This page was reviewed under our medical and editorial policy by
Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix
This page was reviewed on March 17, 2023.
Breast self-exams, Pap smears, PSA screenings, genetic tests, colonoscopies—everywhere you turn, it seems, new recommendations are coming out about screening tests for various cancers. The information overload and sometimes-contradicting guidelines have many people confused: Should I get screened? If so, why, when and how often? The answers aren’t simple, or always black and white, but knowing which screenings are recommended for which cancers, and understanding your risks, is the first step in making sense of the confusion—and arming yourself with information you need to know about catching cancer early, when more options are more likely available to treat it, or prevent it altogether.
Given all the talk about cancer prevention these days, it may surprise you to know that screening tests have been developed for some but not all cancers, and a variety of considerations must be weighed by both doctor and patient when determining whether screening for a particular cancer type is warranted. Risk factors such as lifestyle habits, family history, comorbidities (other serious medical conditions, such as diabetes or heart disease) and environmental exposures all play pivotal roles in the decision-making process.
Cancer screenings are of increasing importance, with the number of new cancer diagnoses remaining largely unchanged but with a slightly downward trend in recent years, according to the National Cancer Institute (NCI). The American Cancer Society (ACS) expects a little more than 2 million (2,001,140) new cases of cancer to be diagnosed in 2024. At the same time, more and more people are surviving longer with cancer. The ACS reports that the five-year relative survival rate for all cancers has increased dramatically since the early 1960s—improving from 39 percent to 69 percent among white people, and from 27 percent to 65 percent among Black people. Cancer-related deaths also continue to drop steadily, according to the ACS. The rate of death from cancer for both men and women fell 33 percent from its peak in 1991 to 2021, the most recent year for which data is available. This means that nearly 4.1 million fewer people died from cancer during these years than would have been expected had the death rate not fallen. Experts attribute the improved outcomes to treatment advances, prevention awareness efforts and screenings designed to detect cancer in the early stages (when interventions tend to have the most impact).
So which cancers should you be screened for, and when? It depends. Below is your guide to the three R’s of cancer screenings—risk factors, recommendations and rationale—by cancer type. We’ve compiled a list based on the recommendations of the leading cancer organizations—the American Cancer Society (ACS), the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetricians and Gynecologists (ACOG) and the Society of Gynecologic Oncology (SGO). Namely, the guide will cover the three R's for:
If you're interested in scheduling a cancer screening at City of Hope, or it you believe you have symptoms of cancer and want to schedule an appointment for a diagnostic evaluation, call us or chat online with a member of our team.
Risk factors: When it comes to breast cancer, women are typically categorized as high-, moderate- or low-risk (the last category representing most women).
Recommendations and screening tests: The leading cancer organizations differ on breast cancer screening guidelines.
Rationale: The ACS now recommends against breast exams, either performed routinely by a doctor or as a self-exam, instead urging women to know how their breasts normally look and feel and to report any breast changes to their health care provider. But many experts encourage women to perform breast self-exams frequently enough to be able to detect changes.
For healthy women with no family history of breast cancer, City of Hope experts recommend beginning annual mammograms between ages 40 and 45 and continuing until age 70, then getting the tests every other year. Women should also get a 3D mammogram when possible because it provides a clearer picture, especially of dense breasts.
Breast MRI screening is typically reserved for “very high-risk women” who carry inherited gene mutations, such as BRCA1, BRCA2 or Li–Fraumeni Syndrome. In those cases, women should get both an annual mammogram and MRI, spaced six months apart. Women of Ashkenazi Jewish heritage who have no family history of breast cancer and are not carriers of a BRCA mutation should follow the same screening guidelines for women of average risk. We strongly recommend these women undergo genetic testing since Ashkenazi Jewish women are at an increased risk of having a BRCA mutation.
The most important recommendation here is if a woman has a family history of breast cancer, she should have her first mammogram 10 years before the youngest age at which breast cancer was diagnosed in her family.
GI cancers affect the tissue and organs in the digestive system, which starts at the mouth and ends at the anus. Guidelines on screenings and risk factors have been developed for several GI cancers: colorectal, esophageal, liver, and pancreatic.
Risk factors: Your risk of developing colorectal cancer increases with:
Recommendations and screening tests: Colorectal screening guidelines vary according to risk:
Note: In October 2020, the USPSTF recommended lowering the age to begin colorectal cancer screenings from 50 to 45. In doing so, the USPSTF, an independent body of medical experts tasked with making evidence-based recommendations about preventative clinical services, joined the American Cancer Society (ACS), which since 2018 has recommended starting screenings at age 45.
