Let’s face it, cancer is scary.  And when we think about cancer screening tests, we think about cancer, so that’s scary too.   

But the fact is, cancer screening saves lives.  Between 1991 and 2019 (most recent data), cancer deaths fell by 32% in the United States thanks to early detection.  That accounts for about 3.5 million lives saved! 

Another problem is that official recommendations for the ages cancer screenings should begin and how often we should get them seem to change regularly.  It is sometimes hard to know what is appropriate, and what insurance will pay for.   

To make things easier, we consulted the American Cancer Society (ACS) and the National Institutes of Health (NIH) to help cut through the confusion.  We’ve pulled together a basic cancer screening timeline, divided by age group and cancer type.  We all should be able to take charge of our health and get the benefit of early intervention without our heads exploding.  

Risk Factors 

Before you decide about cancer screenings you need to determine if you have a higher-than-average risk of getting any cancer, outside of any lifestyle issues you may have (ex. Smoking, obesity, excessive alcohol consumption, low activity levels, etc.).  If you fall into a high-risk category for any cancer, you should talk to a medical provider about getting screened earlier or more often for that cancer. 

These are the most common factors you can’t change that put you at higher risk for certain cancers.   

Breast Cancer 

• Getting older. The risk for breast cancer increases with age. Most breast cancers are diagnosed after age 50. 

• Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer. 

• Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer. 

• Having dense breasts.  Women with dense breasts which have more connective tissue than fatty tissue, are more likely to get breast cancer. 

• Personal history of breast cancer.  Women who have had breast cancer are more likely to get breast cancer a second time.  

• Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer.  

Cervical Cancer 

• HPV.  Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that can be passed from one person to another during sex.  

• HIV and compromised immunity.  Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems puts you at greater risk for this particular type of cancer connected to a virus. 

Colon Cancer 

• A family history (parents, siblings, aunts, uncles, grandparents) of colorectal cancer or certain types of polyps  

• Inflammatory bowel disease (ex. ulcerative colitis or Crohn’s disease).  If you have an IBD, you are at greater risk of cancer thanks to inflammation. 

• Getting older, the risk of colon cancer increases significantly as we age. 

• Native Americans have the highest rates of colorectal cancer in the US, followed by African American men and women. 

• Jews of Eastern European descent (Ashkenazi Jews) have one of the highest colorectal cancer risks of any ethnic group in the world.  

Lung Cancer 

• Having been a smoker.  It’s true that quitting smoking reduces a smoker’s risk of getting lung cancer, with the risk getting smaller as the time increases since the last cigarette.  But former smokers are still at higher risk than those who have never smoked. 

• Family history.  Family history is not as big a factor in lung cancer risk, but if you have had lung cancer, you have a higher risk developing another lung cancer.   

• Radiation to the chest.  People who have had radiation treatment to their chest for another cancer have a higher risk of developing lung cancer. 

Prostate Cancer 

• All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime. 

• Getting older. The older a man is, the greater the chance of getting prostate cancer. 

• African American men are more likely to get prostate cancer than other men and at a younger age than other men. 

• Family history.  You are at greater risk if you have a first degree relative (father, son, or brother) who had prostate cancer, or several second or third-degree relatives, including relatives in three generations on your mother’s or father’s side of the family.

If you fall into a risk category, it’s important that you discuss this with your medical providers (whether or not they ask) to determine if you need to create your own screening timeline.  If you are at average risk, here’s what you need to know: 

 
Screening Timeline 

In Your 20s and 30s: 

• Cervical Cancer: Cervical cancer is the only cancer anyone with a cervix needs to start screening for early. Young women should be seeing a gynecologist, getting screened for HPV and getting pap tests beginning at age 21. If results are normal, your doctor may recommend repeating the test every three years.  Pap tests and HPV tests should continue throughout a woman’s life. 

• Breast Cancer: Experts recommend that women start breast self-exams in their 20s.  Most women worry that they don’t really know what to look for, so there is low compliance on self-exams. Clinical breast exams are recommended during regular health exams, about every three years for women in their 20s and 30s. 

In Your 40s: 

• Breast Cancer: Women should consider starting annual mammograms at age 40. Guidelines have recently changed, suggesting mammograms every two years for women at average risk.  Under the Affordable Care Act, insurers are required to pay for yearly screening mammograms.  Discuss your options with your healthcare provider, especially if you have a family history or other risk factors. 

• Colorectal Cancer: Begin screening at age 45. Options include colonoscopy, stool-based (non-invasive) tests, and more. Fecal tests prevent significantly fewer deaths than colonoscopies and should be repeated yearly or more often.  

In Your 50s: 

• Breast Cancer: Continue annual mammograms. The frequency may change based on individual risk factors and previous results. 

• Colorectal Cancer: If you didn’t begin screening at age 45, now is the time. Colonoscopies are recommended every five years.  Fecal tests much more often.  Discuss the most appropriate test and frequency with your healthcare provider. 

• Lung Cancer: People ages 50 to 80 should get yearly lung cancer screening with a low-dose CT (LDCT) scan if they smoke or used to smoke, and if they have at least a 20 pack-year history of smoking. A pack-year is equal to smoking 1 pack or about 20 cigarettes per day for a year.  If you’ve never smoked, discuss screening with your medical provider. 

• Prostate Cancer: Starting at age 50, all men at average risk should talk with a health care provider about the potential benefits of testing. Discuss PSA blood testing and rectal testing with your doctor, considering your risk factors and family history.  Prostate cancer screening has fewer side effects than most other cancer screenings.  For many men this testing is a part of their annual physical. 

In Your 60s and Beyond: 

• Breast Cancer: Continue regular mammograms. Your doctor may advise less frequent screenings depending on your history and risk factors. 

• Colorectal Cancer: Continue regular screenings until age 75; beyond this age, the decision should be individualized based on your overall health and prior screening history. 

• Lung Cancer: If you have risk factors and have been screening for lung cancer, your medical provider will likely suggest that you continue.  If not, depending on your lifestyle and location, you might want to discuss starting to screen with your medical provider. 

The Bottom Line on Cancer Screenings 

Cancer screenings absolutely save lives, but they are not completely without risk.  The most important thing to do is consider the risk factors you can change and the ones you can’t and take the timeline guidelines very seriously.  

Regular screenings can give you peace of mind and/or a much better chance of beating any cancer you might find.  And while none of us like to think about cancer, regular screenings may just keep you mindful enough to make a few healthy lifestyle changes.