Routine Cancer Screening: Guidelines and Advances

A Guide to Routine Cancer Screening

Written By Jillian Foglesong Stabile, MD

Cancer screening has entered a new era. With updated guidelines, lowered screening ages, and innovative technologies emerging, staying informed about routine cancer screening recommendations has never been more crucial for your health.

Routine cancer screening represents one of modern medicine's most powerful tools for preventing cancer deaths. These evidence-based tests detect cancer before symptoms appear, when treatment is most effective and survival rates are highest.^[1] Understanding current guidelines and emerging innovations can help you make informed decisions about your screening schedule.

What Are Routine Cancer Screenings?

Routine cancer screenings are standardized tests performed on asymptomatic individuals at average risk for specific cancers. Unlike diagnostic tests ordered when symptoms are present, these screenings aim to catch cancer early or identify precancerous changes that can be treated before they become malignant.^[2]

The U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society establish screening guidelines based on extensive research evaluating the balance between benefits and potential harms of each test.

2025 Screening Guidelines: What's Changed

Routine cancer screening guidelines were changed in a number of areas in 2025.

Breast Cancer Screening

The most significant update came in 2024 when the USPSTF lowered the recommended starting age for breast cancer screening to 40, down from 50, a reversal of their 2016 decision to raise the age from 40 to 50.^[3] Women ages 40 through 74 should now receive mammograms every two years. This change particularly benefits Black women, who face higher breast cancer mortality rates and often develop the disease at younger ages.^[4]

The American Cancer Society continues recommending annual mammograms starting at age 45, with the option to begin at 40 for those who choose earlier screening.^[5] Women with higher risk factors, including family history or genetic mutations like BRCA1/BRCA2, may need earlier or more frequent screening.

Colorectal Cancer Screening

Colorectal cancer screening at age 45 became the standard after the American Cancer Society updated its guidelines in 2018, followed by the USPSTF in 2021.^[6],[9] This change responds to rising colorectal cancer rates in younger adults, with cases increasing by 15% since 2004.^[7]

Screening options include colonoscopy every 10 years, flexible sigmoidoscopy every 5 years, or annual stool-based tests like fecal immunochemical tests (FIT). The choice depends on personal preference, risk factors, and availability.^[8]

Cervical Cancer Screening

Cervical cancer screening guidelines emphasize HPV testing as the primary method. Women should start screening with Pap tests every three years beginning at age 21, and then transition to HPV testing or co-testing (HPV plus Pap) every five years between ages 30 and 65. At age 65, women can typically end screening if they have had adequate prior screening and have no high-risk factors.^[10]

Lung Cancer Screening

Healthcare providers recommend lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50–80 with a 20-pack-year smoking history who currently smoke or quit within the past 15 years. This targeted approach reflects lung cancer's strong association with tobacco use.^[11]

Emerging Screening Innovations

The future of cancer screening includes multi-cancer early detection (MCED) tests, which analyze blood samples for circulating tumor DNA from multiple cancer types simultaneously. While promising, these tests remain under investigation and haven't yet received widespread clinical adoption.^[12]

Artificial intelligence is increasingly integrated into screening programs, particularly in mammography and colonoscopy, where AI assists radiologists and gastroenterologists in detecting subtle abnormalities that might otherwise be missed.

Understanding Your Risk Level

Screening recommendations vary significantly based on individual risk factors. Average-risk individuals follow standard guidelines, while those with higher risk due to family history, genetic mutations, or previous cancer may need earlier or more frequent screening.

Genetic counseling and testing can identify hereditary cancer syndromes affecting screening schedules. For example, women with BRCA mutations may begin breast screening with MRI in their 20s, while those with Lynch syndrome need colonoscopy screening starting at age 25 or 10 years before the youngest affected family member's diagnosis.

Addressing Common Concerns

All screening tests come with a chance of false results. A false negative result occurs when cancer is present, but the test result comes back negative.

A false positive result occurs when a test result suggests cancer is present even though it is not present. If a screening test result comes back positive, follow-up testing is necessary to confirm whether cancer is present. While false positives are anxiety-provoking and are a significant concern in routine screening, they are a known part of the screening's overall risk-benefit equation of early detection.

