Practice Guidelines

Cancer Screening: ACS Releases Annual Summary of Recommendations


Am Fam Physician. 2019 Jun 1;99(11):719-722.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• The ACS recommends yearly screening for breast cancer in women 45 to 54 years of age and those 40 to 44 years of age who choose earlier screening.

• Women with atypical squamous cells of undetermined significance on cervical cancer screening that were found to be negative for HPV should have repeat screening in three years.

• Physicians should initiate discussions on prostate cancer with those at average risk starting at 50 years of age, at 45 years with higher risk, and at 40 years in those at even higher risk.

From the AFP Editors

The American Cancer Society (ACS) provides a summary of recommendations for cancer screening (Table 1) each year, including any updates and recent data, and advice for when recommendations cannot be made. In addition to this summary, the 2018 report outlines issues that affect screening for breast, cervical, colorectal, and prostate cancer; further explains the 2013 recommendations for lung cancer screening via low-dose computed tomography; compares the ACS recommendations with those of other professional health care organizations; and provides information from the National Health Interview Survey.

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

Cancer sitePopulationTest or procedureRecommendations


Women 40 to 54 years of age


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


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


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


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


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


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 s

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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