Your 40s and 50s: A Physician’s Guide to Cancer Screenings by Age

COVID-19 may have you nervous about seeking care, but cancer screenings are still vitally important.

The following is the second article in a three-part series about cancer screenings. These first appeared on our blog in 2019, but nothing has changed. During these uncertain times, early cancer detection can still save your life.

You should also visit with a primary care provider yearly and be in touch if you have any health concerns, including mental health questions. Because your health is always a priority, in-person appointments with your provider are set up with your safety in mind. Most providers also offer other options to fit your comfort level, including telephone and telehealth visits. Be sure to check-in with your doctor for any questions about how to protect yourself from COVID-19.

My recommendations are below.

In Your 40's

Men/women:

• Colon cancer screening: recommended if your family or genetic history indicates higher risk.  You may want to discuss with your primary care physician about early screening and/or genetic testing.

Women:

• Cervical cancer screening: pap smear with HPV co-testing every five years (preferred) or pap smear alone every three years. A new alternative for screening to discuss with your primary care physician is high-risk HPV screening alone every five years.
• Breast cancer screening: annual or biennial mammogram recommended if your family or genetic testing indicates higher risk.  You may want to discuss with your primary care physician about early screening.  Some individuals may benefit from genetic testing if their family history indicates higher risk as well.

Men:

• Prostate cancer screening is not indicated, but if you have symptoms or are considered high risk (if you are African-American or have a first-degree relative with prostate cancer), you may want to discuss with your primary care physician about early screening.

In Your 50's

Men/Women:

• Colon cancer screening: colonoscopy (preferred) every three, five or 10 years pending results and family history.  Alternatives are yearly fecal occult blood test or fecal immunochemical testing, flexible sigmoidoscopy every five years pending results, or Cologuard (stool DNA testing) every three years pending results.
• Lung cancer screening: recommended for individuals 55-80 years with at least a 30-pack per year smoking history who are either currently smoking or who have quit within the past 15 years.  This test is done annually with a low dose contrast CT chest scan if you are a current smoker or until you have been a nonsmoker for 15 years.

Women:

• Cervical cancer screening: pap smear with HPV co-testing every five years (preferred) or pap smear alone every three years.  A new alternative for screening to discuss with your primary care physician is high-risk HPV screening alone every five years.
• Breast cancer screening with a recommend yearly mammogram.  Some women may be recommended to have whole breast ultrasound supplemental screening if you are considered to have dense breasts.  This should be discussed with your primary care physician.

Men:

• Prostate cancer screening starting at age 55, you should have a discussion with your primary care physician about early screening if you have symptoms or are considered high risk (if you are African-American or have a first-degree relative with prostate cancer).  Men 55-69 years old, discuss with your primary care physician about the risks versus benefits for screening with the blood test called prostate specific antigen (PSA) and digital rectal exam (DRE).  This is usually done every one-to-two years.

The following cancers do not currently have any specific recommendations or testing for screening. So no matter your age, you should discuss family history with your physician and be very aware of related symptoms:

• Bladder cancer
• Oral cancer
• Ovarian or uterine cancer-however, pending positive family or genetic history, you may want to discuss genetic testing with your primary care physician.
• Pancreatic cancer-however, pending positive family or genetic history, you may want to discuss genetic testing with your primary care physician
• Skin cancer- however, an individual with skin findings, positive family history or significant risk factors may want to discuss screening with a primary care physician or dermatologist
• Testicular cancer
• Thyroid cancer

Many patients are understandably apprehensive about testing for fear of the results, but there is some relief in being aware of your results—which are most often normal. Besides, early results can mean early intervention and therefore much better outcomes from treatment.

All adults should have a yearly check-up with a primary care physician. It is a great time to discuss all screening tests that are right for you and your health history (as well as your family’s health history). If you do not have a primary care physician, you can find one here.

This blog post is part two in a three part series. Check out cancer screenings in 20's and 30's and 60's & beyond.