What cancer screenings are recommended for women?

Cancer Screening Recommendations for Women

Women should undergo three primary cancer screenings: annual mammography starting at age 40, cervical cancer screening with Pap testing beginning at age 21, and colorectal cancer screening starting at age 45.

Breast Cancer Screening

Average-Risk Women

Annual mammography beginning at age 40 provides the greatest mortality reduction (up to 40%), earlier stage diagnosis, and better treatment options. 1, 2

• Women aged 40-54 years: Annual mammography is recommended, with the option to begin screening between ages 40-44 1
• Women aged 55 years and older: Transition to biennial (every 2 years) screening is acceptable, though annual screening may continue based on individual preference 1
• Clinical breast examination: Every 3 years for women aged 20-39, then annually after age 40 1
• Breast self-examination: Optional; women should be counseled about breast self-awareness and promptly report any changes 1, 3

Screening should continue past age 74 without an upper age limit unless severe comorbidities limit life expectancy to less than 10 years. 1, 2

High-Risk Women

Women at high risk require earlier and more intensive screening with both mammography AND breast MRI starting at age 25-30. 4

High-risk criteria include:

• Genetic mutations (BRCA1/2, TP53, PTEN): Lifetime risk 45-85%; begin annual mammography PLUS annual MRI at age 25-30 3, 4
• Calculated lifetime risk ≥20% using Tyrer-Cuzick or similar models: Begin annual mammography PLUS MRI at age 30 5, 4
• Chest radiation ≥10 Gy before age 30: Begin annual MRI at age 25 or 8 years post-radiation, whichever is later 5, 4
• Personal history of breast cancer diagnosed before age 50: Annual mammography PLUS MRI 3, 4
• Dense breasts with other risk factors: Consider supplemental MRI 4

For high-risk women who cannot undergo MRI, contrast-enhanced mammography or ultrasound should be used as alternatives. 3, 4

Critical pitfall: Do not delay screening in Black women—they have 39% higher breast cancer mortality rates and twice the incidence of aggressive triple-negative breast cancer. All women, especially Black women and those of Ashkenazi Jewish descent, should undergo risk assessment by age 25-30. 5, 4

Cervical Cancer Screening

Cervical cancer screening should begin at age 21 regardless of sexual activity onset, with different strategies based on age. 1

Age-Specific Protocols

• Ages 21-29 years: Pap test (cytology) alone every 3 years; HPV testing should NOT be used in this age group 1
• Ages 30-65 years:
  • Preferred: Co-testing (Pap + HPV) every 5 years 1
  • Acceptable: Pap test alone every 3 years 1
• Age >65 years: Discontinue screening if 3 consecutive negative Pap tests OR 2 consecutive negative co-tests within the past 10 years, with the most recent test within 5 years 1

Annual screening is NOT recommended at any age—this represents overscreening. 1

Special Circumstances

• Post-hysterectomy (with cervix removal) for benign disease: No screening needed 1
• History of CIN2/3 or cervical cancer: Continue screening for 10 years after treatment, even past age 65 1
• Immunocompromised (HIV, transplant, chronic steroids): Screen twice in first year after diagnosis, then annually; no age to stop 1
• DES exposure in utero: Continue screening indefinitely 1

Colorectal Cancer Screening

All adults should begin colorectal cancer screening at age 45, with multiple acceptable testing options. 1

Screening Options (Choose One)

Stool-based tests:

• Fecal immunochemical test (FIT): Annually 1
• High-sensitivity guaiac-based fecal occult blood test: Annually 1
• Multi-target stool DNA test: Every 3 years 1

Structural examinations:

• Colonoscopy: Every 10 years 1
• CT colonography: Every 5 years 1
• Flexible sigmoidoscopy: Every 5 years 1

All positive non-colonoscopy tests must be followed with timely colonoscopy. 1

Age-Specific Guidance

• Ages 45-75 years: Continue regular screening 1
• Ages 76-85 years: Individualize based on life expectancy, health status, and prior screening history 1
• Age >85 years: Discourage continued screening 1

Endometrial Cancer

No routine screening is recommended for average-risk women. 1

• At menopause, counsel women about endometrial cancer symptoms (unexpected bleeding or spotting) and strongly encourage prompt reporting 1
• High-risk women (Lynch syndrome, hereditary nonpolyposis colorectal cancer) require specialized surveillance protocols 1

Lung Cancer Screening

Current or former smokers aged 55-74 years with significant smoking history should undergo low-dose helical CT screening. 1

This applies to women with:

• 30+ pack-year smoking history AND
• Currently smoke or quit within past 15 years 1

Ovarian Cancer

No routine screening is recommended for average-risk women due to lack of evidence for mortality benefit. 1

Women with strong family history or genetic mutations require specialized high-risk surveillance protocols beyond routine screening. 1