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Cancer screening: which tests make sense, and when?

Clinical review pending

A practical guide to US cancer screening recommendations, personal risk, follow-up testing, false alarms, and what multicancer blood tests can tell us.

A hand holds an open blank book with three colored windows.

The right screening test depends on the cancer, your age, and your personal risk. Breast, cervical, and colorectal cancer screening have established roles for people in defined age groups. Lung cancer screening is aimed at people whose smoking history puts them at higher risk. In each case, the potential benefit has to be weighed against false alarms, missed cancers, and diagnoses or treatments that would never have been necessary.

The ages and testing intervals below come from US guidelines. Screening programs in Germany and other countries use different eligibility rules. These recommendations concern people without symptoms; a new symptom needs its own assessment, even after a recent normal screening result.

What is cancer screening?

Cancer screening means testing people who have no symptoms of the cancer being sought. The aim is to find cancer at a stage when treatment often works better. Some tests also find precancerous changes that can be treated before cancer develops. Services may be advertised as cancer checks, screening tests, or cancer blood tests, but a name alone does not establish whether a test is suitable for screening. [1]

For 2024, an estimated 2,001,140 new cancer cases and 611,720 cancer deaths were projected in the United States. The US cancer death rate has fallen since 1991. Less smoking, earlier detection of certain cancers, and better treatment have all contributed. Screening is one part of that improvement, rather than its only explanation. These figures are the published 2024 estimates, not a current-year forecast. [17]

Screening and diagnostic testing: what is the difference?

A screening test looks for cancer before symptoms appear. Its result alone cannot confirm cancer or reliably rule it out. A diagnostic test investigates the cause of a symptom or an abnormal screening result. [1]

Screening test Diagnostic test
Purpose Look for cancer before symptoms develop Find the cause of a symptom or an abnormal screening result
Who is tested? People without signs or symptoms of the cancer being sought People with symptoms, an abnormal examination, or an abnormal screening result
What does the result mean? It indicates whether more testing may be needed or no immediate investigation appears necessary; it is not a diagnosis It helps establish a cancer diagnosis, another explanation, or no evidence of the suspected cancer

Source: National Cancer Institute. [1]

Screening for breast, cervical, colorectal, and lung cancer has demonstrated benefits in the populations studied. For lung cancer, that specifically means people at increased risk because of their smoking history, not adults at average risk. Other tests are appropriate only for selected risk groups or have not been established for routine screening. [2]

Professional organizations sometimes recommend different starting ages and intervals. Those differences, along with your preferences and medical history, belong in the decision. The table summarizes common options for people at average risk unless a higher-risk group is specified. Previous abnormal results, a cancer history, inherited syndromes, or other medical conditions may call for a different schedule.

USPSTF stands for the US Preventive Services Task Force; ACS stands for the American Cancer Society.

Cancer Who is screening recommended for? Test How often?
Breast Women ages 40–74 under USPSTF guidance; ACS recommends starting at 45, with the option to start at 40 Screening mammogram Every two years under USPSTF guidance; annually at ages 45–54, then annually or every two years under ACS guidance
Cervical People with a cervix ages 21–65 under USPSTF guidance; ages 25–65 under ACS guidance, with stopping dependent on adequate prior screening Cervical cytology, high-risk HPV testing, or both Cytology every 3 years; clinician-collected HPV testing or cotesting every 5 years when appropriate for age and guideline; ACS accepts self-collected HPV testing every 3 years after a negative result
Colorectal Adults ages 45–75 at average risk; selected adults ages 76–85 after an individual assessment Stool tests or examinations of the colon Options include annual fecal immunochemical testing (FIT) or colonoscopy every 10 years
Lung Adults ages 50–80 with at least 20 pack-years who currently smoke or quit within 15 years under USPSTF guidance; ACS does not impose a years-since-quitting limit Low-dose CT Annually, when health and willingness to undergo potentially curative treatment make screening appropriate
Prostate Men ages 55–69 after discussing benefits and harms; USPSTF recommends against routine screening at age 70 or older Prostate-specific antigen (PSA) blood test The testing interval is decided with the clinician rather than fixed by this recommendation

These recommendations come from guidelines on breast [4, 5], cervical [6, 18, 28], colorectal [3, 19], lung [7, 8], and prostate cancer [20]. The guide to total PSA explains that blood marker.

