Chronological History of ACS Recommendations for the Early Detection of Cancer in Asymptomatic People
The following tables give the history of cancer detection tests that have been recommended by the American Cancer Society for people who are at average risk for cancer (unless otherwise specified) and do not have any specific symptoms.
People who are at increased risk for certain cancers may need to follow a different testing schedule, such as starting at an earlier age or being tested more often. Those with symptoms that could be related to cancer should see their doctor right away.
This is not meant to be an official document for American Cancer Society recommendations.
Breast cancer (women)
Dates |
Test |
Age |
Frequency |
|
Pre 1980 |
Breast self-exam (BSE) |
Start during high school years |
Monthly |
Clinical breast exam (CBE) |
Over 20 |
"Periodically" | |
|
Mammogram |
35 - 39 |
Only if personal history of breast cancer | |
|
40 - 49 |
May have mammogram if they or their mother or sisters had breast cancer | ||
Over 50 |
May have mammograms yearly | ||
|
1980 - 1982 |
Breast self-exam (BSE) |
Start during high school years |
Monthly |
Clinical breast exam (CBE) |
20 - 39 |
Every 3 years | |
Over 40 |
Yearly | ||
|
Mammogram |
35 - 39 |
Baseline mammogram | |
40 - 49 |
Consult personal physician | ||
Over 50 |
Yearly | ||
|
1983 - 1991 |
Breast self-exam (BSE) |
Over 20 |
Monthly |
Clinical breast exam (CBE) |
20 - 39 |
Every 3 years | |
Over 40 |
Yearly | ||
|
Mammogram |
35 - 39 |
Baseline mammogram | |
40 - 49 |
Every 1-2 years | ||
Over 50 |
Yearly | ||
|
1992 - |
Breast self-exam (BSE) |
Over 20 |
Monthly |
Clinical breast exam (CBE) |
20 - 39 |
Every 3 years | |
Over 40 |
Yearly | ||
Mammogram |
40 - 49 |
Every 1-2 years | |
Over 50 |
Yearly | ||
|
March 1997 - May 2003 |
Breast self-exam (BSE) |
Over 20 |
Monthly |
Clinical breast exam (CBE) |
20 - 39 |
Every 3 years | |
Over 40 |
Yearly | ||
Mammogram |
Over 40 |
Yearly | |
|
May 2003 - Present*,** |
Breast self-exam (BSE) |
Over 20 |
Optional. Women should be told about benefits and limitations of BSE. They should report any new symptoms to their health care professional. |
|
Clinical breast exam (CBE) |
20 - 39 |
Part of a periodic health exam, preferably every 3 years | |
Over 40 |
Part of a periodic health exam, preferably every year | ||
|
Mammogram |
Over 40 |
Yearly, continuing for as long as a woman is in good health |
*May 2003 - May 2007: Women at increased risk (family history, genetic tendency, past breast cancer) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (breast ultrasound, MRI), or having more frequent exams.
**May 2007 - Present: Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.
Cervical cancer (women)
Dates |
Test |
Age |
Frequency |
Pre 1980 |
Pap test |
Not specified |
As part of a regular check-up |
|
1980 - 1987 |
Pap test |
Over 20; under 20 if sexually active |
Yearly, but after 2 negative exams 1 year apart, at least every 3 years |
Pelvic exam |
20 – 39 |
Every 3 years | |
Over 40 |
Yearly | ||
|
1987 - 2002 |
Pap test |
18 & over or sexually active |
Yearly, but after 3 consecutive normal exams, less frequently at the discretion of the doctor |
Pelvic exam |
18 & over or sexually active |
Yearly | |
|
2003 - 2012 |
Pap test |
Start 3 years after first vaginal intercourse but no later than 21 |
Yearly with conventional Pap test or every 2 years with liquid-based Pap test |
|
Over 30 |
After 3 normal results in a row, screening can be every 2 to 3 years. An alternative is a Pap test plus HPV DNA testing every 3 years.* | ||
|
Over 70 |
After 3 normal Pap tests in a row within the past 10 years, women may choose to stop screening** | ||
Pelvic exam |
Not specified |
Discuss with health care provider | |
|
2012 – present1 |
Pap test |
21 - 29 |
Every 3 years* |
Pap test plus HPV DNA test |
30 - 65 |
Every 5 years* An alternative is screening with a Pap test alone every 3 years* | |
Over 65 |
A woman should stop screening unless she had a serious cervical pre-cancer or cancer in the last 20 years |
*Doctors may suggest a woman be screened more often if she has certain risk factors, such as a history of DES exposure, HIV infection, or a weak immune system
**Women with a history of cervical cancer, DES (diethylstilbestrol) exposure, or who have a weak immune system should continue screening as long as they are in reasonably good health
1. These guidelines are not meant to apply to women who have been diagnosed with cervical cancer. These women should have follow-up testing as recommended by their healthcare team.
