Approved Cancer Screening Modalities for Average-Risk Adults in the United States
The approved cancer screening tests for average-risk adults include breast cancer screening (mammography), cervical cancer screening (Pap test with or without HPV testing), colorectal cancer screening (multiple modalities including colonoscopy, FIT, and others), and lung cancer screening (low-dose CT for high-risk smokers). 1
Breast Cancer Screening
Women should begin annual mammography at age 45 years, with the option to start at age 40. 2, 1
- Women aged 45-54 years should undergo annual mammography 2
- Women aged 40-44 years may choose to begin annual screening 2, 1
- Women aged 55 years and older should transition to biennial screening or continue annually based on preference 2, 1
- Continue screening as long as overall health is good and life expectancy exceeds 10 years 2
- Clinical breast examination every 3 years for women in their 20s and 30s, then annually after age 40 2
Cervical Cancer Screening
Cervical cancer screening should begin at age 21 years regardless of sexual activity onset. 2, 1
- Women aged 21-29 years: Pap test alone every 3 years (HPV testing should NOT be used in this age group) 2, 1
- Women aged 30-65 years: HPV test plus Pap test (co-testing) every 5 years (preferred) OR Pap test alone every 3 years (acceptable) 2, 1
- Discontinue screening after age 65 years if 3 consecutive negative Pap tests OR 2 consecutive negative co-tests within the prior 10 years, with the most recent test within 5 years 2, 1
- Women who have had total hysterectomy (with cervix removal) and no history of cervical cancer should stop screening 2
Colorectal Cancer Screening
Average-risk adults should begin colorectal cancer screening at age 45 years using either stool-based tests or structural examinations. 2, 1
First-Tier Screening Options:
Second-Tier Screening Options:
- High-sensitivity guaiac-based fecal occult blood test (gFOBT) annually 2
- Multitarget stool DNA test (e.g., Cologuard) every 3 years 2, 3
- CT colonography every 5 years 2, 3
- Flexible sigmoidoscopy every 5 years 2, 3
Age-Specific Recommendations:
- Continue screening through age 75 years for adults in good health with life expectancy >10 years 2
- Ages 76-85 years: individualize decisions based on health status, prior screening history, and life expectancy 2
- Discourage screening after age 85 years 2
Critical caveat: All positive non-colonoscopy screening tests MUST be followed up with diagnostic colonoscopy to complete the screening process. 2
Lung Cancer Screening
Low-dose helical CT (LDCT) is approved for high-risk adults, not average-risk individuals. 2
- Current or former smokers (quit within past 15 years) aged 55-74 years 2
- Must have at least 30 pack-year smoking history 2
- Must be in good health to benefit from screening 2
Prostate Cancer Screening
Prostate cancer screening with PSA and digital rectal examination is available but requires shared decision-making due to uncertain benefit-harm balance. 2, 1
- Offer PSA test and DRE annually starting at age 50 years for men with life expectancy ≥10 years 2
- The American Cancer Society recommends screening for men aged 55-69 years based on shared decision-making 1
- Discuss potential benefits and harms before initiating screening 1
Common Pitfalls to Avoid
- Never use single-panel gFOBT collected during digital rectal examination - this has very low sensitivity and is not an acceptable screening method 2
- Do not use FIT as a diagnostic test in symptomatic patients - rectal bleeding, weight loss, or bowel habit changes require immediate diagnostic colonoscopy regardless of FIT results 3
- Never rely on standard screening protocols for high-risk patients - those with family history, genetic syndromes, or inflammatory bowel disease require more intensive surveillance 2
- Do not screen women under age 21 for cervical cancer regardless of sexual activity 2
- Avoid annual cervical cancer screening at any age - it provides no additional benefit and increases harms 2