Routine cancer screenings for older adults: Mammograms, colonoscopies, PSA tests, and more

If you’ve diligently undergone cancer screening tests for years, or perhaps decades, you might assume they should continue indefinitely — but that’s not typically the case.

Most cancer screening guidelines recommend an upper age limit to cease testing, but “plenty of people get diagnosed with cancer when screenings end, so I think some people are surprised and confused when they’re told to stop,” says Timothy Rebbeck, a professor of cancer prevention at Harvard-affiliated Dana-Farber Cancer Institute.

What is cancer screening?

Cancer screening uses various tests to detect cancer before symptoms appear. The goal is to catch it early, when it’s easier to treat. But as we age, screening is no longer one-size-fits-all, Rebbeck says, because the balance of benefits versus harms can shift.

Screening can lead to overdiagnosis — finding cancers that would never advance enough to cause symptoms — as well as unnecessary treatment, which can lead to dangerous complications. Treatment side effects can also outweigh any benefits.

Which cancer screenings do older adults need?

Below is a breakdown of common cancer screenings and age recommendations for people at average risk for cancer. Take a look at the guidelines about each, then talk to your doctor. Your overall health and life expectancy — not just your age — are key factors in deciding to continue cancer screenings beyond the recommended cutoffs. “It’s tricky, because everyone is different,” Rebbeck says.

Colon cancer screening. The American Cancer Society (ACS) and other major health organizations recommend screening for colorectal cancer in adults beginning at age 45 and continuing until age 75. People ages 76 to 85 should ask their clinician whether it makes sense to continue screening. Those older than 85, or with a life expectancy of fewer than 10 years, should not continue routine screening.

The gold standard screening method is a colonoscopy: a doctor examines your entire colon. This usually requires sedation and is done in a hospital or surgical center. It’s recommended every 10 years for people at average risk for colorectal cancer, or more often if the risk for cancer is higher. Other acceptable screening tests include an annual fecal immunochemical test that uses antibodies to detect hidden blood in the stool; a stool DNA test that looks for both blood and genetic markers from cancer cells; and a blood test (called Shield) that detects tumor DNA fragments.

Breast cancer screening. Major health organizations’ mammogram screening guidelines differ considerably. The U.S. Preventive Services Task Force (USPSTF), which bases its recommendations on the strength of research results, says regular screening mammograms for women at average risk of breast cancer should stop after age 74. The ACS recommends mammograms continue if an older woman is in good health and expected to live another 10 years or more, while the American College of Radiology advocates for individualized decision-making, with no firm end to screening.

Cervical cancer screening. The American College of Obstetricians and Gynecologists (ACOG) and other major health organizations recommend cervical cancer screening with Pap smears alone from ages 21 to 29. Starting at age 30 until age 65, the preferred screening strategy is a primary human papillomavirus (HPV) test or a combined HPV and Pap test every five years. Another option is a Pap test alone every three years. After 65, screening isn’t needed if tests were normal in the preceding 10 years.

Other cancer screening tests

Some screenings are not recommended routinely but may be important depending on your cancer risk.

Lung cancer screening. The American Lung Association recommends low-dose CT to detect early signs of lung cancer for people ages 50 to 80 who have, in their lifetime, smoked a pack per day for 20 years (or an equivalent total over a shorter or longer period) and who have smoked within the past 15 years.

Skin cancer screening. The USPSTF says there’s not enough evidence to recommend regular visual skin exams by a doctor to screen for skin cancer, and that screenings increase the risk for unnecessary biopsies, overdiagnosis, and overtreatment. People with an increased risk for melanoma, the deadliest form of skin cancer, should undergo an annual total-body skin exam with a dermatologist, according to the American Academy of Dermatology.

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