Cancer Screening: ACS Annual Summary of Recommendations

Breast Cancer

Breast cancer is the most common cancer in women living in the United States, with an estimated 266,120 patients diagnosed with invasive breast cancer in 2018 and an associated 40,920 deaths. The ACS screening recommendations in women at average risk were updated in 2015 and have not changed. This guideline underscores the importance of yearly screening in women 45 to 54 years of age and those 40 to 44 years who choose earlier screening, because evidence has shown that such screening in premenopausal women is associated with a significantly decreased risk of identifying advanced breast cancer compared with screening performed every other year. Postmenopausal women do not have similar benefits associated with yearly screening, unless they are currently receiving hormone treatment for menopause; therefore, women 55 years or older can receive screening every other year or yearly, depending on patient preference. An age to stop screening is not identified, but continued screening may be beneficial in certain women 75 years or older, taking into account mortality, age, comorbidities, and function. These recommendations were made after a review of the burden of disease and of the benefits and harms of screening. An update to the 2007 screening recommendations in women at greater than average risk is currently being completed.

Table 1. American Cancer Society Recommendations for the Early Detection of Cancer in Average-Risk Asymptomatic Adults*
Cancer site	Population	Test or procedure	Recommendations
Breast	Women 40 to 54 years of age	Mammography	Should be routinely performed starting at 45 years of age and should be performed annually in women 45 to 54 years of age Should have the opportunity to begin annual screening between 40 and 44 years of age
Women 55 years or older	Should transition to biennial screening or have the opportunity to continue screening annually Mammography should be continued as long as the woman's overall health is good and she has a life expectancy of at least 10 years
Cervix	Women 21 to 29 years of age	Pap smear	Should be performed starting at 21 years of age and should be performed using conventional or liquid-based options every three years
Women 30 to 65 years of age	Pap smear and HPV DNA test	Combined testing (preferred) should be performed every five years, or a Pap smear alone (acceptable) should be performed every three years (acceptable)
Women older than 65 years	Pap smear and HPV DNA test	Screening should no longer be performed in women older than 65 years who have had at least three consecutive Pap smears with negative results or at least two consecutive HPV tests with negative results and Pap smears within the past 10 years, with the most recent test being performed in the past five years
Women who have had a total hysterectomy	—	Screening should no longer be performed
Colorectal	Men and women 45 to 75 years of age, for all tests listed	Fecal immunochemical test (annual), high-sensitivity guaiac-based fecal occult blood test (annual), multitarget stool DNA test (every three years per manufacturer's recommendation), colonoscopy (every 10 years), CT colonography (every five years), or flexible sigmoidoscopy (every five years)	Regular screening should be performed with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability; as part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy Screening should be continued until 75 years of age in patients in good health with a life expectancy of more than 10 years
Men and women 76 to 85 years of age	—	Screening decisions should be individualized, based on patient preference, life expectancy, health status, and screening history; if a decision is made to continue screening, the patient should be offered options as listed above
Men and women older than 85 years	—	Should be discouraged from continuing screening
Endometrial	Women, at menopause	—	Should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians
Lung	Current or former smokers 55 to 74 years of age in good health with at least a 30-pack-year history of smoking	Low-dose helical CT	Should be performed annually in adults who currently smoke or have quit within the past 15 years, and who have at least a 30-pack-year smoking history; receive evidence-based smoking cessation counseling (if they are current smokers); have undergone a process of informed or shared decision-making that included information about the potential benefits, limitations, and harms of screening with low-dose CT; and have access to a high-volume, high-quality lung cancer screening and treatment center
Prostate	Men 50 years or older	Prostate-specific antigen test with or without digital rectal examination	Men who have a life expectancy of at least 10 years should have an opportunity to make an informed decision with their health care professional about whether to be screened after receiving information about the potential benefits, risks, and uncertainties associated with screening; should not occur without an informed decision-making process

Table 1. American Cancer Society Recommendations for the Early Detection of Cancer in Average-Risk Asymptomatic Adults*

Cancer site

Population

Test or procedure

Recommendations

Breast

Women 40 to 54 years of age

Mammography

Should be routinely performed starting at 45 years of age and should be performed annually in women 45 to 54 years of age Should have the opportunity to begin annual screening between 40 and 44 years of age

Women 55 years or older

Should transition to biennial screening or have the opportunity to continue screening annually Mammography should be continued as long as the woman's overall health is good and she has a life expectancy of at least 10 years

Cervix

Women 21 to 29 years of age

Pap smear

Should be performed starting at 21 years of age and should be performed using conventional or liquid-based options every three years

Women 30 to 65 years of age

Pap smear and HPV DNA test

Combined testing (preferred) should be performed every five years, or a Pap smear alone (acceptable) should be performed every three years (acceptable)

Women older than 65 years

Pap smear and HPV DNA test

Screening should no longer be performed in women older than 65 years who have had at least three consecutive Pap smears with negative results or at least two consecutive HPV tests with negative results and Pap smears within the past 10 years, with the most recent test being performed in the past five years

Women who have had a total hysterectomy

—

Screening should no longer be performed

Colorectal

Men and women 45 to 75 years of age, for all tests listed

Fecal immunochemical test (annual), high-sensitivity guaiac-based fecal occult blood test (annual), multitarget stool DNA test (every three years per manufacturer's recommendation), colonoscopy (every 10 years), CT colonography (every five years), or flexible sigmoidoscopy (every five years)

Regular screening should be performed with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability; as part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy Screening should be continued until 75 years of age in patients in good health with a life expectancy of more than 10 years

Men and women 76 to 85 years of age

—

Screening decisions should be individualized, based on patient preference, life expectancy, health status, and screening history; if a decision is made to continue screening, the patient should be offered options as listed above

Men and women older than 85 years

—

Should be discouraged from continuing screening

Endometrial

Women, at menopause

—

Should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physicians

Lung

Current or former smokers 55 to 74 years of age in good health with at least a 30-pack-year history of smoking

Low-dose helical CT

Should be performed annually in adults who currently smoke or have quit within the past 15 years, and who have at least a 30-pack-year smoking history; receive evidence-based smoking cessation counseling (if they are current smokers); have undergone a process of informed or shared decision-making that included information about the potential benefits, limitations, and harms of screening with low-dose CT; and have access to a high-volume, high-quality lung cancer screening and treatment center

Prostate

Men 50 years or older

Prostate-specific antigen test with or without digital rectal examination

Men who have a life expectancy of at least 10 years should have an opportunity to make an informed decision with their health care professional about whether to be screened after receiving information about the potential benefits, risks, and uncertainties associated with screening; should not occur without an informed decision-making process

Cancer Screening: ACS Releases Annual Summary of Recommendations

Breast Cancer

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