Breast cancer screening

Guidelines on mammography, an X-ray examination of the breast, differ mainly in when to begin and how often to test. USPSTF recommends a mammogram every two years for women ages 40–74. ACS recommends regular screening from age 45: annually through age 54, then annually or every two years from age 55. Its guidance also allows women to start at age 40 if they prefer. [4, 5]

USPSTF found insufficient evidence to determine the balance of benefits and harms of supplemental ultrasound or MRI after a negative mammogram in women with dense breasts, and of screening women age 75 or older. MRI stands for magnetic resonance imaging. That uncertainty is specific to these screening questions; it does not mean that MRI has no role for people at high risk or when a finding needs investigation. [4]

A clinical breast examination is an examination by a health professional, including feeling the breast tissue. The cited ACS guideline does not recommend it as a screening test for average-risk women at any age. [5]

Cervical cancer screening

Cervical screening recommendations differ in both starting age and test choice. The USPSTF’s published final recommendation advises cervical cytology every three years at ages 21–29. Cytology examines cells collected from the cervix. At ages 30–65, it offers three options: cytology every three years, a test for high-risk human papillomavirus (HPV) alone every five years, or combined HPV and cell testing, called cotesting, every five years. [18]

ACS starts average-risk screening at age 25. Its 2020 guideline favored primary HPV testing, and its update published online in 2025 retains a five-year interval after a negative clinician-collected HPV test. It also accepts self-collected vaginal samples using approved collection-device and HPV-test combinations, with repeat testing after three years if negative. Clinician collection remains preferred. Stopping at 65 requires an adequate negative screening history; reaching that birthday alone is not a reason to stop. People with previous cervical abnormalities or higher risk may need different follow-up. [6, 28]

Screening can reduce the chance of developing cervical cancer in the first place. It can find precancerous changes that can be treated before they become an invasive tumor, one that grows into surrounding tissue. In the United States, cervical cancer deaths fell from 2.8 to 2.3 per 100,000 women between 2000 and 2015, although no single measure explains that entire decline. [18] See the guide to cervical cancer for more about the disease.

Colorectal cancer screening

The cited US guidelines recommend screening at ages 50–75 and also at ages 45–49. The earlier starting age reflects changing disease patterns. An estimated 10.5% of new colorectal cancers occurred in people younger than 50 in the evidence informing these recommendations. Incidence among adults ages 40–49 rose by nearly 15% between 2000–2002 and 2014–2016. ACS recommended starting at 45 in 2018; USPSTF followed in 2021. These are dated findings documenting the rise in early-onset colorectal cancer, rather than estimates for every current population. Screening at ages 76–85 is selective, taking account of health, previous screening, and preferences. [3, 19, 21]

Options include stool testing and examinations of the colon. Annual FIT looks for blood in stool; colonoscopy examines the colon directly and can be repeated every 10 years after a normal screening examination in an average-risk person. A positive stool screening test needs follow-up colonoscopy, not another stool test to dismiss the result. [3]

A trial involving 84,585 adults examined the effect of an invitation to colonoscopy. Over 10 years, colorectal cancer risk fell from 1.20% to 0.98%, an 18% relative reduction. Colorectal cancer deaths did not differ significantly over that period. Only 42% of those invited actually underwent screening. The result therefore measures an invitation strategy; it does not directly establish the effect of undergoing colonoscopy. [19, 22] Related guides explain colorectal cancer and colonoscopy.

