What cancer screening is recommended for a 40‑year‑old woman with no personal or strong family history of cancer?

Cancer Screening Recommendations for a 40-Year-Old Woman

For an average-risk 40-year-old woman with no personal or strong family history of cancer, annual mammography screening should begin immediately, along with cervical cancer screening every 3 years with Pap testing alone or every 5 years with combined HPV/Pap co-testing. 1

Breast Cancer Screening

Begin annual mammography at age 40 and continue annually. 1

• The American Cancer Society, American College of Radiology, and multiple other major guidelines consistently recommend starting annual mammography at age 40 for average-risk women 1, 2
• Annual screening provides a 40% mortality reduction when performed regularly, with the greatest benefit achieved through annual rather than biennial intervals 2
• Women screened in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors compared to unscreened women 2
• Clinical breast examination (CBE) should be performed annually as part of periodic health examinations, ideally prior to mammography 1

Breast Self-Examination Considerations

• Breast self-examination (BSE) is optional—women may choose to perform it monthly, irregularly, or not at all 1
• Regardless of BSE practice, emphasize the importance of promptly reporting any new breast symptoms or changes to a healthcare provider 1
• Women who choose to perform BSE should receive instruction and periodic technique review 1

Cervical Cancer Screening

For women aged 21-29 years: Pap test alone every 3 years 1

For women aged 30-65 years (including this 40-year-old patient): Either HPV/Pap co-testing every 5 years (preferred) OR Pap test alone every 3 years (acceptable) 1

• Cervical cancer screening should have begun at age 21, regardless of sexual history 1
• Annual screening is explicitly not recommended at any age 1
• Screening continues until age 65 in women with adequate prior negative screening 1

Colorectal Cancer Screening

Begin colorectal cancer screening at age 45-50 years 1

• At age 40, this patient does not yet meet the age threshold for average-risk colorectal cancer screening 1
• When she reaches age 45-50, options include: annual fecal immunochemical test (FIT), colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, or CT colonography every 5 years 1

Other Cancer Screening Considerations

Endometrial Cancer

• No routine screening is recommended for average-risk women 1
• At menopause, counsel about risks and symptoms of endometrial cancer and emphasize reporting any unexpected bleeding or spotting 1

Lung Cancer

• Not applicable at age 40 unless she is a current or former smoker with at least a 30 pack-year history 1
• If she meets high-risk smoking criteria in the future (age 55-74 with ≥30 pack-year history), low-dose CT screening should be discussed 1

Cancer-Related Checkup

• During periodic health examinations, include examination for cancers of the thyroid, skin, oral cavity, and lymph nodes 1
• Provide health counseling about tobacco use, sun exposure, diet, nutrition, and other risk factors 1

Critical Pitfalls to Avoid

• Do not delay mammography screening until age 45 or 50—this results in unnecessary loss of life, particularly affecting minority women 2
• Do not use ultrasound as a primary breast cancer screening modality in average-risk women—it is not recommended and lacks evidence for this population 3
• Do not perform annual cervical cancer screening—this provides no additional benefit and increases harms 1
• Do not use single-sample fecal occult blood testing collected during digital rectal examination—this is inadequate for colorectal cancer screening 1

When to Reassess Risk Status

• Update breast cancer risk assessment every 1-2 years, particularly if family history changes (e.g., a relative is diagnosed with breast or ovarian cancer) 1
• If she develops a strong family history or other high-risk features in the future, she may require earlier or more intensive screening with breast MRI starting as early as age 25-30 4, 5
• All women should undergo formal breast cancer risk assessment by age 25-30, especially Black women and those of Ashkenazi Jewish descent 5