USPSTF Cancer and Osteoporosis Screening Guidelines
Osteoporosis Screening
Screen all women aged 65 years or older with dual-energy x-ray absorptiometry (DEXA) of the hip and lumbar spine, regardless of risk factors. 1
Women Under Age 65
- Screen postmenopausal women younger than 65 years only if their 10-year fracture risk equals or exceeds 9.3% (the risk of a 65-year-old white woman with no additional risk factors). 1
- Use the FRAX calculator to determine 10-year fracture risk, which incorporates age, BMI, parental fracture history, smoking, and alcohol use. 1
- Risk factors warranting earlier screening include: body weight <70 kg, previous fragility fracture, parental hip fracture history, long-term glucocorticoid use, rheumatoid arthritis, excessive alcohol consumption, and current smoking. 2
Men
- The evidence is insufficient to recommend for or against routine osteoporosis screening in men. 1
- Despite insufficient USPSTF evidence, the National Osteoporosis Foundation recommends screening men aged 70 years or older. 2
Screening Intervals
- For women with normal bone density: repeat DEXA in 2-3 years or longer depending on baseline values. 3, 4
- For women with osteoporosis or on treatment: repeat DEXA in 1-2 years to monitor treatment response. 3, 2, 4
- Evidence shows that repeating BMD after 8 years is not more predictive of fracture risk than the original measurement in women with normal baseline density. 3, 2
Breast Cancer Screening
All women should undergo biennial screening mammography starting at age 40 and continuing through age 74 years. 5
- Screen every 2 years from ages 40-74. 5
- Evidence is insufficient to recommend for or against screening in women 75 years or older. 5
- Evidence is insufficient to recommend supplemental screening with breast ultrasound or MRI in women with dense breasts on otherwise negative mammography. 5
Cervical Cancer Screening
Screen women aged 21-29 years every 3 years with cervical cytology alone. 6
Screen women aged 30-65 years using one of three strategies: 6
- Cervical cytology alone every 3 years, OR
- High-risk HPV testing alone every 5 years, OR
- Cotesting (HPV + cytology) every 5 years
Do Not Screen:
- Women younger than 21 years. 6
- Women older than 65 years who have had adequate prior screening and are not otherwise at high risk. 6
- Women who have had a hysterectomy with cervix removal for indications other than high-grade precancerous lesion or cervical cancer. 6
Lung Cancer Screening
Screen adults aged 50-80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years with annual low-dose computed tomography (LDCT). 7
- Discontinue screening once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or ability to undergo curative lung surgery. 7
- This represents an expansion from the previous 2013 recommendation that used age 55-80 years and 30 pack-year threshold. 7
Prostate Cancer Screening
For men aged 55-69 years, the decision to undergo periodic PSA-based screening should be individualized after discussion of potential benefits and harms with their clinician. 8
- Do not screen men who do not express a preference for screening. 8
- Screening may prevent approximately 1.3 deaths per 1000 men screened over 13 years and 3 cases of metastatic disease per 1000 men screened. 8
- Harms include false-positives, overdiagnosis, and treatment complications: 1 in 5 men develop long-term urinary incontinence and 2 in 3 develop long-term erectile dysfunction after radical prostatectomy. 8
Do not screen men 70 years and older. 8
- The harms outweigh benefits in this age group due to increased false-positives, biopsy complications, and treatment harms. 8
Common Pitfalls
- Osteoporosis: Avoid repeating DEXA scans more frequently than every 2 years in women with normal BMD, as testing precision limitations make shorter intervals unreliable and expose patients to unnecessary radiation. 3, 2
- Breast cancer: The 2024 USPSTF guidelines lowered the starting age from 50 to 40 years—ensure you're using current recommendations. 5
- Cervical cancer: Do not screen women under 21 years even if sexually active, as harms outweigh benefits. 6
- Lung cancer: The 2021 update lowered both the age threshold (from 55 to 50) and pack-year requirement (from 30 to 20)—many eligible patients are being missed with outdated criteria. 7