General Cancer Screening for Women

Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens.

In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, and thyroid. Not all screening tests are right for everyone. Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. 

Breast Cancer Screening

• Women ages 40-44 should have the choice to start screening mammograms after discussing the risks and benefits with their provider.
• Women ages 45 to 54 should get a mammogram every year.
• Women ages 55 and older should get a mammogram every 2 years, with the choice to continue getting them every year.
• Continue screening as long as the woman is in good health and expected to live 10 years or more.
• A clinical breast exam (CBE), performed by a healthcare professional, is no longer recommended.
• While monthly self-breast exams are no longer recommended, women should still be familiar with their normal breast tissue and report any changes in appearance, size, or feel of the tissue or nipples, or any nipple discharge to their health care provider.

If you have a family history of breast cancer or a personal health history that increases your risk (radiation exposure, genetic mutation, etc), speak with your provider about starting mammograms earlier, depending on your personal and/or family history. The American Cancer Society now recommends yearly breast MRI and mammogram for breast cancer screening in women who:

• Carry a known BRCA 1 or 2 mutation or have a first-degree relative with a BRCA1 or BRCA2 gene mutation but have not been tested themselves, 
• Those with a lifetime risk of breast cancer that is higher due to a family history of breast cancer. 
• Have Li-Fraumeni, Cowden, or Bannayan-Riley-Ruvalcaba syndromes or a first-degree relative with one of them. 

Talk with your healthcare provider about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS website, Breast Cancer Prevention and Early Detection.

Cervical Cancer Screening

The American Cancer Society recommends the following guidelines for cervical cancer screening:

• All women should begin cervical cancer screening at age 25.
• Women between the ages of 25 and 65 should have:
  • Primary HPV testing every 5 years. This test is not yet available at many centers/practices.
  • If this test is not available, you should be screened with co-testing, which is a combination of an HPV and Pap test. This should be done every 5 years.
  • If HPV testing is not available, then a Pap test alone should be performed every three years.
• Women over age 65 who have had regular cervical screenings that were normal should not be screened for cervical cancer. 
• Women who have been diagnosed with cervical pre-cancer should continue to be screened until they meet one of the following criteria over the previous 10 years:
  • Two negative, consecutive HPV tests.
  • Or 2 negative, consecutive co-tests.
  • Or 3 negative, consecutive pap tests in the last 3-5 years.
• Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
• Women who have had the HPV vaccine should still follow the screening recommendations for their age group.
• While the ACS does not recommend cervical cancer screening every year, women should still see their provider for a well-woman checkup.

Women who are at high risk for cervical cancer may need to be screened more often. Women at high risk might include those with HIV infection, organ transplant, or in-utero exposure to the drug DES. They should talk with their doctor or nurse for specific recommendations.

Endometrial Cancer Screening

The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, especially those with a history of hereditary non-polyposis colon cancer, may want to consider having a yearly endometrial biopsy starting at age 35. Please talk with your provider about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

Colon and Rectal Cancer Screening

Most men and women over the age of 45-50 should undergo routine screening for colon and rectal cancer, up until age 75. The American Cancer Society suggests starting screening at age 45 whereas the United States Preventive Services Task Force suggests starting at age 50. Insurance may not cover screening before the age of 50 so you should talk with your provider and insurance company before screening. Testing may be appropriate for younger people with a high-risk personal or family health history. 

Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options on OncoLink.

The "preferred screening" recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 45 (unless you are considered "high risk," see below), using one of the following testing schedules:

Tests that find polyps and cancer:

(Preferred over those that find cancer alone. If any of these tests are positive, a colonoscopy should be done.)

• Flexible sigmoidoscopy every 5 years, or
• Colonoscopy every 10 years, or
• CT colonography (virtual colonoscopy) every 5 years

Tests that primarily test for cancer:

• Yearly guaiac-based fecal occult blood test (FOBT)*, or
• Yearly fecal immunochemical test (FIT) *, or
• Stool DNA test (sDNA), every 3 years*

*The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

• Individuals with a family history of colon or rectal cancer.
• Individuals with a history of polyps.
• Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
• Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.
• Individuals who have had radiation to the belly or pelvic area to treat a prior cancer.

Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer screening from the ACS, you can read ACS recommendations for colorectal cancer early detection.

Lung Cancer Screening

In general, screening is not recommended for people who are at average risk. However, the US Preventative Task Force does have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

• 50 to 80 years of age and in fairly good health.
• Currently smoke or have quit within the past 15 years.
• Have at least a 20 pack-year smoking history (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 20 years has a 20 pack-year smoking history, as does someone who smoked 2 packs a day for 10 years).
• Have gone through smoking cessation counseling if they are current smokers.

Screening is done with a yearly low-dose CT scan (LDCT) of the chest. If you fit the list above, you and your provider should talk about whether you want to start screening. There are risks, benefits, and limitations to low-dose CT scans that you should discuss with your care team. Learn more about lung cancer screening.

Sun Exposure and Skin Cancer Risk

Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, it is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality, you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to the sun (on the soles of the feet, under nails, and genitals).

You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad-spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10 am-4 pm when the rays are strongest), and wearing protective clothing such as hats, sunglasses, and long-sleeved shirts.

Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a "mole map.”  The American Academy of Dermatology has a helpful guide to performing a skin exam.

Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

This is a basic guide to cancer screening for women. Each situation is unique. Ask your provider which screening tests are right for you and when you should have them done.