an ongoing dialogue with their health care providers and develop a personalized cancer screening plan that considers their specific risks and tolerance of potential harms from screening tests. Those at an Average Risk of Being Diagnosed with Cancer Individuals at average risk of being diagnosed with cancer are those who do not have a family history of cancer or personal history of cancer, and do not have an inherited genetic condition that places them at a higher risk of developing cancer. Two key considerations for recommending screening in average-risk individuals are gender and age. USPSTF recommends that average-risk individuals should receive routine screening for breast, cervical, and colorectal cancer when they reach the eligible age (Grades A and/or B recommendations). For prostate cancer screening, USPSTF recommends that average-risk individuals should have an ongoing dialogue with their health care provider to make an informed and shared decision, when they reach the eligible age (Grade C) (see Sidebar 21, p. 60). The probability of developing cancer increases with advanced age. According to the most recent estimates, 88 percent of people diagnosed with cancer in the U.S. are 50 or older (28). Therefore, researchers continually evaluate, among other factors, the optimal age for starting or stopping cancer screening, and expert panels, such as USPSTF, periodically update guidelines based on the new evidence. As one example, in May 2023, USPSTF proposed reducing the recommended starting age of screening from 50 to 40 for women who are at an average risk of developing breast cancer. Researchers estimate that the new guidance could save 19 percent more lives from breast cancer (284). People should discuss cancer screening during routine consultations with their health care providers, and evaluate their cancer screening plans according to the most up-to-date information. USPSTF Guidelines for Cancer Screening* The U.S. Preventive Services Task Force (USPSTF) carefully reviews available data and weighs the risks and benefits for the general population before issuing cancer screening guidelines (see Figure 11, p. 58). Currently, USPSTF has guidelines for five types of cancer, four of which apply to individuals who are at an average risk of being diagnosed with breast, colorectal, prostate, or cervical cancer. Guidelines for lung cancer apply to those who smoked previously or who currently smoke; these individuals are at a higher-than-average risk of being diagnosed with the disease because of tobacco use. BREAST CANCER** The new draft recommends mammogram every other year for women ages 40 to 74. CERVICAL CANCER** Cervical cytology every three years for women ages 21 to 65; high-risk human papillomavirus testing alone, or in combination with cytology, every five years for women ages 30 to 65. COLORECTAL CANCER Stool-based tests every one to three years, and/or colonoscopy/flexible sigmoidoscopy every five to 10 years, for all adults ages 45 to 75. LUNG CANCER†Low-dose computed tomography every year for all adults ages 50 to 80 who are current smokers or who quit within the past 15 years, with a 20 pack-year smoking history. PROSTATE CANCER Periodic prostate-specific antigen-based test, by making a shared decision with health care provider through an ongoing dialogue, for men ages 55 to 69. * Only USPSTF guidelines are included here. Several other professional societies issue evidence-based screening guidelines for certain types of cancer that may differ from those issued by USPSTF. Furthermore, guidelines have been simplified for brevity. Readers are advised to visit the USPSTF website (https://www. uspreventiveservicestaskforce.org/uspstf/) for a complete description of guidelines and more detailed information. ** USPSTF is currently in the process of updating the recommendations for breast and cervical cancer. †S creening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. SIDEBAR 21 PSA AACR Cancer Progress Report 2023 Screening for Early Detection 60
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