Lung cancer screening

Eligibility depends heavily on smoking history. USPSTF recommends annual low-dose computed tomography, or low-dose CT, for adults ages 50–80 with at least 20 pack-years who currently smoke or stopped within the previous 15 years. Pack-years combine the number of packs smoked each day with the number of years of smoking. ACS uses the same age range and minimum pack-year exposure but does not set a limit on years since quitting, so people who stopped decades ago may still qualify. It calls for a shared decision before screening. Both health status and willingness to undergo potentially curative treatment matter; screening is not appropriate when serious illness makes that treatment unrealistic. [7, 8]

Two randomized trials, which assigned participants to comparison groups by chance, found fewer lung cancer deaths with low-dose CT. In the National Lung Screening Trial, lung cancer mortality was 20.0% lower than with chest X-ray screening. The NELSON trial found a 24% relative reduction among men compared with no screening; 2.1% of screened participants were referred for suspicious lung nodules. The comparison groups and screening protocols differed, so these figures are not interchangeable predictions for an individual. [9, 10] See the guide to lung, bronchus, and tracheal cancer.

Prostate cancer screening

Under the cited USPSTF recommendation, men ages 55–69 should decide about PSA screening after discussing the potential benefit and harms with a clinician. Routine screening is not recommended at age 70 or older. For average-risk men, a PSA test is therefore a decision to weigh, rather than an automatic part of every checkup. False-positive results and overdiagnosis are central to that discussion. [2, 20]

For every 1,000 men screened over approximately 13 years, screening may prevent about 1.3 prostate cancer deaths and about 3 cases of metastatic cancer, cancer that has spread elsewhere. Treatment can also cause lasting harm. After radical prostatectomy, surgery to remove the prostate, about 1 in 5 men develops long-term urinary incontinence and about 2 in 3 develops long-term erectile dysfunction. Those side-effect estimates refer to men who have surgery, not to everyone who has a screening test. [20]

When personal risk changes the screening plan

For some tests, a person’s risk profile is the main reason to offer screening. Certain examinations are recommended only for people at high risk of that particular cancer. [1]

Availability alone does not make a test useful for screening. Several familiar tests are not recommended routinely for average-risk adults because the evidence is insufficient to judge their value or because their harms outweigh their benefits. Those are different conclusions and should not be confused. [2]

Family history and inherited risk

USPSTF recommends a brief, standardized familial risk assessment for women with a personal or family history of breast, ovarian, fallopian tube, or peritoneal cancer, or ancestry associated with BRCA1/2 variants. Certain changes in BRCA1 and BRCA2 increase cancer risk. If the assessment suggests increased risk, genetic counseling and, when appropriate, testing follow. Routine BRCA risk assessment and testing are not recommended for women without these indications. [23]

The cited guideline estimates that harmful BRCA1/2 variants occur in approximately 1 in 300–500 women and account for about 5–10% of breast cancers and 15% of ovarian cancers. These figures concern inherited risk, not a blood test that detects an existing tumor. [23]

Skin, liver, and ovarian cancer screening

For adults without symptoms, USPSTF found insufficient evidence to weigh the benefits and harms of a clinician’s visual skin examination for screening. The value remains uncertain; that is not a recommendation against examining a concerning skin change. Melanoma accounts for about 1% of skin cancers but most skin cancer deaths. It is more often diagnosed at a later stage in people with darker skin. [24] The melanoma guide explains more.

In people with cirrhosis, regular liver cancer surveillance was associated with more early-stage diagnoses, more treatment with curative intent, and better survival. Those observational associations do not establish causation on their own. Four studies reported surveillance-related physical harms from false-positive or indeterminate results in 8.8–27.5% of patients, most of them mild. Those studies did not measure the full financial or psychological burden. [25]

Ovarian cancer screening is not recommended for women without a known high-risk inherited syndrome. It has not reduced ovarian cancer deaths and can lead to unnecessary surgery. Neither the CA-125 blood marker nor transvaginal ultrasound, an ultrasound examination through the vagina, is recommended as a routine ovarian screening test in this group. [26] Read more about ovarian cancer and cirrhosis.

What about blood tests that look for several cancers?

