Cancer Screening for Longevity: The Evidence-Based Guide to What to Get and When
Cancer screening can find some cancers earlier, when treatment works better, but every test also brings false alarms and the risk of treating cancers that would never have caused harm. US cancer death rates kept falling through 2021, helped by less smoking, earlier detection of some cancers and better treatment.1 This guide sets out what the US Preventive Services Task Force (USPSTF) recommends, what the trials behind those recommendations found, and where newer blood tests stand.
- In people at high risk, low-dose CT cut lung cancer deaths by 20% compared with chest X-rays, although 96% of positive scans were false alarms.7
- The USPSTF recommends colorectal screening from 45 to 75, mammography every two years from 40 to 74, cervical screening from 21 to 65, and yearly low-dose CT from 50 to 80 for people with a 20 pack-year smoking history who smoke now or quit within 15 years.8,3,9,6
- Multi-cancer blood tests are still being evaluated: in the PATHFINDER study, 1.4% of adults tested had a positive result, 38% of those turned out to have cancer, and false alarms took a median of 162 days to resolve.5
- For men aged 55 to 69, PSA screening is an individual decision: it may prevent about 1.3 prostate cancer deaths per 1,000 men screened over 13 years, but treatment can cause lasting incontinence and erectile dysfunction.4
- Prevention matters as much as screening: in a Swedish population study, HPV vaccination before age 17 was linked to an 88% lower risk of invasive cervical cancer.10
US cancer death rates have fallen for three decades, but incidence is rising for 6 of the 10 most common cancers, and colorectal cancer is now the leading cause of cancer death in men under 50 and the second in women under 50.1
Evidence-Based Screening: USPSTF Grade A and B Recommendations
Colorectal cancer: The USPSTF recommends screening for all adults aged 50 to 75 and for adults aged 45 to 49, and selective screening from 76 to 85 depending on health and past screening.8 In the NordICC trial, adults aged 55 to 64 who were invited to a single screening colonoscopy had an 18% lower risk of colorectal cancer over 10 years than those who were not invited (0.98% versus 1.20%). The reduction in colorectal cancer deaths (0.28% versus 0.31%) was not statistically significant, and only 42% of those invited had the colonoscopy.2
Lung cancer: The USPSTF recommends yearly low-dose CT for adults aged 50 to 80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years, stopping once someone has not smoked for 15 years or develops a health problem that limits life expectancy.6 In the National Lung Screening Trial, 53,454 people at high risk were screened three times with low-dose CT or chest X-rays. CT reduced lung cancer deaths by 20% and deaths from any cause by 6.7%, but 96.4% of positive CT results were false positives.7
Breast cancer: The USPSTF recommends mammography every two years for women aged 40 to 74. It found the evidence insufficient to judge screening after 75, and insufficient to judge extra ultrasound or MRI for women with dense breasts.3 Women at higher risk, for example because of a BRCA mutation or a strong family history, should discuss their own screening plan with a clinician.
Cervical cancer: The USPSTF recommends a Pap test every three years from 21 to 29. From 30 to 65, the options are a Pap test every three years, high-risk HPV testing every five years, or both together every five years. A draft update released in December 2024 would make HPV testing every five years the preferred option from 30 to 65 and allow women to collect their own sample; it had not been finalized as of October 2026 (USPSTF draft). It recommends against screening before 21, after 65 for women with adequate prior screening who are not at high risk, and after a hysterectomy that removed the cervix for reasons other than precancer or cancer.9 In a Swedish study of 1.7 million girls and women, HPV vaccination before 17 was associated with an 88% lower risk of invasive cervical cancer.10
The PSA Conversation
PSA testing for prostate cancer is a personal decision. The USPSTF's 2018 recommendation, which updated its 2012 guidance, says that for men aged 55 to 69 the net benefit is small for some men: screening may prevent about 1.3 prostate cancer deaths and 3 cases of metastatic cancer per 1,000 men screened over about 13 years. The harms include false-positive results and, from treatment, erectile dysfunction, urinary incontinence and bowel symptoms; about 1 in 5 men who have the prostate removed develop long-term incontinence, and 2 in 3 long-term erectile dysfunction. In men older than 70 the harms are greater.4
One way to reduce overdiagnosis after a raised PSA is an MRI scan before any biopsy. In the PRECISION trial of 500 men, MRI followed by targeted biopsy found clinically significant cancer in 38% of men versus 26% with standard biopsy, diagnosed fewer insignificant cancers, and spared 28% of men in the MRI group a biopsy altogether.11
Multi-Cancer Early Detection: The Emerging Frontier
Multi-cancer early detection tests look for cancer signals in DNA shed into the blood. In PATHFINDER, 6,662 adults aged 50 or older without symptoms of cancer had the test. A cancer signal was found in 92 of the 6,621 with results (1.4%); of those, 35 (38%) were diagnosed with cancer and 57 (62%) were false positives.5
Resolving a false positive took a median of 162 days, compared with 57 days for a true positive, and most people in both groups had laboratory tests and imaging. The authors concluded that the study supports the feasibility of this kind of screening and that its clinical usefulness still needs research.5
Put this research into practice: What Should I Test Next?
References
- 1Siegel RL, et al. "Cancer statistics, 2024." CA Cancer J Clin. 2024;74(1):12-49. PubMed · DOI
- 2Bretthauer M, et al. "Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death." N Engl J Med. 2022;387(17):1547-1556. PubMed · DOI
- 3Nicholson WK, et al. "Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement." JAMA. 2024;331(22):1918-1930. PubMed · DOI
- 4Grossman DC, et al. "Screening for Prostate Cancer: US Preventive Services Task Force Recommendation Statement." JAMA. 2018;319(18):1901-1913. PubMed · DOI
- 5Schrag D, et al. "Blood-based tests for multicancer early detection (PATHFINDER): a prospective cohort study." Lancet. 2023;402(10409):1251-1260. PubMed · DOI
- 6Krist AH, et al. "Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement." JAMA. 2021;325(10):962-970. PubMed · DOI
- 7Aberle DR, et al. "Reduced lung-cancer mortality with low-dose computed tomographic screening." N Engl J Med. 2011;365(5):395-409. PubMed · DOI
- 8Davidson KW, et al. "Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement." JAMA. 2021;325(19):1965-1977. PubMed · DOI
- 9Curry SJ, et al. "Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement." JAMA. 2018;320(7):674-686. PubMed · DOI
- 10Lei J, et al. "HPV Vaccination and the Risk of Invasive Cervical Cancer." N Engl J Med. 2020;383(14):1340-1348. PubMed · DOI
- 11Kasivisvanathan V, et al. "MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis." N Engl J Med. 2018;378(19):1767-1777. PubMed · DOI
