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Cancer Screening
If you can’t prevent cancer, the next best thing is to catch it early. You do that by getting the recommended screening for your age and other demographics. If you get a colonoscopy, for example, doctors can remove a polyp before it even becomes cancer. Or if you get your regular mammogram and they find cancer in the early stages, then it’s easier to cure it. There are Pap smear tests for cervical cancer, and CT scans to look for lung cancer in previous or current smokers. The earlier you catch something, the more likely you are to cure it. In the years I have been treating cancer patients, I have seen screening become much more sensitive and much more specific.
Richard Schulick, MD, MBA, Director, University of Colorado Cancer Center
What is cancer screening?
The goal of cancer screening is to help people live longer and better. Cancer screening is used to find cancer in its early stages, before symptoms appear. Cancers that are detected early generally have the greatest chance for successful treatment or cure. By the time cancer symptoms are present, the disease may have grown and spread to other parts of the body, making it more difficult to treat or cure.
Screening tests do not usually diagnose cancer, but if results from a test are abnormal, this lets a clinician know that further tests to check for cancer might be needed. There is no need to worry if a clinician recommends cancer screening. They recommend screening based on criteria for who might benefit.
Who should receive screening?
Different cancer screening is recommended depending on a person’s age, sex, family history, and smoking history. Also, certain gene mutations have been linked to cancer, as has exposure to cancer-causing agents.
The following cancer screenings are recommended for those at average risk for cancer. It is important to discuss cancer screening with a clinician because some cancer screenings are used more commonly for people who have certain risk factors. Other screenings are recommended for people of certain ages.
What types of cancer screening are recommended?
The guidance presented here is sourced from highly trusted authorities, including the National Comprehensive Cancer Network, the American Cancer Society, and the United States Preventive Services Task Force. Additionally, it includes information on what Centers for Medicare & Medicaid Services (CMS) and Health First Colorado (Colorado's Medicaid program) will cover for care. The CU Cancer Center recommends consulting with your health care provider and insurance company to determine the most suitable approach for your individual needs.
How can I determine if I am at a high risk?
High risk for cancer can be influenced by various factors, including family history, age, lifestyle, and certain medical conditions. If you're concerned about your risk, it's essential to consult with a health care professional who can assess your individual situation.
Here are some factors that might contribute to an increased risk of cancer:
- Family History: If you have close relatives (parents, siblings) who have had cancer, it could indicate a higher risk.
- Genetics: Some people inherit genetic mutations that increase their susceptibility to certain types of cancer.
- Age: The risk of cancer generally increases with age.
- Lifestyle Choices: Factors like smoking, poor diet, lack of physical activity, and excessive sun exposure can contribute to a higher risk.
- Medical History: Certain pre-existing conditions or previous cancer diagnoses may increase your risk.
It's crucial to have regular check-ups with your health care provider, discuss your family history, and undergo appropriate screenings based on your age and risk factors. They can provide personalized advice and guidance tailored to your specific situation.
Screening guidelines for specific types of cancer
Breast Cancer
A mammogram is the most common breast cancer screening tool. This is an X-ray of the breast. For women at high risk or who have dense breast tissue, a magnetic resonance imaging (MRI) scan may be used along with a mammogram.
Screening guidelines from national organizations
| Organization | Recommendations |
| National Comprehensive Cancer Network | Beginning at age 40, women at average breast cancer risk should discuss mammograms with their clinician and be offered the choice of having them annually. For individuals identified as high risk, it is advisable to explore available options through consultation with a health care provider. |
| United States Preventive Services Task Force | Beginning at age 40, women at average breast cancer risk should discuss mammograms with their clinician and be offered the choice of having them every other year. |
| American Cancer Society | Between the ages of 40–44, women with an average risk of breast cancer should be given the option to undergo annual mammograms following a discussion with their health care provider. Commencing at the age of 45, women with an average risk of breast cancer are advised to undergo annual mammograms. Upon reaching 55, the frequency of mammograms can be modified to biennial intervals after discussing with one's health care provider. |
Screening covered by Medicare
| Organization | Coverage offered |
| Centers for Medicare & Medicaid Services | For women between age 35 and 39 with an average risk of breast cancer, one mammogram is covered to set a baseline. At age 40, CMS will cover one mammogram per year. |
Health First Colorado (Colorado’s Medicaid Program) | From the age of 40 onward, women with an average risk of breast cancer may undergo annual mammograms with coverage. |
Colorectal Cancer
Multiple screening tests are available for colorectal cancer. One of the most prevalent is a colonoscopy, where a physician utilizes a scope to inspect the interior of the colon. Given the various screening options for colorectal cancer, it is advisable to talk with your clinician to determine the most suitable test for your specific situation.
Article: Colonoscopy vs. Stool-Based Tests: What is the Best Way to Detect Colorectal Cancer?
Screening guidelines from national organizations
| Organization | Recommendations |
| National Comprehensive Cancer Network | Beginning at age 45, it is advisable to engage in an annual discussion with your health care provider regarding colon screening. For individuals deemed high- risk, it is recommended to thoroughly explore and discuss all available screening options. |
| United States Preventive Services Task Force | From age 45–75, it is advisable to engage in an annual discussion with your health care provider regarding colon screening. |
| American Cancer Society | Individuals with an average risk should undergo annual colon screenings starting at the age of 45. |
Screening covered by Medicare
| Organization | Coverage offered |
| Centers for Medicare & Medicaid Services | At age 45, CMS provides coverage for an annual colon screening for individuals at average risk. If you are identified as high risk, it is advised to explore available options through consultation with your CMS representative. |
Health First Colorado (Colorado’s Medicaid Program) | Between the ages of 45 and 75, it is advisable to undergo an annual colon screening covered by insurance. For individuals aged 76 to 85, it is recommended to talk with your health care provider to assess the necessity of a colon screening. Beyond the age of 85, colon screenings are no longer covered. |
Cervical Cancer
The recommended screening tests for cervical cancer are human papillomavirus (HPV) tests and Pap tests, which a clinician may recommend separately or in combination. Regardless of the test, it is important to test regularly. Even if you have been vaccinated against HPV, it is still important to discuss cervical cancer screening with your clinician.
