Cancer Screening Clinical Practice Guidelines (2019)

American Cancer Society (ACS)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

August 01, 2019

The guidelines on early detection of selected cancers in average-risk asymptomatic adults were released in June 2019 by the American Cancer Society (ACS).[1]

Breast Cancer

Women should have the opportunity to begin annual screening between 40 and 44 years of age.

Screening mammography should be routinely performed starting at 45 years of age and should be performed annually in women 45 to 54 years of age.

Women 55 years or older should transition to biennial screening or have the opportunity to continue screening annually.

Mammography should be continued as long as the woman's overall health is good and she has a life expectancy of at least 10 years.

Cervical Cancer

In women 21 to 29 years of age, Pap smears using conventional or liquid-based options should be performed every 3 years.

In women 30 to 65 years of age, the preferred screening approach is combined testing with Pap smear and HPV DNA test performed every 5 years; a Pap smear alone performed every 3 years is acceptable.

Screening should be discontinued in women older than 65 years who have had at least three consecutive Pap smears with negative results or at least two consecutive HPV tests with negative results and Pap smears within the past 10 years, with the most recent test being performed in the past 5 years.

Screening should be discontinued in women who have had a total hysterectomy.

Colorectal Cancer

In men and women 45 to 75 years of age, screening options include the following:

  • Fecal immunochemical test, repeated annually

  • High-sensitivity guaiac-based fecal occult blood test, repeated annually

  • Multitarget stool DNA test, repeated every 3 years, per manufacturer's recommendation

  • Colonoscopy every 10 years

  • CT colonography every 5 years

  • Flexible sigmoidoscopy every 5 years

Regular screening should be performed with either a high-sensitivity stool-based test or a structural (visual) examination, depending on patient preference and test availability. As part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy. Screening should be continued until age 75 years, in patients in good health with a life expectancy of more than 10 years.

In men and women 76 to 85 years of age, screening decisions should be individualized, based on patient preference, life expectancy, health status, and screening history; if a decision is made to continue screening, the patient should be offered options as for younger patients.

Men and women older than 85 years should be discouraged from continuing screening.

Endometrial Cancer

At menopause, women should be informed about the risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physician.

Lung Cancer

Low-dose helical chest CT should be performed annually in patients 55 to 74 years of age in good health who meet all the following criteria:

  • Currently smoke or quit within the past 15 years, and have at least a 30-pack-year smoking history

  • If they are current smokers, receive evidence-based smoking cessation counseling

  • Have undergone a process of informed or shared decision-making that included information about the potential benefits, limitations, and harms of screening with low-dose CT

  • Have access to a high-volume, high-quality lung cancer screening and treatment center

Prostate Cancer

Men 50 years or older who have a life expectancy of at least 10 years should have an opportunity to make an informed decision with their health care professional about whether to undergo screening for prostate cancer, after receiving information about the potential benefits, risks, and uncertainties associated with screening. Screening should not occur without an informed decision-making process. Screening is with a prostate-specific antigen test, with or without digital rectal examination.

For more information, see Breast Cancer, Cervical Cancer, Colorectal Cancer Guidelines, Endometrial Carcinoma, Prostate Cancer, Non-Small Cell Lung Cancer (NSCLC), and Small Cell Lung Cancer. For more Clinical Practice Guidelines, please go to Guidelines.


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