Suggested recommendations for routine cancer screening

Cervical cancer

Cervical cancer screening should begin at age 25 (2020 American Cancer Society Cervical Cancer Screening Guidelines). Primary human papillomavirus (HPV) testing every 5 years through age 65 is preferred. If primary HPV testing is not available, individuals aged 25 to 65 should be screened with co-testing (HPV testing in combination with cytology) every 5 years or cytology alone every 3 years. Testing intervals after abnormal results are determined based on risk of cervical intraepithelial neoplasia (CIN) 3 or invasive cancer (see 2019 ASCCP Risk Based Management Guidelines). Individuals with any of the following risk factors may require more frequent cervical cytology:

• 1.

  Individuals who are immunosuppressed

• 2.

  Individuals who are infected with human immunodeficiency virus (HIV)

• 3.

  Individuals who were exposed to diethylstilbestrol in utero

• 4.

  Individuals diagnosed with high-risk HPV or who were previously treated for CIN 2, 3 or cancer

Individuals who have had a total hysterectomy for benign indications without a history of high-grade CIN2 or more in the past 25 years can discontinue routine screening.

It is reasonable to discontinue cervical cancer screening in individuals older than age 65 who have had adequate negative screening in the 10 years prior (two consecutive negative primary HPV tests, two negative co-tests, or three negative cytology tests) and who have no history of CIN 2 or more within the past 25 years.

Individuals who have been vaccinated against HPV-16 and HPV-18 should follow age-specific screening recommendations.

Breast cancer

Individuals should be offered a clinical breast examination every 1 to 3 years from age 25 to 39. Beginning at age 40, clinical breast examinations should be offered annually. Mammography should be performed every year for average risk individuals starting at age 40 through age 75. Continued screening with mammography beyond age 75 is a decision that should be based on individual risk and a shared decision-making process between the patient and their provider. Average risk individuals can be screened with conventional mammography or with digital breast tomosynthesis (commonly known as three-dimensional mammography). Benefits of tomosynthesis include decreased call-backs for follow up testing and increased cancer detection rates compared to conventional mammography alone. Potential harms of tomosynthesis include increased radiation exposure and an unknown increased risk of overdiagnosis. For individuals with dense breasts, adjunctive screening with breast ultrasound or magnetic resonance imaging (MRI) may be recommended in addition to mammography. There are currently no clinical practice guidelines with recommendations for adjunctive screening in individuals identified to have dense breasts on an otherwise negative screening mammogram.

Individuals who are at high risk for breast cancer should have a breast MRI and mammogram each year, typically starting at age 30. This includes individuals with a lifetime breast cancer risk of 20%–25% according to risk assessment tools, have a known gene mutation that increases the risk of breast cancer (ex BRCA1 or BRCA2), have a first-degree relative with such a gene mutation (and have not been tested themselves), have had radiation therapy to the chest between the ages of 10 and 30 years, have a diagnosis of Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have a first-degree relative with one of these syndromes.