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. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.
The American Cancer Society (ACS) recommends these screening guidelines for women:
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.
- 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, those with a very strong family history of breast or ovarian cancer, and those who have had prior radiation treatment to the chest (for example, radiation as part of treatment for Hodgkin's Lymphoma). 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 document, Breast Cancer Prevention and Early Detection.
Cervical Cancer Screening
All women should begin cervical cancer screening at age 21 using the following methods:
- Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
- Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
- Over age 65: women who have had normal Pap results can stop testing all together. Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
- Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing. If the hysterectomy was done as treatment for pre-cancer the above guidelines should be followed or you should follow the guidelines that your provider gives you.
- Women who have had the HPV vaccination should still have Pap testing per the above guidelines.
Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Prevention and Early Detection for more information.
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, may want to consider having a yearly endometrial biopsy. Please talk with your doctor 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 50 should undergo routine screening for colon and rectal cancer. 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 50 (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
- Double-contrast barium enema every 5 years, or
- CT colonography (virtual colonoscopy) every 5 years
Tests that primarily test for cancer:
- Yearly 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 in a relative who was diagnosed before the age of 60.
- 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.
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, read: ACS recommendations for colorectal cancer early detection.
Lung Cancer Screening
The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do 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:
- 55 to 74 years of age and in fairly good health
- Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (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 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)
Screening is done with a yearly low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.
Sun Exposure and Skin Cancer Risk
Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this 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 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 (10am-4pm, 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". SkinCancerNet has a helpful guide to performing a skin exam.