and until better test and better treatment options are available, prostate cancer screening should not be done.
The ACS recommends that at age 50 (or 45 if African American or have an immediate family member who had prostate cancer before age 65) men should talk to their doctors about the pros and cons of screening; and if a man does decide to get screened he should have a prostate-specific antigen (PSA) blood test with or without a rectal exam.
Cancer in Louisiana: An Overview and Screening Guide
As part of the Louisiana Cancer Prevention and Control Program’s Cancer-Quality Improvement Project, the Louisiana Comprehensive Cancer Control Program (LCCCP) created a booklet giving an overview of and screening recommendations for breast, cervical, and colorectal cancers. The booklet can be downloaded here.