Cancer Screening in Older Adults

Cancer screening guidelines for older adults are increasingly recommending individualized decision-making rather than relying on age cutoffs. This is in large part due to the individual complexity of aging, such as functional differences, risks of diagnostic procedures, remaining life expectancy, perceived quality of life, and goals of care. The US Preventive Services Task Force (USPSTF) recommends screening for breast cancer until 74 years of age, whereas the American Cancer Society suggests screening as long as the patient is in good health or has a life expectancy of at least 10 years. The USPSTF recommends that men 55 to 69 years of age discuss the potential benefits and harms of prostate-specific antigen screening with their doctor before making an individual decision; for men 70 years and older, the USPSTF and the American Urological Association do not recommend routine screening. Most guidelines recommend that cervical cancer screening should stop at 65 years of age in patients who have adequate prior screening results and do not have high risk. The USPSTF and the American Cancer Society recommend routine colorectal cancer screening until 75 years of age, after which individualized screening can occur based on shared decision-making until 85 years of age. Guidelines recommend lung cancer screening for patients who are 50 to 80 years of age, have at least a 20-pack-year smoking history, and are able and willing to have curative surgery.