Colon and rectum cancer (men & women)
Dates |
Test |
Age |
Frequency |
Pre 1980 |
Proctosigmoidoscopy |
Over 40 |
As part of a regular check-up |
|
1980 - 1989 |
Digital rectal exam (DRE) |
Over 40 |
Yearly |
Fecal occult blood test (FOBT) |
Over 50 |
Yearly | |
Proctosigmoidoscopy |
Over 50 |
After 2 normal exams 1 year apart, every 3 to 5 years | |
|
1989 - 1997 |
Digital rectal exam (DRE) |
Over 40 |
Yearly |
Fecal occult blood test (FOBT) |
Over 50 |
Yearly | |
Sigmoidoscopy (preferably flexible) |
Over 50 |
Every 3 to 5 years, based on advice of physician | |
|
1997 - 2001 |
Follow 1 of these 3 schedules*: | ||
Fecal occult blood test AND Flexible sigmoidoscopy |
Over 50 |
Yearly Every 5 years | |
Colonoscopy |
Over 50 |
Every 10 years | |
Double-contrast barium enema (DCBE) |
Over 50 |
Every 5 to 10 years | |
|
2001 - March 2008 |
Follow 1 of these 5 schedules*: | ||
Fecal occult blood test (FOBT)** or Fecal immunochemical test1 (FIT)*** |
Over 50 |
Yearly | |
Flexible sigmoidoscopy*** |
Over 50 |
Every 5 years | |
FOBT** or FIT1 AND Flexible sigmoidoscopy*** |
Over 50 |
Yearly Every 5 years | |
Colonoscopy |
Over 50 |
Every 10 years | |
Double-contrast barium enema (DCBE) |
Over 50 |
Every 5 years | |
|
March 2008 - Present |
Follow one of these schedules (for those at average risk of colorectal cancer)2: | ||
Flexible sigmoidoscopy3 |
Over 50 |
Every 5 years | |
Colonoscopy |
Over 50 |
Every 10 years | |
Double-contrast barium enema (DCBE)3 |
Over 50 |
Every 5 years | |
CT colonography (virtual colonoscopy)3 |
Over 50 |
Every 5 years | |
Fecal occult blood test (FOBT)**,3 |
Over 50 |
Yearly | |
Fecal immunochemical test (FIT)3 |
Over 50 |
Yearly | |
Stool DNA test3 |
Over 50 |
Interval uncertain | |
*A digital rectal exam should be done at the same time as sigmoidoscopy, colonoscopy, or DCBE.
**For FOBT or FIT, the take-home multiple sample method should be used. A FOBT or FIT done during a digital rectal exam in the doctor's office is not adequate for screening.
***Yearly FOBT or FIT plus flexible sigmoidoscopy every 5 years is preferred over either option alone.
1The fecal immunochemical test (FIT) was adopted as part of the ACS guidelines in 2003.
2The first 4 tests (flexible sigmoidoscopy, colonoscopy, DCBE, and CT colonography) are designed to find both early cancer and polyps. The last 3 tests (FOBT, FIT, and Stool DNA test) will primarily find cancer and not polyps. The first 4 tests are preferred if they are available to you and you are willing to have one of these more invasive tests. Note that people with certain genetic disorders or family history of colorectal cancer may be at higher than average risk and should speak to their doctors about start screening at a younger age.
3If test results are positive, colonoscopy should be done.
Endometrial cancer (women) -- see also cervical cancer
Dates |
Test |
Age/Risk |
Frequency |
|
Pre 1980 |
Pap test |
Not specified |
As part of a regular check-up |
Pelvic exam |
At menopause |
Not specified | |
Endometrial tissue sample |
At menopause (only in those at high risk*) |
Not specified | |
|
1980 - 1987 |
Pap test |
Over 20; under 20 if sexually active |
Yearly, but after 2 negative exams 1 year apart, at least every 3 years |
Pelvic exam |
Over 40 |
Yearly | |
Endometrial tissue sample |
At menopause (only in those at high risk*) |
Not specified | |
|
1987 - 1992 |
(Pap test recommendations were separated out as screening for cervical cancer - see above.) | ||
Pelvic exam |
Over 40 |
Yearly | |
Endometrial tissue sample |
At menopause (only in those at high risk*) |
Not specified | |
|
1992 - 2001 |
Pelvic exam |
Over 40 |
Yearly |
Endometrial tissue sample |
At menopause (only in those at high risk*) |
At the discretion of the physician | |
|
2001 - Present |
At menopause (average risk) |
Women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctor | |
|
At menopause (increased risk**) |
Women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctor. They should also be informed about the potential benefits, risks, and limitations of early endometrial cancer detection. | ||
|
Endometrial biopsy |
By age 35 (high risk***) |
Should be offered yearly. Women should also be informed about the risks and symptoms of endometrial cancer, and about the potential benefits, risks, and limitations of early endometrial cancer detection. | |
*High risk was defined as having a history of infertility, obesity, failure of ovulation, abnormal uterine bleeding, or use of estrogen therapy or tamoxifen.
