Screening Guidelines for the Early Detection of Cancer in Average-risk Asymptomatic People:


Population - Women, age 20+

Test or Procedure Frequency
Breast self-examination
It is acceptable for women to choose not to do BSE or to do BSE regularly (monthly) or irregularly. Beginning in their early 20s, women should be told about the benefits and limitations of BSE. Whether or not a woman ever performs BSE, the importance of prompt reporting of any new breast symptoms to a health professional should be emphasized. Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a periodic health examination.
Clinical breast examination
For women in their 20s and 30s, it is recommended that CBE be part of a periodic health examination, preferably at least every three years. Asymptomatic women aged 40 and over should continue to receive a CBE as part of a periodic health examination, preferably annually.
Mammography Begin annual mammography at age 40.*



Population - Women, ages 21-65

Test or Procedure Frequency
Pap test &
HPV DNA test
Cervical cancer screening should begin at age 21. For women ages 21-29, screening should be done every 3 years with conventional or liquid-based Pap tests. For women ages 30-65, screening should be done every 5 years with both the HPV test and the Pap test (preferred), or every 3 years with the Pap test alone (acceptable). Women aged 65+ who have had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test occurring within 5 years, and women who have had a total hysterectomy should stop cervical cancer screening. Women should not be screened annually by any method at any age.



Population - Men and women, ages 50+

Test or Procedure Frequency
Fecal occult blood test (FOBT) with at least 50% test sensitivity for cancer, or fecal immunochemical test (FIT) with at least 50% test sensitivity for cancer, or Annual, starting at age 50. Testing at home with adherence to manufacturer’s recommendation for collection techniques and number of samples is recommended. FOBT with the single stool sample collected on the clinician’s fingertip during a digital rectal examination is not recommended. Guaiac based toilet bowl FOBT tests also are not recommended. In comparison with guaiac-based tests for the detection of occult blood, immunochemical tests are more patient-friendly, and are likely to be equal or better in sensitivity and specificity. There is no justification for repeating FOBT in response to an initial positive finding.
Stool DNA test**, or Interval uncertain, starting at age 50
Flexible sigmoidoscopy (FSIG), or Every 5 years, starting at age 50. FSIG can be performed alone, or consideration can be given to combining FSIG performed every 5 years with a highly sensitive gFOBT or FIT performed annually.
Double contrast barium enema (DCBE), or Every 5 years, starting at age 50
Colonoscopy Every 10 years, starting at age 50
CT Colonography Every 5 years, starting at age 50



Population - Women, at menopause

At the time of menopause, women at average risk should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians.



Population - Current or former smokers ages 55-74 in good health with at least a 30 pack-year history

Test or Procedure Frequency
Low dose helical CT
Clinicians with access to high-volume, high quality lung cancer screening and treatment centers should initiate a discussion about lung cancer screening with apparently healthy patients ages 55-74 who have at least a 30 pack-year smoking history, and who currently smoke or have quit within the past 15 years. A process of informed and shared decision making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with LDCT should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation



Population - Men, ages 50+

Test or Procedure Frequency
Digital rectal examination (DRE) and prostate-specific antigen test (PSA) Men who have at least a ten-year life expectancy should have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the potential benefits, risks, and uncertainties associated with prostate cancer screening. Prostate cancer screening should not occur without an informed decision making process.


Cancer- related checkup

Population - Men and women, ages 20+

On the occasion of a periodic health examination, the cancer-related checkup should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures.

*Beginning at age 40, annual clinical breast examination should be performed prior to mammography.
**The stool DNA test approved for colorectal cancer screening in 2008 is no longer commercially available. New stool DNA tests are presently undergoing evaluation and may become available at some future time.

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