Cancer Screening* Recommendations for Older Patients

Cancer to Be Detected	Test	Frequency	Comments†
Breast cancer	Mammography	Every 2 years	For women 50–74: B recommendation by the USPSTF For women 40–49: Individualized screening decision based on assessment of potential benefits and harms: C recommendation by the USPSTF For women ≥ 75: I recommendation by the USPSTF Continuing screening if in good health and life expectancy is >10 years recommended by the ACS
Cervical cancer or uterine cancer	Papanicolaou (Pap) test (evidence for newer methods is insufficient)	One of the following: At least every 3 years with a Pap test Every 5 years with high-risk human papillomavirus (hrHPV) testing alone Every 5 years with hrHPV testing plus a Pap test	For women > 65: D recommendation against screening by the USPSTF if results of adequate recent screening have been normal and women are not at high risk For women who have had a total hysterectomy and no history of high-grade precancerous lesions or cancer: D recommendation against having Pap tests by the USPSTF For women > 65: Stopping screening suggested by ACOG if women have no history of cervical changes plus one of the following: 3 negative Pap test results in a row 2 negative HPV test results in a row 2 negative co-tests (Pap plus HPV) within the past 10 years, with the most recent test being done within the past 3–5 years
Colorectal cancer	Screening test (FOBT/FIT, flexible sigmoidoscopy, colonoscopy)		For adults 50–75: A recommendation by USPSTF For adults 45–49: B recommendation by USPSTF For adults 76–85: C recommendation by USPSTF (citing a very small net benefit of screening in those who have been previously screened) for selective routine screening (should be individualized, taking into account patient’s overall health and screening history) For people> 85: Stopping screening (USPSTF guidelines state that most organizations recommend that screening stop in people > 85 years)
	gFOBT FIT FIT-MT-sDNA	gFOBT and FIT: Yearly FIT-MT-sDNA: Every 1–3 years
	Flexible sigmoidoscopy	Every 5 years	When sigmoidoscopy is used with FIT, every 10 years plus FIT every year, recommendation by the USPSTF
	Colonoscopy	Every 10 years	Recommendation by the USPSTF
	CT colonography	Every 5 years	Recommendation by the USPSTF
Lung cancer	Low-dose CT	Every year	For patients 50–80 who have a ≥ 20 pack-year smoking history and currently smoke or have quit within the past 15 years: B recommendation by the USPSTF
Prostate cancer	PSA measurement DRE	Individualized	For men 55 to 69: PSA screening based on individualized evaluation of harms versus benefits (C recommendation by the USPSTF) For men ≥ 70 years: D recommendation against PSA screening by the USPSTF
* Cancer screening should be carefully considered and individual risks versus benefits should be considered, particularly in patients with an estimated life expectancy ≤ 10 years. Recommendations vary slightly among different professional societies and groups.
† Recommendations in the table rely mainly on the USPSTF and sometimes on the CDC and other organizations. USPSTF recommendations are based on strength of evidence and net benefit (benefit minus harm): A = Strong evidence in support B = Good evidence in support C = Balance of benefit and harm too close to justify recommendation D = Evidence against I = Insufficient evidence to recommend for or against
ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; DRE = digital rectal examination; FIT = fecal immunochemical test; FOBT = fecal occult blood test; gFOBT = guaiac FOBT; PSA = prostate-specific antigen; MT-sDNA = multitarget stool DNA; USPSTF = U.S. Preventive Services Task Force.

Cancer to Be Detected

Test

Frequency

Comments†

Mammography

Every 2 years

For women 50–74: B recommendation by the USPSTF

For women 40–49: Individualized screening decision based on assessment of potential benefits and harms: C recommendation by the USPSTF

For women ≥ 75: I recommendation by the USPSTF

Continuing screening if in good health and life expectancy is >10 years recommended by the ACS

Cervical cancer or uterine cancer

Papanicolaou (Pap) test (evidence for newer methods is insufficient)

One of the following:

At least every 3 years with a Pap test
Every 5 years with high-risk human papillomavirus (hrHPV) testing alone
Every 5 years with hrHPV testing plus a Pap test

For women > 65: D recommendation against screening by the USPSTF if results of adequate recent screening have been normal and women are not at high risk

For women who have had a total hysterectomy and no history of high-grade precancerous lesions or cancer: D recommendation against having Pap tests by the USPSTF

For women > 65: Stopping screening suggested by ACOG if women have no history of cervical changes plus one of the following:

3 negative Pap test results in a row
2 negative HPV test results in a row
2 negative co-tests (Pap plus HPV) within the past 10 years, with the most recent test being done within the past 3–5 years

Colorectal cancer

Screening test (FOBT/FIT, flexible sigmoidoscopy, colonoscopy)

For adults 50–75: A recommendation by USPSTF

For adults 45–49: B recommendation by USPSTF

For adults 76–85: C recommendation by USPSTF (citing a very small net benefit of screening in those who have been previously screened) for selective routine screening (should be individualized, taking into account patient’s overall health and screening history)

For people> 85: Stopping screening (USPSTF guidelines state that most organizations recommend that screening stop in people > 85 years)

gFOBT

FIT

FIT-MT-sDNA

gFOBT and FIT: Yearly

FIT-MT-sDNA: Every 1–3 years

Flexible sigmoidoscopy

Every 5 years

When sigmoidoscopy is used with FIT, every 10 years plus FIT every year, recommendation by the USPSTF

Colonoscopy

Every 10 years

Recommendation by the USPSTF

CT colonography

Every 5 years

Recommendation by the USPSTF

Lung cancer

Low-dose CT

Every year

For patients 50–80 who have a ≥ 20 pack-year smoking history and currently smoke or have quit within the past 15 years: B recommendation by the USPSTF

Prostate cancer

PSA measurement

DRE

Individualized

For men 55 to 69: PSA screening based on individualized evaluation of harms versus benefits (C recommendation by the USPSTF)

For men ≥ 70 years: D recommendation against PSA screening by the USPSTF

* Cancer screening should be carefully considered and individual risks versus benefits should be considered, particularly in patients with an estimated life expectancy ≤ 10 years. Recommendations vary slightly among different professional societies and groups.

† Recommendations in the table rely mainly on the USPSTF and sometimes on the CDC and other organizations.

USPSTF recommendations are based on strength of evidence and net benefit (benefit minus harm):

A = Strong evidence in support
B = Good evidence in support
C = Balance of benefit and harm too close to justify recommendation
D = Evidence against
I = Insufficient evidence to recommend for or against

ACS = American Cancer Society; ACOG = American College of Obstetricians and Gynecologists; DRE = digital rectal examination; FIT = fecal immunochemical test; FOBT = fecal occult blood test; gFOBT = guaiac FOBT; PSA = prostate-specific antigen; MT-sDNA = multitarget stool DNA; USPSTF = U.S. Preventive Services Task Force.

In these topics

Prevention of Disease in Older Adults