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History of ACS Recommendations for the Early Detection of Cancer in People Without 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. These recommendations have changed over time as new tests have become available and as more evidence for or against the value of some of these tests has emerged.

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

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 - October 2015*,**

                                                                                                                                                    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

                                                                                                                                                                          October 2015 - present**,***

                                                                                                                                                                          Mammogram

                                                                                                                                                                            40 - 44

                                                                                                                                                                              Women in this age group should have the choice to start annual screening with mammograms if they wish to do so. The risks of screening as well as the potential benefits should be considered.

                                                                                                                                                                                45 - 54

                                                                                                                                                                                  Yearly

                                                                                                                                                                                    55 and over

                                                                                                                                                                                      Every 2 years; women should also have the chance to continue yearly screening if they choose to. Screening mammograms should continue as long as a woman is in good health and is expected to live at least 10 more years.

                                                                                                                                                                                        *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.
                                                                                                                                                                                        *** All women should be familiar with the known benefits, limitations, and potential harms associated with breast cancer screening.
                                                                                                                                                                                         

                                                                                                                                                                                        Cervical cancer

                                                                                                                                                                                        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 - 20201

                                                                                                                                                                                                                                                        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

                                                                                                                                                                                                                                                                        2020 - present2 Primary HPV test- (preferred) 25 - 65

                                                                                                                                                                                                                                                                        Every 5 years*

                                                                                                                                                                                                                                                                        Alternatives include:

                                                                                                                                                                                                                                                                        A Co-test (Pap test plus HPV test) every 5 years*

                                                                                                                                                                                                                                                                        OR

                                                                                                                                                                                                                                                                        A Pap test alone every 3 years*

                                                                                                                                                                                                                                                                            Over 65

                                                                                                                                                                                                                                                                        Screening should stop if regular screening tests have been normal the past 10 years and there is no history of serious cervical pre-cancer or cancer in the last 25 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.
                                                                                                                                                                                                                                                                        2. These guidelines are not meant to apply to women who have been diagnosed with cervical cancer or pre-cancer. These women should have follow-up testing as recommended by their healthcare team.

                                                                                                                                                                                                                                                                        Colon and rectum (colorectal) cancer

                                                                                                                                                                                                                                                                        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 – May 2018

                                                                                                                                                                                                                                                                        Follow one of these schedules2:

                                                                                                                                                                                                                                                                        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

                                                                                                                                                                                                                                                                        Guaiac-based fecal occult blood test (FOBT)**,3

                                                                                                                                                                                                                                                                        50 and over

                                                                                                                                                                                                                                                                        Yearly

                                                                                                                                                                                                                                                                        Fecal immunochemical test (FIT)**,3

                                                                                                                                                                                                                                                                        50 and over

                                                                                                                                                                                                                                                                        Yearly

                                                                                                                                                                                                                                                                        Stool DNA test3

                                                                                                                                                                                                                                                                        50 and over

                                                                                                                                                                                                                                                                        Every 3 years4

                                                                                                                                                                                                                                                                        June 2018 - present

                                                                                                                                                                                                                                                                        Get screened regularly between ages 45 and 75, as long as you are in good health.
                                                                                                                                                                                                                                                                        People ages 76 to 85 should talk with their health care provider about whether to continue screening.
                                                                                                                                                                                                                                                                        People over 85 should no longer be screened.
                                                                                                                                                                                                                                                                        Screening can be done with any of these tests/schedules:

