At a certain age, you might start to wonder if you should be stepping up your screening for cancer. And then you might start to wonder: what exactly is that age? And what kinds of cancer screening should I consider?
While there are some guidelines to these questions, there has to be a lot of individualized assessment when counseling patients about screening for certain cancers. Every woman’s personal health risks may vary, says Kimberly Peairs, M.D., an assistant professor of medicine at Johns Hopkins and clinical director of internal medicine at Green Spring Station. For a woman with a clear genetic disposition to certain cancers—such as a family history of the BRCA mutations linked to certain breast and ovarian cancers—“screening may also be recommended to start earlier than would be done with an average risk patient,” Peairs says.
The benefit of cancer screening varies on the cancer type. Most cancers become more prevalent as women get older but there are some exceptions.
Younger than 40?: You’ve got a few more years for most screenings at this age, but “cervical cancer screening is important to have done in the earlier years to establish if a patient is high risk from HPV infection,” Peairs says. “That would help determine how frequently she would need to be screened thereafter.”
In Your 40s: The most common screening question that comes up for women in their 40s is when and how often to get a mammogram, Peairs notes. The recommendations for a mammogram use vary in this decade. Patients should be made aware of this and providers should help them decide what the right screening timeline is for each individual. “This decision will depend on a woman’s risk for breast cancer as well as their individual preferences,” Peairs says. Risks can include a family history of breast cancer as well as genetic factors. “A patient-centered conversation regarding the risks and benefits of screening in this age group is very important,” she adds. Cervical cancer screening, especially for women at high-risk for HPV infection, can continue in the 40s.
In Your 50s: Peairs recommends breast cancer screening, cervical cancer screening, and the start of colon cancer screening during this decade of life. “There are several options to discuss for colon cancer screening but presently, the gold standard is still a screening colonoscopy, with appropriate follow-up testing depending on a patient’s individual risks,” she says. Women with a long history of continued smoking may consider lung cancer screening at age 55.
In Your 60s: Breast cancer and colon cancer screening should continue, and cervical cancer screening could continue into your mid- 60s, says Peairs. Lung cancer screenings can continue in women with a risky history of smoking.
60s and Beyond?: Patients can ask their doctors about guidelines for when it might be appropriate to stop doing a colonoscopy or a mammogram, taking into account a patient’s individual risk for specific cancers. In general, Peairs says, if a patient is not likely going to be living more than five years because of age or other medical conditions, the benefits of most cancer screening is limited.
In all cases, patients should talk with their doctors about their personal risks for each type of cancer. You could be reluctant to get a mammogram or a colonoscopy, but you may change your mind after you have a thorough discussion of “the potential benefits or harms of the screening test,” Peairs says. “Ideally, the physician and the patient can identify an approach they are both comfortable with.”