Preventative Screening Guidelines for Adults
For adults with no significant medical history, begin colorectal cancer screening at age 50, cervical cancer screening at age 21 (or 3 years after sexual activity onset), breast cancer screening with annual mammography at age 40 for women, and lipid screening for men starting at age 35 and women at age 45. 1
Colorectal Cancer Screening
All average-risk adults should begin screening at age 50 years with one of the following options 1:
- Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT) 1
- Flexible sigmoidoscopy every 5 years 1, 2
- Colonoscopy every 10 years 1, 2
- Annual FOBT/FIT plus flexible sigmoidoscopy every 5 years 1
- CT colonography every 5 years 1, 2
- Double-contrast barium enema every 5 years 1
For individuals with family history, screening begins earlier: If a first-degree relative (parent, sibling, or child) had colorectal cancer or adenomatous polyps, begin screening at age 40 instead of age 50 1. If the relative was diagnosed before age 55 (cancer) or age 60 (polyp), ensure screening occurs without delay 1.
Breast Cancer Screening
Women should begin annual mammography at age 40 and continue as long as they are in good health and would be candidates for treatment 1. Clinical breast examination should be performed every 3 years for women ages 20-39, then annually starting at age 40 1.
The decision to stop screening should be individualized based on overall health status and life expectancy, not a specific age cutoff 1. Women with life expectancy less than 5 years are unlikely to benefit from continued screening 3.
Cervical Cancer Screening
Begin screening approximately 3 years after onset of vaginal intercourse but no later than age 21 1. The screening schedule is:
- Ages 21-29: Annual screening with conventional Pap test or every 2 years with liquid-based cytology 1
- Age 30 and older: Every 2-3 years after 3 consecutive normal results 1
- Alternative for age 30+: HPV DNA testing with cytology every 3 years 1
Stop screening at age 70 if: The woman has had 3 or more consecutive normal Pap tests and no abnormal results in the preceding 10 years 1.
Do not screen women who have had total hysterectomy for benign disease 1. Women with subtotal (supracervical) hysterectomy should continue routine screening 1.
Prostate Cancer Screening
Offer annual PSA testing and digital rectal examination starting at age 50 for men with at least 10-year life expectancy, but only after shared decision-making discussion 1. This reflects the controversy around prostate screening benefits versus harms.
Begin screening at age 45 for higher-risk men: This includes men of sub-Saharan African descent and those with a first-degree relative diagnosed before age 65 1. Men with multiple first-degree relatives diagnosed before age 65 should begin at age 40 1.
Cardiovascular Disease Screening
Screen men starting at age 35 and women starting at age 45 for lipid disorders by measuring total cholesterol and HDL cholesterol 1. Screening can be performed on non-fasting samples 1.
Begin screening earlier (men age 20-35, women age 20-45) if any of the following are present 1:
- Diabetes
- Family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives
- Family history suggesting familial hyperlipidemia
- Multiple coronary heart disease risk factors (tobacco use, hypertension)
Repeat screening every 5 years for average-risk individuals, with shorter intervals for those with borderline values and longer intervals for consistently low-risk individuals 1.
Diabetes Screening
Screen for prediabetes (fasting plasma glucose 100-125 mg/dL or 2-hour OGTT 140-199 mg/dL) in adults with risk factors including obesity, family history, and sedentary lifestyle 1. Identifying prediabetes allows for lifestyle modification interventions that can prevent or delay progression to type 2 diabetes 1.
Endometrial Cancer Screening
Routine screening is not recommended for average-risk women 1. Women should be informed at menopause about risks and symptoms (unexpected bleeding or spotting) and encouraged to report these promptly 1.
Begin screening at age 35 only for women with hereditary nonpolyposis colon cancer (HNPCC) genetic mutations or strong family history 1.
Important Caveats
Obesity significantly reduces screening participation: Obese women are less likely to undergo cervical cancer screening (OR 0.73) and breast cancer screening (OR 0.71), even after accounting for other factors 4. Organized screening programs may help address these barriers 4.
Life expectancy determines screening benefit: Cancer screening provides no survival benefit unless life expectancy exceeds 5 years 3. Consider comorbidities and functional status when recommending screening in older adults 3.
Single-panel FOBT during digital rectal examination is inadequate for colorectal cancer screening due to very low sensitivity 1. Annual at-home testing with high-sensitivity FOBT or FIT is required for effectiveness 1.