What cancer screening tests are recommended for a patient with no specific medical history or demographic information?

Cancer Screening Tests for Average-Risk Adults

For an average-risk adult with no specific medical history, begin colorectal cancer screening at age 50 with one of several acceptable options, and consider age-appropriate breast, cervical, and prostate cancer screening based on sex and shared decision-making. 1

Colorectal Cancer Screening (Starting Age 50)

All average-risk adults should begin colorectal cancer screening at age 50 and continue through age 75. 1, 2 The following options are equally acceptable, with no single test ranked as superior:

Screening Options

• Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT) using a home kit 1
• Flexible sigmoidoscopy every 5 years 1
• Annual FOBT/FIT plus flexible sigmoidoscopy every 5 years (this combination is more accurate than either test alone) 1
• Colonoscopy every 10 years 1
• Double-contrast barium enema every 5 years 1
• CT colonography every 5 years 3

Critical Considerations

Digital rectal examination (DRE) should be performed at the time of sigmoidoscopy or colonoscopy. 1 The choice among screening methods should maximize patient adherence, as approximately one-third of eligible U.S. adults have never been screened for colorectal cancer. 1

For adults aged 76-85 years, screening decisions should be individualized based on overall health, prior screening history, and life expectancy, with screening most appropriate for those healthy enough to undergo treatment if cancer is detected. 1

Breast Cancer Screening (Women)

Women aged 50-70 years should undergo clinical breast examination and mammography every 1-2 years. 4 The specific interval depends on individual risk factors and should be discussed with the clinician.

Cervical Cancer Screening (Women)

Pap smear screening should be performed every 1-3 years in women of appropriate age. 4 The exact interval depends on age, prior screening results, and risk factors.

Prostate Cancer Screening (Men)

For men aged 55-69 years, PSA-based screening should be an individual decision after discussing potential benefits and harms with their clinician. 5 Screening may prevent approximately 1.3 deaths per 1000 men screened over 13 years, but carries risks of false-positives, overdiagnosis, and treatment complications including erectile dysfunction (67% of men) and urinary incontinence (20% of men after radical prostatectomy). 5

Men aged 70 years and older should NOT undergo PSA-based screening, as harms outweigh benefits in this age group. 5

Special Considerations for Prostate Screening

• African American men and men with family history of prostate cancer have increased risk and should discuss screening earlier. 5
• Clinicians should not screen men who do not express a preference for screening after informed discussion. 5

Lung Cancer Screening

Annual low-dose CT (LDCT) screening is recommended for adults aged 55-80 years with ≥30 pack-year smoking history who currently smoke or quit within the past 15 years. 6 This screening should only be performed in conjunction with smoking cessation interventions due to high false-positive rates and potential radiation harms. 6

Endometrial Cancer Screening

Routine screening for endometrial cancer is NOT recommended in average-risk women, as it is neither cost-effective nor warranted. 1

Lung Cancer Screening (Non-Smokers)

Routine screening for lung cancer is NOT recommended in average-risk individuals without significant smoking history. 1, 4

Cancer-Related Health Maintenance

During periodic health examinations, cancer-related checkups should include health counseling (particularly smoking cessation) and age-appropriate examinations for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries. 1

Common Pitfalls to Avoid

• Do not delay colorectal cancer screening past age 50 in average-risk individuals, as this is the second leading cause of cancer death in the United States. 1, 2
• Do not assume all screening tests are harmless—every screening test carries potential harms including false-positives, overdiagnosis, and treatment complications. 7
• Do not screen for prostate cancer without informed discussion of the balance between small mortality benefit and substantial treatment-related harms. 5
• Do not continue colorectal cancer screening past age 75 unless the patient has never been screened and is healthy enough for treatment. 1