                                                                                                                                                                                                                                                                        Fecal immunochemical test (FIT)**,3

                                                                                                                                                                                                                                                                        See above

                                                                                                                                                                                                                                                                        Yearly

                                                                                                                                                                                                                                                                        Guaiac-based fecal occult blood test (gFOBT)**,3

                                                                                                                                                                                                                                                                        See above

                                                                                                                                                                                                                                                                        Yearly

                                                                                                                                                                                                                                                                        Stool DNA test3

                                                                                                                                                                                                                                                                        See above

                                                                                                                                                                                                                                                                        Every 3 years

                                                                                                                                                                                                                                                                        Colonoscopy

                                                                                                                                                                                                                                                                        See above

                                                                                                                                                                                                                                                                        Every 10 years

                                                                                                                                                                                                                                                                        CT colonography (virtual colonoscopy)3

                                                                                                                                                                                                                                                                        See above

                                                                                                                                                                                                                                                                        Every 5 years

                                                                                                                                                                                                                                                                        Flexible sigmoidoscopy3

                                                                                                                                                                                                                                                                        See above

                                                                                                                                                                                                                                                                        Every 5 years

                                                                                                                                                                                                                                                                        *A digital rectal exam should be done at the same time as sigmoidoscopy, colonoscopy, or DCBE.
                                                                                                                                                                                                                                                                        **For FOBT or FIT, highly-sensitive versions of the tests should be used with the take-home multiple sample method. 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.

                                                                                                                                                                                                                                                                        1 The fecal immunochemical test (FIT) was adopted as part of the ACS guidelines in 2003.
                                                                                                                                                                                                                                                                        2 The 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.
                                                                                                                                                                                                                                                                        3 If test results are positive (abnormal), colonoscopy should be done.
                                                                                                                                                                                                                                                                        4  The 3-year interval was specified in 2014. When the guidelines were published in 2008, the interval was not specified.

                                                                                                                                                                                                                                                                        Endometrial cancer -- 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

                                                                                                                                                                                                                                                                                                                                                              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 - May 2018

                                                                                                                                                                                                                                                                                                                                                                                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.

                                                                                                                                                                                                                                                                                                                                                                                    June 2018 - October 2023

                                                                                                                                                                                                                                                                                                                                                                                      Low-dose CT of the chest

                                                                                                                                                                                                                                                                                                                                                                                        55 to 74 years (in certain individuals)

                                                                                                                                                                                                                                                                                                                                                                                          The ACS recommends annual screening in adults ages 55 to 74 years in fairly good health* who: currently smoke or have quit within the past 15 years; have at least a 30-pack-year smoking history**; get counseling about quitting smoking (for current smokers); have discussed with their doctor the potential benefits, limits, and harms of screening; and have access to a center experienced in lung cancer screening and treatment.

                                                                                                                                                                                                                                                                                                                                                                                            November 2023 Low-dose CT of the chest 50 to 80 years (in certain individuals)

                                                                                                                                                                                                                                                                                                                                                                                            The ACS recommends yearly lung cancer screening with a low-dose CT (LDCT) scan for people who are aged 50 to 80 years and who smoke or used to smoke AND have at least a 20 pack-year history of smoking (A pack-year is equal to smoking 1 pack or about 20 cigarettes per day for a year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years, or by smoking 2 packs a day for 10 years.) Before deciding to be screened, people should discuss with their healthcare provider the purpose of screening, how it is done, and the benefits, limits, and possible harms of screening. People who still smoke should be counseled about quitting and offered resources to help them quit.

                                                                                                                                                                                                                                                                                                                                                                                             

                                                                                                                                                                                                                                                                                                                                                                                            *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 15 years.
                                                                                                                                                                                                                                                                                                                                                                                            +NOTE: This represents a language clarification, not a change in the guidelines, as the previous language was often misinterpreted.
                                                                                                                                                                                                                                                                                                                                                                                             
                                                                                                                                                                                                                                                                                                                                                                                             

                                                                                                                                                                                                                                                                                                                                                                                            Prostate cancer

                                                                                                                                                                                                                                                                                                                                                                                            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.

                                                                                                                                                                                                                                                                                                                                                                                                                                                           

                                                                                                                                                                                                                                                                                                                                                                                                                                                          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 - 2015

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                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.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      The American Cancer Society medical and editorial content team

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Last Revised: August 27, 2021

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