Cost and accessibility remain barriers to screening for many Americans. The Affordable Care Act requires insurance coverage for recommended screenings without cost-sharing, though specific coverage varies by plan and provider.

Frequently Asked Questions

What are the three most important cancer screening tests for average-risk adults?

The three cornerstone screenings are breast cancer screening (mammography), colorectal cancer screening (colonoscopy or stool tests), and cervical cancer screening (HPV testing/Pap tests). These tests have the strongest evidence for reducing cancer mortality.

Are routine cancer screenings worth the potential risks?

For recommended screenings in appropriate age groups, research consistently shows benefits outweigh risks. However, you should make the decision with your healthcare provider, considering your individual risk factors and preferences.

What routine screening options exist for skin cancer?

Unlike other cancers, routine skin cancer screening lacks universal guidelines due to insufficient evidence.^[8] However, individuals with risk factors like fair skin, multiple moles, or family history should discuss regular dermatologic examinations with their healthcare provider.

Taking Action: Your Next Steps

Creating a personalized screening plan starts with discussing your risk factors with your healthcare provider. Consider your family history, lifestyle factors, and any symptoms you've noticed. Keep track of when you've had screenings and when the next ones are due.

Prepare for screenings by following pre-test instructions carefully, arranging time off work if needed, and planning for potential follow-up testing. Remember that screening is a process, not a one-time event.

Everlywell and At-Home Screening Options

Everlywell offers several at-home screening kits that align with updated guidelines, including options for HPV testing and cholesterol monitoring—two key indicators in cancer prevention and general health. While we do not currently offer mammography or colonoscopy tests, our offerings help you take the first step in monitoring your health at home.

Take Control of Your Health Today

Explore Everlywell's convenient at-home screening options and take the first step toward proactive cancer prevention.

Routine cancer screening continues evolving as research advances our understanding of cancer prevention and early detection. Staying informed about current guidelines and emerging innovations empowers you to make the best decisions for your health. Work with your healthcare provider to develop a screening plan tailored to your individual needs and risk factors.

References

1. National Cancer Institute. Cancer screening tests. Updated 2024. Accessed June 17, 2025. https://www.cancer.gov/about-cancer/screening/screening-tests
2. American Cancer Society. Cancer screening guidelines. Updated 2024. Accessed June 17, 2025. https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html
3. U.S. Preventive Services Task Force. Final recommendation statement: screening for breast cancer. April 30, 2024. Accessed June 17, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/announcements/final-recommendation-statement-screening-breast-cancer-0
4. American Academy of Family Physicians. AAFP backs updated USPSTF breast cancer screening guidance. June 13, 2024. Accessed June 17, 2025. https://www.aafp.org/news/health-of-the-public/2024-breast-cancer-screening-update.html
5. American Cancer Society. ACS supports updated USPSTF breast cancer screening guidelines. 2024. Accessed June 17, 2025. https://pressroom.cancer.org/releases?item=1320
6. American Cancer Society. Colorectal cancer screening guidelines. Updated 2024. Accessed June 17, 2025. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
7. Colorectal Cancer Awareness Month: What to Know about the Rise of Colorectal Cancer in Younger Adults. ACS. March 5, 2024. Accessed July 10, 2025. https://www.facs.org/media-center/press-releases/2024/colorectal-cancer-awareness-month-what-to-know-about-the-rise-of-colorectal-cancer-in-younger-adults/
8. Skin cancer: screening. Published April 18, 2023. Accessed July 10, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/skin-cancer-screening
9. U.S. Preventive Services Task Force. Recommendation: colorectal cancer screening. May 18, 2021. Accessed June 17, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
10. American Cancer Society. Cervical cancer screening guidelines. Updated 2024. Accessed June 17, 2025. https://www.cancer.org/cancer/types/cervical-cancer/detection-diagnosis-staging/cervical-cancer-screening-guidelines.html
11. U.S. Preventive Services Task Force. Recommendation: lung cancer screening. Updated 2021. Accessed June 17, 2025. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
12. National Cancer Institute. Multi-cancer detection tests for screening. Updated 2024. Accessed June 17, 2025. https://www.cancer.gov/news-events/cancer-currents-blog/2024/multi-cancer-detection-tests-screening