Screening guidelines from national organizations
| Organization | Recommendations |
| National Comprehensive Cancer Network | Currently, there is no specific recommendation available. |
| United States Preventive Services Task Force | Between the ages of 21 and 29, it is advisable to undergo testing every three years. Subsequently, from ages 30 to 65, the recommended frequency decreases to every five years. |
| American Cancer Society | Between the ages of 25 and 65, it is advisable to undergo testing every five years. Following age 65, annual testing is not deemed necessary if the preceding 10 years have been characterized by good health. |
Screening covered by Medicare
| Organization | Coverage offered |
| Centers for Medicare & Medicaid Services | At present, there is no designated coverage accessible. |
Health First Colorado (Colorado’s Medicaid Program) | Testing is covered at five-year intervals for individuals aged 30 to 65. |
Lung Cancer
Ask your clinician about annual low-dose CT scans to screen for early lung cancer. Screening may benefit you if you are a current or past smoker.
Article: What are Pack Years? (learn the meaning of this term used in lung cancer diagnosis and treatment)
Screening guidelines from national organizations
| Organization | Recommendations |
| National Comprehensive Cancer Network | For individuals aged 50 and above with a history of smoking totaling at least 20 pack-years, annual screening is strongly advised. |
| United States Preventive Services Task Force | Individuals aged 50 and older with a history of smoking amounting to at least 20 pack-years, and/or who ceased smoking within the last 15 years, are strongly recommended to undergo annual screening. |
| American Cancer Society | For individuals aged 50 to 80 with a history of smoking totaling at least 20 pack-years, annual screening is strongly advised. |
Screening covered by Medicare
| Organization | Coverage offered |
| Centers for Medicare & Medicaid Services | Individuals between the ages of 50 and 77, particularly those with a history of smoking equivalent to at least 20 pack-years and/or those who quit smoking within the last 15 years, are eligible for annual screening. |
Health First Colorado (Colorado’s Medicaid Program) | At present, there is no designated coverage accessible. |
Prostate Cancer
This screening may involve a digital rectal exam or a prostate-specific antigen blood test.
Screening guidelines from national organizations
| Organization | Recommendations |
| National Comprehensive Cancer Network | Men at average risk should initiate a discussion with their clinician about prostate cancer screenings starting at the age of 50. However, Black men and those with a family history of prostate cancer, who are at an elevated risk, are advised to undergo screenings starting at the age of 40. |
| United States Preventive Services Task Force | Between the ages of 55 and 69, men at average risk should engage in a dialogue with their health care provider regarding prostate cancer screenings. Beyond the age of 70, prostate cancer screenings are no longer advised. |
| American Cancer Society | Men at average risk are encouraged to talk with their health care provider regarding prostate cancer screenings at the age of 50. For Black men, it is advisable to initiate discussions with their doctor about screenings at the age of 45. Those with a family history of prostate cancer, indicating an elevated risk, are recommended to undergo screenings starting at the age of 40. |
Screening covered by Medicare
| Organization | Coverage offered |
| Centers for Medicare & Medicaid Services | From the age of 50 onward, men with an average risk profile are eligible for annual screenings, with coverage provided on a yearly basis. |
Health First Colorado (Colorado’s Medicaid Program) | From the age of 50 onward, men with an average risk profile are eligible for annual screenings, with coverage provided on a yearly basis. |
What other types of cancer screening may be available?
In addition to the cancer screening tests listed above, there are additional cancer screening tests that might be of interest. It is important to note that the data supporting recommendations for these preventative screenings is not conclusive, and as such, firm recommendations cannot be made.
Skin Cancer & Melanoma
Starting at age 18, ask your clinician about receiving an annual total body skin exam. For certain individuals, the option of mole mapping may prove beneficial. This involves periodic photographs taken by a physician to document any skin changes observed over time.
Head & Neck Cancer
Ask your clinician regarding screenings for cancers affecting the head, neck, mouth, throat, thyroid, and sinuses. Additionally, prioritize regular dental checkups, as they play a crucial role in screening for head and neck cancer.
Endometrial Cancer
The American Cancer Society recommends that, upon reaching menopause, women should receive comprehensive information regarding the risks and symptoms associated with endometrial cancer. This aims to heighten awareness and promote proactive measures for early detection and prevention.
What are some questions to ask your physician about screening?
Individuals vary in terms of their histories, risk factors, and specific concerns regarding cancer. Engaging in open conversations with your primary care clinician is crucial to addressing your unique needs. You may also contemplate inquiring about:
- What cancer screening tests are recommended for people like me?
- How often should I be screened for cancer?
- Can you perform the screening tests, or do I need to schedule an appointment with a specialist?
- If you recommend a certain screening test, do I need to schedule it right away?
- Should I be worried if I missed one of the screening tests that is recommended annually?
- Where can I get screened?
- Are there any screening tests I can do at home?
- What happens during the screening test?
- How might I benefit from this type of cancer screening?
- What risks are associated with the screening test?
- How long until I receive my screening test results?
- How will I receive the results of my screening test?
- Do I need to schedule an appointment with you to discuss my results?
- How much do these screening tests cost?
- Where can I get screening tests if I do not have insurance, or if my insurance does not cover the test?
- What are the risks if I put off the screening test?
- What happens if my test results are not normal?
- What if I am not ready to start screening yet?