As with all decisions related to your health care, it is your choice to decide whether or not to do any screenings. 

The concept of screening is to identify a condition or problem as soon as possible so that measures can be taken to improve your health, prevent further disease, and prolong valued life. Keep in mind that frequency of screening is based on normal results. If any test result is abnormal, then alternative testing and future screenings will be advised to you. 

Breast Cancer Screening

Breast cancer screening is done primarily through a mammogram which is an x-ray. The goal of a mammogram is to find and diagnose breast cancer as early as possible. This allows for early treatment before the cancer grows and spreads if possible. Mammograms detect breast cancer, they can never prevent breast cancer. The timing of mammogram screening varies depending on the group of experts asked. Most recommend beginning screening at age 40 or 50, and then every 1-2 years after that.   

United States Preventive Services Task Force (USPSTF): every 2 years beginning at 40 through age 74.

Centers for Disease Control (CDC): every 2 years beginning at age 50 through age 74; discuss with your primary care provider whether mammograms are right for you in the 40-49 years age range. 

National Cancer Institute (NCI): annually beginning at age 50.

Breastcancer.org and the National Comprehensive Cancer Network (NCCN): annually beginning at age 40.

Cervical Cancer Screening

Cervical cancer screening is done through a pelvic exam with pap smear. The pap smear is a mild scraping of the surface of the cervix and just inside the cervical opening to check for abnormal cells. Most often, the pap smear is also used to test for HPV (human papilloma virus) as this is the most common cause for abnormal cervical cells. Cervical cells can be normal, abnormal, or cancerous. Abnormal cells are called dysplastic (or dysplasia) and will be mild, moderate, or severe. Most HPV is cleared by the body’s immune system and any abnormal cells are healed.

Pap smear testing is advised as follows by the American College of Obstetrics and Gynecology, the USPSTF, and the World Health Organization (WHO): first pap smear at age 21 (regardless of when sexual activity begins), then every 3 years until 29; then at ages 30-65, obtain pap and HPV testing every 5 years or pap only every 3 years or HPV testing only every 5 years.  Pap smears end at age 65. 

Colon & Rectal Cancer Screening

Colon and rectal (colorectal) cancer screening is done through a FIT test (stool test for blood) once yearly, Cologuard (stool test for blood and DNA) every 3 years, and colonoscopy (internal scope/camera to visualize the inside of the anus, rectum, and colon) every 10 years.  If one of the stool tests is done first and is positive, then colonoscopy is advised. Otherwise, stool testing can be skipped and just colonoscopy performed. 

The timing for first screening is advised based on risk. Most average risk people (no family history of colorectal cancer) will start screening at age 45 or 50. Guidelines are as follows from the National Cancer Institute (NCI): start at age 45 or 50, and continue screening through age 75. The American Cancer Society (ACS) and USPSTF advise: start age 45, then regular intervals for ages 50-75; over age 75 consult with your health care provider. Other sources suggest no further screening past 85 years of age. 

Lung Cancer Screening

Lung cancer screening is done through a low dose Computed Tomography (CT) scan of the chest. The NCI and ACS recommend this scan annually for those aged 50-80 who are currently smoking or have quit in the previous 15 years, plus have a 20+ pack-year smoking history (1 pack daily for 20 years). 

Ovarian Cancer Screening

Routine screening for ovarian cancer is not advised.  However, if you are high risk, then a blood test called CA125 can be done as well as a pelvic ultrasound. The USPSTF defines high risk as having family history of ovarian cancer and/or breast cancer, or genetic mutations such as the BRCA1 or BRCA2 genes.

Bone Density Screening

 Bone density screening is usually done by DEXA scan which is a type of x-ray. Results are reported with a T-score of your lumbar spine and hips. T-scores of -1.0 and above are normal, -1.0 to -2.5 are bone thinning called osteopenia, -2.5 and below are osteoporosis.

This test is recommended by the USPSTF beginning at age 65 for all women no matter if there are any risk factors present. DEXA is also advised for adults that have had a “fragility fracture.” This is a broken bone due to an injury that you wouldn’t expect to break a bone, such as a fall from a standing position versus an elevated height. DEXA is also advised if someone has a condition or takes a medication that causes reduced bone mass. Two common medications used chronically that can cause reduced bone mass are stomach acid reducers (Prilosec, omeprazole, Nexium, Protonix) and corticosteroids such as prednisone.) Depending on individual factors, bone density testing can be done every 2-3 years, or may be advised every 3-5 years. 

Please talk with your primary care practitioner to discuss what screenings might be best for you and the questions you have regarding these.