Multicancer detection tests look for signals from several cancers in one blood sample. The NCI information cited in 2024 reported that none had FDA authorization at that time. This is a changing field: an FDA advisory panel considered Galleri in September 2026 and voted favorably on its benefit-risk balance. An advisory vote is not itself a final FDA approval. Regulatory status and evidence of fewer cancer deaths are also separate questions. [2, 30]

NCI describes important unanswered questions about the overall balance of benefits and harms. These tests cannot replace guideline-recommended screening. Offering one as an additional test does not, by itself, establish an additional health benefit. [29]

The PATHFINDER study illustrates what a cancer signal can lead to. Among 6,621 adults age 50 or older without signs or symptoms of cancer, the test found a signal in 92 people, or 1.4%. Thirty-five were true positives and 57 were false positives. The median time to diagnostic resolution was 79 days overall: 57 days for true-positive results and 162 days for false-positive results. The median is the middle value when observations are ordered. A positive signal could therefore trigger months of follow-up before it became clear whether cancer was present. [15]

Another study, SYMPLIFY, enrolled people urgently referred because they had possible cancer symptoms. Its findings cannot be transferred directly to screening people without symptoms. In that referred group, sensitivity was 66.3% and specificity was 98.4%. Sensitivity describes the proportion of cancers detected; specificity describes the proportion of people without cancer correctly receiving a negative result. Sensitivity ranged from 24.2% at stage I to 95.3% at stage IV. Early disease was detected least often, even though finding it is a central goal of screening. [16]

What do normal and abnormal results mean?

An abnormal or positive screening result is not a cancer diagnosis. Further testing must establish what caused it. Often there is an explanation other than cancer; how often depends on the test and the population. [1]

The next steps depend on the finding and the screening method:

  1. Screening produces a normal or abnormal result.
  2. The appropriate diagnostic follow-up is arranged, such as additional mammogram views. After a positive FIT or other stool screening test, colonoscopy is needed; repeating the stool test is not a substitute. [3]
  3. If required, further diagnostic imaging or a biopsy follows. A biopsy removes a sample of tissue for examination.
  4. The investigation establishes cancer, another explanation, or no evidence of the suspected cancer. [1]

Waiting for an answer can be distressing. In one study, false-positive mammograms were associated with greater anxiety shortly after screening, but that difference was no longer detectable at 12 months. The measured health-related utility score, a measure reflecting health and quality of life, did not fall significantly. Women with false-positive results were more likely to say that they intended to return for screening. [11]

Screening’s limits: false results and overdiagnosis

Screening can cause harm as well as help. Four terms describe the main concerns. [1]

  • A false-positive result suggests cancer when none is present. In the National Lung Screening Trial, 24.2% of low-dose CT screening examinations were positive; 96.4% of those positive results were false positives. These are findings from that trial and its criteria, not a universal rate for modern CT screening. [9]
  • A false-negative result misses a cancer that is present. A normal result therefore does not guarantee that someone is cancer-free. [1]
  • Overdiagnosis means finding a cancer that would never have caused symptoms or harm during the person’s lifetime. For mammography every two years at ages 50–74, one study estimated that 15.4% of screen-detected breast cancers were overdiagnosed, about 1 in 7. [14]
  • Overtreatment occurs when an overdiagnosed condition is treated, causing side effects without a corresponding health benefit. [1]

The more often people are screened, the greater their cumulative chance of experiencing at least one false alarm. A study of 903,495 women estimated that probability over 10 years. With annual screening, 49.6% of women receiving digital breast tomosynthesis and 56.3% receiving digital mammography were recalled at least once because of a false-positive result. Tomosynthesis is an X-ray technique that produces layered breast images. With screening every two years, the corresponding estimates were 35.7% and 38.1%. Screening interval and age had a greater effect on the probability than the imaging technology. [12]

Estimates of overdiagnosis vary widely. Across studies in a systematic review, they ranged from 0% to 54%; estimates from randomized trials ranged from 11% to 22%. These are not the same outcome as false-positive recalls. [13]

Earlier diagnosis does not necessarily mean longer life. The UKCTOCS ovarian screening trial followed 202,562 postmenopausal women for a median of 16.3 years. Annual multimodal screening using CA-125 found more cancers at an earlier stage, including 47.2% more stage I diagnoses. It did not significantly reduce ovarian or fallopian tube cancer deaths. [27]

Diagnosing the same cancer earlier automatically increases the measured time lived with the diagnosis, even if the person dies at exactly the same age. This is called lead-time bias. Survival measured from diagnosis alone is therefore not enough to establish that a screening test saves lives. [1]

How can you decide which screening is right for you?

