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Chronological History of ACS Recommendations for the Early Detection of Cancer in People Without Cancer Symptoms

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)

    20 and over

    "Periodically"

    Mammogram
    (starting in 1976)

    35 - 39

    Only if personal history of breast cancer

    40 - 49

    May have mammogram if they or their mother or sisters had breast cancer

    50 and over

    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

    40 and over

    Yearly

    Mammogram

    35 - 39

    Baseline mammogram

    40 - 49

    Consult personal physician

    50 and over

    Yearly

    1983 - 1991

    Breast self-exam (BSE)

    20 and over

    Monthly

    Clinical breast exam (CBE)

    20 - 39

    Every 3 years

    40 and over

    Yearly

    Mammogram

    35 - 39

    Baseline mammogram

    40 - 49

    Every 1-2 years

    50 and over

    Yearly

    1992 -
    March 1997

    Breast self-exam (BSE)

    20 and over

    Monthly

    Clinical breast exam (CBE)

    20 - 39

    Every 3 years

    40 and over

    Yearly

    Mammogram

    40 - 49

    Every 1-2 years

    50 and over

    Yearly

    March 1997 - May 2003

    Breast self-exam (BSE)

    20 and over

    Monthly

    Clinical breast exam (CBE)

    20 - 39

    Every 3 years

    40 and over

    Yearly

    Mammogram

    40 and over

    Yearly

    May 2003 - present*,**

    Breast self-exam (BSE)

    20 and over

    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

    40 and over

    Part of a periodic health exam, preferably every year

    Mammogram

    40 and over

    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 based on certain factors should get an MRI and a mammogram every year. This includes women with about a 20% or greater risk using risk assessment tools based mainly on family history, women who had radiation therapy to the chest when they were between the ages of 10 and 30 years, and women who either have or who are at high risk for mutations in certain genes that greatly increase their breast cancer risk.

Cervical cancer (women)

Dates

Test

Age

Frequency

 

    Pre 1980

    Pap test

    Not specified

    As part of a regular check-up

    1980 - 1987

    Pap test

    20 and over; 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

    40 and over

    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

    30 and over

    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.*

    70 and over

    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

    40 and over

    As part of a regular check-up

    1980 - 1989

    Digital rectal exam (DRE)

    40 and over

    Yearly

    Fecal occult blood test (FOBT)

    50 and over

    Yearly

    Proctosigmoidoscopy

    50 and over

    After 2 normal exams 1 year apart, every 3 to 5 years

    1989 - 1997

    Digital rectal exam (DRE)

    40 and over

    Yearly

    Fecal occult blood test (FOBT)

    50 and over

    Yearly

    Sigmoidoscopy (preferably flexible)

    50 and over

    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

    50 and over

    Yearly

    Every 5 years

    Colonoscopy

    50 and over

    Every 10 years

    Double-contrast barium enema (DCBE)

    50 and over

    Every 5 to 10 years

    2001 -

    March 2008

    Follow 1 of these 5 schedules*:

    Fecal occult blood test

    (FOBT)** or

    Fecal immunochemical test1 (FIT)***

    50 and over

    Yearly

    Flexible sigmoidoscopy***

    50 and over

    Every 5 years

    FOBT** or FIT1

    AND

    Flexible sigmoidoscopy***

    50 and over

    Yearly

    Every 5 years

    Colonoscopy

    50 and over

    Every 10 years

    Double-contrast barium enema (DCBE)

    50 and over

    Every 5 years

    March 2008 - present

    Follow one of these schedules (for those at average risk of colorectal cancer)2:

    Flexible sigmoidoscopy3

    50 and over

    Every 5 years

    Colonoscopy

    50 and over

    Every 10 years

    Double-contrast barium enema (DCBE)3

    50 and over

    Every 5 years

    CT colonography (virtual colonoscopy)3

    50 and over

    Every 5 years

    Fecal occult blood test (FOBT)**,3

    50 and over

    Yearly

    Fecal immunochemical test (FIT)3

    50 and over

    Yearly

    Stool DNA test4

    50 and over

    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.
4This test was an option in the guidelines published in 2008, but is no longer available.

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

    20 and over; under 20 if sexually active

    Yearly, but after 2 negative exams 1 year apart, at least every 3 years

    Pelvic exam

    40 and over

    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

    40 and over

    Yearly

    Endometrial tissue sample

    At menopause (only in those at high risk*)

    Not specified

    1992 - 2001

    Pelvic exam

    40 and over

    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

    35 and over

    (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 - 2013

    None

    Not specified

    No recommendation

    2013 - present

    Low-dose CT of the chest

    55 to 74 years (in certain individuals)

    Doctors should discuss the benefits, limitations, and potential harms of lung cancer screening with patients who are in fairly good health*, in the correct age range, have at least a 30 pack-year history of smoking**, and are still smoking or have quit within the last 15 years. If patients decide to go forward with screening, they should have low-dose CT of the chest yearly through age 74 as long as they remain in good health.

*fairly good health was defined as not requiring home oxygen therapy, having other serious medical problems that would shorten their lives or keep them from having surgery, and having metal implants in the chest (such as pacemakers or spinal rods) that would interfere with the CT images.
**Pack-years is the number of packs of cigarettes smoked per day multiplied by the number of years smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 10 years and then a pack a day for another 10 years.

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)

    40 and over

    Yearly

    Prostate-specific antigen (PSA) blood test

    50 and over

    Yearly

    1997 - 2000

    Digital rectal exam (DRE) and prostate-specific antigen (PSA) blood test

    50 and over

    (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

    50 and over (average risk)

    Should be offered yearly (along with information on potential risks & benefits) to men with at least a 10-year life expectancy

    45 and over

    (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).

    50 and over (average risk)

    45 and over

    (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

    40 and over

    Yearly

    2003 - present

    Physical exam** and health counseling***

    20 and over

    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.

Last Medical Review: 02/28/2014
Last Revised: 02/28/2014