Preventive Medicine
Cancer & Adult Screening — Complete Reference
Preventive Medicine

Cancer & Adult Screening — Complete Reference

Age-appropriate screening for all major cancers and conditions.

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◆Colorectal cancer (CRC)

  • •Average risk: colonoscopy q10 years starting age 45 until 75
  • •Alternatives: FIT annually, sigmoidoscopy q5y + FIT q3y, Cologuard q3y
  • •FHx in 1st-degree relative: start at 40 OR 10 years before relative's dx (whichever earlier)
  • •Relative <60 at dx: repeat q5y; >60: q10y
  • •UC: start 8–10 years after dx, q1–3y
  • •FAP: annual colonoscopy from age 10–12; prophylactic colectomy (100% lifetime CRC risk)
  • •Post-polypectomy: low-risk q5–10y; high-risk (≥3 adenomas, ≥10 mm, villous, HGD, SSP) q3y

◆Lung cancer

  • •Annual low-dose CT (LDCT) for adults 50–80 with ≥20 pack-year history who currently smoke or quit <15 years ago
  • •Stop if: quit ≥15 years ago OR life-expectancy-limiting illness
  • •USPSTF 2021 lowered age from 55→50 and pack-years from 30→20

◆Cervical cancer

  • •Ages 21–29: Pap alone q3 years (no HPV cotesting)
  • •Ages 30–65: Pap + HPV q5 years (preferred) OR Pap alone q3 years
  • •Discontinue at age 65 if adequate prior screening + no high-risk history
  • •HIV+: annual Pap starting at diagnosis or onset of sexual activity
  • •Immunosuppressed (SLE): annual Pap + HPV from sexual activity

◆Breast cancer

  • •Mammography q2 years for average-risk women 50–74 (USPSTF; updated to start at 40 in 2024)
  • •BRCA: genetic counseling if strong FHx; MRI screening if confirmed BRCA mutation
  • •Discontinue when life expectancy <10 years

◆Prostate cancer

  • •Shared decision-making age 55–69 (PSA)
  • •Discuss risks of overdiagnosis + treatment morbidity
  • •Not routinely recommended ≥70

◆Cardiovascular / metabolic

  • •Diabetes T2: all adults ≥45 q3 years; earlier if BMI ≥25 + 1 risk factor (FHx, GDM, HTN, dyslipidemia, certain ethnicities)
  • •Lipid screening: men ≥35, women ≥40–45, q4–6 years; earlier if risk factors
  • •Pediatric lipid screening: once at 9–11 and 17–21
  • •AAA: one-time US for men 65–75 who ever smoked

◆General adult

  • •HCV: all adults 18–79 once (universal); repeat if ongoing IVDU
  • •HBV: chronic dialysis, frequent transfusions
  • •Osteoporosis: DEXA for all women ≥65 (or earlier with risk factors); men ≥70
  • •Hearing: formal audiometry if communication difficulties
  • •IPV: screen all women of childbearing age routinely

◆STI screening

  • •If diagnosed with one STI → screen for HIV, syphilis, gonorrhea, HBV
  • •Sexually active young women: chlamydia + gonorrhea annually
  • •Trichomonas: women only
  • •HSV: only if characteristic lesions present
  • •HIV+ initial: STIs, hepatitis A/B/C, latent TB

◆Pregnancy

  • •Initial: HIV, syphilis, HBsAg, asymptomatic bacteriuria (urine culture)
  • •High-risk (age <25, multiple partners, STI history): gonorrhea + chlamydia at initial + 3rd trimester

High-yield pearls

  • ◆Always start CRC screening earlier if FHx (40 or 10 years before relative's dx)
  • ◆LDCT age 50–80 + ≥20 pack-years + smoking or quit <15 years
  • ◆Don't continue cancer screening when life expectancy <10 years
  • ◆BRCA1/2: prophylactic mastectomy + BSO consideration after childbearing
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