**Increased risk was defined as a history of estrogen therapy or tamoxifen, late menopause, having no children, infertility or failure to ovulate, obesity, diabetes, or high blood pressure.
***High risk was defined as women with or at risk for hereditary non-polyposis colorectal cancer (HNPCC) due to a known or suspected gene mutation.
Lung cancer (men & women)
Dates |
Test |
Age |
Frequency |
|
Pre 1980 |
Chest x-ray |
Not specified |
Supported use of chest x-ray for those in whom lung cancer is most often found (heavy smokers, asbestos workers, etc.) |
1980 - Present |
None |
Not specified |
No recommendation |
Prostate cancer (men)
Dates |
Test |
Age/Risk |
Frequency |
1980 - 1992 |
No specific recommendation |
(see “Cancer-related check-up (men & women)” table) |
Part of the cancer-related check-up |
|
1992 - 1997 |
Digital rectal exam (DRE) |
Over 40 |
Yearly |
Prostate-specific antigen (PSA) blood test |
Over 50 |
Yearly | |
|
1997 - 2000 |
Digital rectal exam (DRE) and prostate-specific antigen (PSA) blood test |
Over 50 (Earlier, i.e. 45, for men at high risk*) |
Should be offered yearly (along with information on potential risks & benefits) to men with at least a 10-year life expectancy |
|
2001 - 2008 |
Digital rectal exam (DRE) and prostate-specific antigen (PSA) blood test |
Over 50 (average risk) |
Should be offered yearly (along with information on potential risks & benefits) to men with at least a 10-year life expectancy |
Over 45 (high risk**) |
Yearly (along with information on potential risks & benefits)*** | ||
|
2009 - 2010+ |
Health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing and offer the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE). If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test). |
Over 50 (average risk) Over 45 (high risk**) |
Discussion and offer of testing should be done yearly for men with at least a 10-year life expectancy Discussion and offer of testing should be done yearly*** |
|
2010-present |
Men should have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. After the discussion about screening, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening. |
50 and over (average risk) |
Discussion at age 50 for men with at least a 10-year life expectancy and then periodically. If PSA is 2.5 ng/ml or greater, testing should be repeated yearly. Men with a PSA of less than 2.5 ng/ml may be tested every other year. |
|
45 and over (high risk**) |
Discussion at age 45 for men with at least a 10-year life expectancy and then periodically. If PSA is 2.5 ng/ml or greater, testing should be repeated yearly. Men with a PSA of less than 2.5 ng/ml may be tested every other year.**** |
*High risk defined as African-American men or those with a strong family history - that is, those with 2 or more affected first-degree relatives (father, brothers).
**High risk defined as African-American men or those with a strong family history of 1 or more first-degree relatives (father, brother, son) diagnosed at an early age (younger than 65).
***Men at even higher risk, due to several close relatives affected at an early age, should have this discussion with their health care professional at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.
**** Men at even higher risk, due to several close relatives affected at an early age, should have this discussion with their health care professional at age 40. If PSA is 2.5 ng/ml or greater, testing should be repeated yearly. Men with a PSA of less than 2.5 ng/ml may be tested every other year.
+NOTE: This represents a language clarification, not a change in the guidelines, as the previous language was often misinterpreted.
Cancer-related check-up (men & women)
Dates |
Test |
Age |
Frequency |
Pre 1980 |
Physical exam |
Not specified |
"Regularly" |
1980 - 2002 |
Physical exam* and health counseling |
20-39 |
Every 3 years |
Over 40 |
Yearly | ||
2003 - Present |
Physical exam** and health counseling*** |
Over 20 |
On the occasion of a periodic health exam |
*Should include examinations for cancers of the thyroid, testicles, mouth, ovaries, skin, prostate, and lymph nodes.
** Should include examinations for cancers of the thyroid, testicles, mouth, ovaries, skin, and lymph nodes.
***Should include counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures.
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