Rationale: Colorectal cancer—cancer of the colon and/or rectum—is the third most commonly diagnosed cancer in the United States, but in many instances, colorectal cancer may be prevented with regular screenings. “Colonoscopy is the gold standard for screening, followed by Cologuard® (an FDA-approved stool sample kit) or CT colonography,” says Pankaj Vashi, MD, Chair of the Department of Medicine at City of Hope Atlanta, Chicago and Phoenix.
The goal of a cancer screening is to identify cancer at an early stage, or as with some colonoscopies, to prevent it altogether by detecting and removing pre-cancerous cells. During a colonoscopy, doctors may remove polyps, which if left intact, may later develop into cancer.
Risk factors: Those with a higher risk of esophageal cancer are:
Recommendation and screening tests: The ACS recommends high-risk patients have a regular upper endoscopy, which uses a thin tube to view the lining of the esophagus, stomach and duodenum.
Rationale: A key study on risk factors, screening and endoscopic treatment in Western and Eastern countries concluded that patients whose esophageal cancer was detected during endoscopic surveillance for Barrett’s esophagus “are more likely to have early-stage cancer, receive curative therapy, and survive longer” than patients who are not diagnosed until they have symptoms.
Risk factors: You are considered high risk for liver cancer if you:
Recommendation and screening tests: The ACS recommends screening only for those at highest risk, defined as patients with cirrhosis or chronic hepatitis B infection. Those patients should have a liver ultrasound and alpha-fetoprotein tumor marker (AFP) blood test performed every six to 12 months.
Rationale: Screening has been linked to improved survival rates in some studies.
Risk factors: Your risk increases for pancreatic cancer with:
Recommendation and screening tests: Only people considered high risk—defined by the ACS as those with a strong family history of pancreatic cancer or a known genetic syndrome that increases the risk—are candidates for endoscopic ultrasound or MRI screening.
Rationale: Endoscopic ultrasound has identified “early, treatable pancreatic cancers in some members of high-risk families,” according to the ACS. Dr. Vashi also recommends that patients who meet all the risk factors undergo CT scans.
The risk factors and recommendations for cervical, ovarian, endometrial (uterine), vaginal and vulvar cancers vary widely by cancer type. However, some gynecologic cancers are caused by human papillomavirus (HPV) infections, which are sexually transmitted. The HPV vaccine, approved in 2006, is designed to protect against cervical, vulvar and vaginal cancers, as well as several other non-gynecologic cancers.
The Pap smear, a routine cervical swab performed in the doctor’s office, is “one of the most reliable and effective cancer screening tests available,” according to the ACS. Before the test’s introduction in the 1950s, cervical cancer was the “No. 1 cause of all cancer deaths in women,” says Julian Schink, MD, Gynecologic Oncologist at City of Hope Phoenix. “The Pap smear has been remarkably successful in the developed world, not just to prevent cervical cancer but for interventions before you get cancer. In the United States today, the biggest risk of cervical cancer is lack of screening.”
Risk factors: Your risk of developing cervical cancer increases if you have a history of:
Recommendations and screening tests: The USPSTF recommends:
Rationale: “The Pap smear is really the prototype of screening tests because cervical dysplasia is a precancerous condition that women have if they have a persistent HPV infection,” says Dr. Schink. The combination of the HPV vaccine and the Pap smear has significantly decreased the rate of cervical cancer, according to the CDC.
Endometrial cancer is a form of uterine cancer that develops in the lining of the uterus. It accounts for more than 95 percent of uterine cancers.
Risk factors: The risk for developing endometrial cancer increases for women who meet any of the following criteria:
Recommendation and screening tests: Currently, there is no standard or routine screening recommendation for endometrial cancer when there are no symptoms. Screening tests for endometrial cancer are being studied.
The NCI recommends that women with abnormal vaginal bleeding have tests to check for cancer, such as:
Pap tests may sometimes detect abnormalities in the endometrium during routine testing, but it’s mostly an incidental finding that’s followed up with further testing.
Additionally, the ACS advises women who have (or may have) hereditary non-polyposis colon cancer (HNPCC, or Lynch syndrome) to consider yearly testing for endometrial cancer with endometrial biopsy starting at age 35. The NCI says that for those with, or possible risk of, HNPCC, yearly screening with transvaginal ultrasound may begin as early as 25.
Risk factors: The risk for ovarian cancer is higher in women who:
Recommendation and screening tests: No reliable test has been developed to screen for ovarian cancer, but for women with an inherited gene mutation, the American Society of Clinical Oncology (ASCO) recommends discussing with your health care provider ways to reduce your risk, including:
Risk factors: Your risk for vaginal and/or vulvar cancer increases if you have had:
Recommendations and screening tests: The National Cancer Institute recommends the two-dose HPV vaccine series for:
Rationale: The HPV vaccine provides protection against the deadly HPV subtypes 16 and 18. Some HPV vaccines also protect against other HPV subtypes, such as those that cause anal and genital warts. Getting the vaccine before being exposed to the virus is key. The vaccine cannot treat HPV once you become infected.