A conversation with your clinician can put the options in context: your risk, the likely benefit of the particular test, and its possible harms. Several guidelines explicitly call for a shared decision. [1, 8]

Five questions can help:

  • What can the test detect, and what can it miss?
  • What follow-up would an abnormal result require?
  • How likely is a false-positive result for someone of my age and risk profile?
  • Does my own or my family’s medical history change the recommendation?
  • When should the test be repeated?

Frequently asked questions

What is the purpose of cancer screening?

Screening aims to find cancer early in people without symptoms, or to find precancerous changes before cancer develops. Certain breast, cervical, and colorectal tests have demonstrated benefits for defined average-risk age groups. Lung cancer screening has shown benefit in selected people at increased risk because of their smoking history. Other tests may be appropriate only for high-risk groups or remain unestablished for routine screening. [1, 2]

How is screening different from a diagnostic test?

Screening looks for cancer before symptoms develop. A screening result alone cannot reliably confirm or exclude cancer and is not a diagnosis. Diagnostic testing investigates a symptom or an abnormal screening result to establish its cause. [1]

At what age should cancer screening begin?

The starting age depends on the cancer and the guideline. The US recommendations discussed here advise colorectal screening at ages 45–75. USPSTF recommends mammography every two years for women ages 40–74; ACS starts regular screening at 45 but allows a start at 40. Cervical screening starts at 21 under the USPSTF final recommendation and at 25 under ACS guidance. Other countries, including Germany, have different programs. Personal risk or a previous abnormal result can change the schedule. [3, 4, 5, 6, 18, 28]

Who is eligible for lung cancer screening?

USPSTF recommends annual low-dose CT at ages 50–80 for people with at least 20 pack-years who currently smoke or stopped within the past 15 years. ACS uses the same age and smoking-exposure thresholds without a years-since-quitting limit. Health and willingness to undergo potentially curative treatment also matter. One randomized trial found a 20.0% reduction in lung cancer mortality compared with chest X-ray screening; another found a 24% relative reduction among men compared with no screening. [7, 8, 9, 10] See the lung cancer guide.

Does an abnormal screening result mean I have cancer?

No. It needs investigation, and another cause is often found. In the National Lung Screening Trial, 96.4% of positive low-dose CT results were false positives. A study of false-positive mammograms found greater short-term anxiety, but that difference was no longer detectable at 12 months. Neither result means follow-up can be skipped. [1, 9, 11]

How common are false-positive screening results?

The answer depends on the test and how often it is repeated. In a study of 903,495 women, the estimated chance of at least one false-positive recall over 10 years of annual mammography was 49.6% with tomosynthesis and 56.3% with digital mammography. Screening every two years produced estimates of 35.7% and 38.1%. Age and interval mattered more than technology. Cumulative false-positive rates are also higher in women ages 40–49 and those with dense breasts. These are risks accumulated across multiple screening rounds, not the chance that any one mammogram is wrong. [12, 13]

What does overdiagnosis mean?

Overdiagnosis is the detection of a cancer that would never have caused symptoms or harm during a person’s lifetime. Treating it can cause side effects without improving health. For mammography every two years at ages 50–74, one estimate put overdiagnosis at 15.4% of screen-detected cancers, approximately 1 in 7. Estimates differ substantially; randomized trials in a systematic review gave a range of 11–22%. [1, 13, 14]

Can multicancer blood tests replace established screening?

No. They do not replace guideline-recommended tests. NCI’s cited 2024 information reported no FDA authorization at that time; Galleri subsequently underwent an FDA advisory panel review in September 2026. That advisory process is distinct from final approval and from evidence of reduced mortality. [2, 29, 30]

In PATHFINDER, 92 of 6,621 adults age 50 or older without cancer symptoms had a cancer signal, but 57 of those results were false positives. In the separate SYMPLIFY study of people referred with symptoms, sensitivity ranged from 24.2% at stage I to 95.3% at stage IV. Those symptomatic-patient findings are not results from an asymptomatic screening population. [15, 16]

References

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