What Cancer Screenings Should Older Adults Get?

A medical oncologist explains what cancers older adults should be screened for, when to start routine screenings — and possibly when to stop.

As you age, your risk of developing certain types of cancer increases. In addition to age, lifestyle habits such as smoking or a family history of cancer also contribute to increased risk over time. This is why routine screenings for certain cancers are recommended for people of different ages.

Cancer screening is important because it can help doctors catch cancer earlier, when treatments are more likely to cure the disease. But cancer screenings can sometimes be costly or pose complications, so there are important factors to consider especially as you get older.

“A lot of different variables play into cancer screening, so you do have to discuss with your physician what’s the best screening program for you,” says Sang-Hoon Ahn, MD, a medical oncologist with the USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC.

Dr. Ahn says that whenever he meets with a patient, he always weighs the pros and cons of screening individualized to that patient. “It’s not black-and-white, because for some people, such as those who have a family history of cancer, we usually need to be more aggressive in starting screenings earlier, screening at shorter intervals and continuing screenings until a later age,” he says.

But other patients who do not have a family history of cancer, are already in their 80s or 90s and have other health complications to consider might prefer not to undergo invasive screenings or endure the potential anxiety from being diagnosed with a cancer that otherwise isn’t causing other symptoms.

One example is prostate cancer, which tends to occur later in life, Dr. Ahn says. “Some prostate cancers are slow-growing and don’t need to be treated. In this instance, a patient might want to forgo the anxiety and process of screening, especially if the patient is likelier to die from old age or a different cause before cancer symptoms even appear.”

There are five basic cancer screenings that most cancer associations and doctors agree are appropriate for older adults, with varying age cutoffs.

1. Breast cancer

For breast cancer screening, Dr. Ahn recommends getting a mammogram from the ages of 40 to 74, either once or twice a year depending on a patient’s health and family history of breast cancer. For some patients over the age of 75 who are in generally good health and have a life expectancy of 10 years or more, he sometimes still recommends mammograms, which are relatively noninvasive.

2. Colorectal cancer

Either a colonoscopy or a stool test is used to screen for colorectal cancer. These tests are usually done up to 75 years of age. For average-risk adults, a colonoscopy is recommended every 10 years, but it may be recommended more frequently depending on the results of your colonoscopy and family history of cancer. And if you are in excellent health, your doctor might continue colorectal cancer screenings up to age 85, Dr. Ahn says.

But colonoscopies are not easy procedures, especially for many older patients, he points out. “For a 77-year-old to do the aggressive bowel cleaning and fasting required for a colonoscopy and then go through the procedure, where there is a small risk of tearing or other complications, it might not be very easy or safe,” he says. “So, for these older patients who still value screening, we might do stool testing instead of a colonoscopy. Again, this is a conversation that varies from patient to patient.”

3. Uterine cervical cancer

Pap smears are recommended every three years for people aged 21 to 65 years. Alternatively, a patient can get a pap smear and human papillomavirus (HPV) test every five years.

“If any of your previous pap smears were abnormal or you didn’t get regular screenings done, we might continue testing you until age 70 or 75,” Dr. Ahn says.

4. Prostate cancer

If, after discussion with your physician, you decide to proceed with screening, it is recommended that men ages 50 to 70 years old get a prostate-specific antigen (PSA) test, which is a simple blood test that measures a protein produced by the prostate gland and can indicate cancer.

5. Lung cancer

“Lung cancer screenings are usually recommended once a year for patients with a history of smoking,” Dr. Ahn says. Screening is done through a low-dose chest CT scan for people from 50 to 80 years old.

“Lung cancer screening is not for everybody,” Dr. Ahn says. “This is for the patients who have a history of smoking at least one pack a day for 20 years and currently smoke or have quit within the past 15 years.”

Screening needs depend on the person

Dr. Ahn recommends working with your doctor to weigh your individual pros and risks of each of these cancer screenings. You also have to take into account your ability to undergo treatment.

“If a patient gets diagnosed with cancer through a screening but they’re not in a condition to treat the cancer, screening can just cause unnecessary anxiety and stress,” he says. “We always have to consider the medical benefits versus the risks and the patient’s preference.”

Some older patients want all the tests, and for these people, Dr. Ahn might consider more aggressive screening schedules, whereas for others more concerned with their quality of life and reducing medical costs, Dr. Ahn says one option is to spread out the screening schedule a little more than guidelines recommend.

“Cancer screening is not one-size-fits-all,” Dr. Ahn says. “And screening is important, but what’s even more important is prevention. Really staying active, eating healthy and controlling chronic conditions are, in my opinion, just as important as screening.”

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