Risk factors: The risk for developing lung cancer is categorized as high, moderate and low.
While exposure to second-hand smoke is currently not included in the screening guidelines, passive smoking, also known as second-hand smoke, increases the risk of lung cancer., according to the National Cancer Institute, which notes that "living with a smoker increases a nonsmoker's chances of developing lung cancer by 20 to 30 percent" and that some 3,000 nonsmokers die each year "as a result of exposure to secondhand smoke."
Recommendations and screening tests: The USPSTF recommends low-dose CT scans for:
In addition to the official lung cancer screening recommendations, City of Hope experts recommend that if a nodule is found, low-dose CT scans should continue yearly, twice yearly or quarterly, depending on the size. Once the nodule is 1.5 cm or larger, it should be removed.
Rationale: Low-dose CT scans are used to detect nodules, or nodes, which are abnormal growths in the lung tissue. Preliminary diagnostic scans may help detect lung cancer in its early stages, instead of waiting until symptoms develop, which typically occurs when the disease has already progressed to advanced stages.
Risk factors: Risk for prostate cancer increases among men who:
Recommendation and screening tests: The ACS recommends that all men discuss with their doctor the risks and benefits of screening, including prostate specific antigen (PSA) blood tests and/or a digital rectal exam (DRE). These screening discussions should begin at age 50 for men at average risk who are expected to live at least 10 more years. Men at high risk—African Americans and men with a first-degree relative diagnosed with prostate cancer before age 65—should start these conversations at age 45. Those at an even higher risk—men with more than one first-degree relative who had prostate cancer at an early age—should initiate those talks even earlier, at age 40.
Rationale: Until 2012, a PSA test and a DRE had long been the standards in screening for prostate cancer, performed on men 40 and older. But on the heels of three large studies, the USPSTF concluded that screening was not warranted because the potential harms—false-positives, biopsy complications and over-diagnosis in 20 percent to 50 percent of men with clinically insignificant disease—outweighed the benefits. Over-diagnosis results in unnecessary treatment. Patients who undergo radiation therapy or surgery are at higher risk of chronic urinary issues and erectile dysfunction, and they may be at risk of a secondary cancer later in life, says Scott Shelfo, MD, Medical Director of Urology at our hospital near Atlanta. “It may not be an issue of over-screening, but an issue of over-treating," Dr. Shelfo says. "It's important to identify patients who are at the highest risk for prostate cancer and focus on treating those patients."
It’s important to gather your family history and share the information with your doctors, says Eric Fowler, MS, LGC, Manager of Genetics Counseling at our hospital near Chicago. Clues that there may be an inherited risk for cancer in a family include:
“If any of the above family history criteria are met, I recommend seeing a licensed genetic counselor. A genetic counselor may help you understand how your personal and family history may impact cancer risks, help you measure your chances of an inherited risk in a family, and provide comprehensive information about genetic testing,” says Fowler.
When you come to City of Hope for cancer screenings—for breast, colorectal or lung cancer—you'll have access to tests that may help increase the accuracy of the screening tools provided. Our team has expertise with these tests and procedures, allowing us to work quickly and efficiently.
If you’re diagnosed with cancer, a multidisciplinary team of experts—which depending on your cancer type may include a medical oncologist, surgical oncologist, radiation oncologist and disease-specific experts such as a breast surgeon or a urologic oncologist—will review your case and develop a personalized plan based on your specific circumstances and needs.
We only treat cancer at City of Hope, which means our cancer experts are skilled at assessing risk associated with each person’s circumstances. We give you the pros and cons of the treatment options available to you, allowing you time to talk with your team of doctors and other experts about those options.
If you choose to receive treatment with us, you may benefit from our integrative approach to cancer treatment. Our multidisciplinary team works together to help prevent and manage the side effects of cancer and its treatment, providing supportive care services, such as:
Regular screenings are critical to reducing your cancer risk, allowing you to prevent cancer when possible, in the case of cervical cancer with the Pap smear or colorectal cancer with colonoscopies, or to help catch the disease in its earlier stages, when it is easier to treat. No matter where you get your screenings, make them a regular part of your wellness plan and keep your calendar up to date with reminders, if necessary.
If you're interested in scheduling a cancer screening at City of Hope, or it you believe you have symptoms of cancer and want to schedule an appointment for a diagnostic evaluation, call us or chat online with a member of our team.
