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GERICLINICS

Reference · Cancer screening

Cancer screening in older adults: when to screen and when to stop

Who to screen for colorectal, breast, cervical, prostate and lung cancer, with which tests, and when screening stops being worthwhile in older age, summarised from the current US Preventive Services Task Force recommendations (2018–2024). These are US recommendations: check the national programme where you practise.

Source
US Preventive Services Task Force (USPSTF) (2021) — US Preventive Services Task Force. Colorectal Cancer: Screening. Final recommendation statement, 18 May 2021. Also published as: Davidson KW, Barry MJ, Mangione CM, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(19):1965–1977. doi:10.1001/jama.2021.6238
Last updated
22 October 2026
Checked against source
22 October 2026
Clinical review
Needs clinical reviewNot yet reviewed by a clinician. Check against the source before relying on it.

Grades are shown as the source states them. USPSTF letter grades: A and B — offer the service (substantial or moderate net benefit); C — offer it selectively, by professional judgement and the person's preferences (small net benefit); D — recommends against; I — the evidence is insufficient to weigh benefits and harms. Screening ages, tests and programmes differ between countries.

Key recommendations

Diagnosis

  • The colorectal recommendations apply to adults without signs or symptoms at average risk: no previous colorectal cancer, adenomatous polyps or inflammatory bowel disease, and no known inherited syndrome such as Lynch syndrome or familial adenomatous polyposis.

    Patient Population Under ConsiderationUS Preventive Services Task Force (USPSTF) 2021

  • The breast recommendations cover women at average risk, including those with a family history or dense breasts, but not those with a high-risk genetic variant such as BRCA1 or BRCA2, chest radiotherapy at a young age, or previous breast cancer or a high-risk lesion on biopsy.

    Patient Population Under ConsiderationUS Preventive Services Task Force (USPSTF) 2024

  • Adequate prior cervical screening, in the definition the USPSTF cites from US specialty societies, means three consecutive negative cytology results or two consecutive negative co-tests in the 10 years before stopping, with the most recent within 5 years.

    Women Older Than 65 YearsUS Preventive Services Task Force (USPSTF) 2018

  • Cervical screening after 65 may be indicated when prior screening was inadequate or unknown — more likely in women with limited access to care or from countries where screening is not available — or when risk is high: a previous high-grade precancerous lesion or cervical cancer, diethylstilbestrol exposure in the womb, or a weakened immune system.

    Women Older Than 65 Years Who Have Not Been Adequately ScreenedUS Preventive Services Task Force (USPSTF) 2018

  • After a high-grade precancerous lesion has regressed or been treated, routine cervical screening continues for at least 20 years, even beyond 65. Once screening has stopped after 65, it is not restarted because of a new sexual partner.

    Women Older Than 65 YearsUS Preventive Services Task Force (USPSTF) 2018

  • For men aged 55 to 69, PSA screening is an individual decision after discussing its benefits and harms; do not screen men who do not express a preference for it.

    Grade CRecommendation SummaryUS Preventive Services Task Force (USPSTF) 2018

Investigations

  • Colorectal screening options and intervals: high-sensitivity guaiac faecal occult blood test or faecal immunochemical test (FIT) every year; stool DNA-FIT every 1 to 3 years; CT colonography every 5 years; flexible sigmoidoscopy every 5 years, or every 10 years with a yearly FIT; or colonoscopy every 10 years.

    Screening IntervalsUS Preventive Services Task Force (USPSTF) 2021

  • Serum and urine tests and capsule endoscopy are not among the recommended colorectal screening tests, because the evidence is limited.

    Screening TestsUS Preventive Services Task Force (USPSTF) 2021

  • Digital mammography and digital breast tomosynthesis (3D mammography) are both effective. Screening every 2 years has a better balance of benefit and harm than yearly screening.

    Screening Tests; Screening IntervalUS Preventive Services Task Force (USPSTF) 2024

  • For women with dense breasts and an otherwise normal mammogram, the evidence is insufficient to recommend supplemental ultrasonography or MRI.

    I statementRecommendation SummaryUS Preventive Services Task Force (USPSTF) 2024

  • Cervical screening from 30 to 65: cytology every 3 years, high-risk HPV testing every 5 years, or co-testing every 5 years.

    Grade ARecommendation SummaryUS Preventive Services Task Force (USPSTF) 2018

Treatment

  • Offer smoking cessation treatment to everyone in a lung screening programme who still smokes. Screening does not prevent most lung cancer deaths, so stopping smoking remains essential.

    Smoking Cessation Counseling; Shared Decision-MakingUS Preventive Services Task Force (USPSTF) 2021

Important geriatric considerations

  • After 75, the point at which colorectal screening stops being worthwhile depends on health status (life expectancy, other illnesses), previous screening and preferences. Modelling suggests few extra life-years are gained by screening past 75 in people already adequately screened.

    Starting and Stopping AgesUS Preventive Services Task Force (USPSTF) 2021

  • Over 85, evidence on colorectal screening is lacking, and competing causes of death probably prevent any survival benefit that would outweigh its harms.

    Starting and Stopping AgesUS Preventive Services Task Force (USPSTF) 2021

  • Bleeding and perforation from colonoscopy become more common with age; bowel preparation can cause dehydration or electrolyte disturbance, especially in older people or those with other illnesses; and incidental findings outside the colon on CT colonography may be commoner in older people.

    Harms of Screening and TreatmentUS Preventive Services Task Force (USPSTF) 2021

  • In a large trial emulation using US Medicare data, continuing mammography from 75 to 84 found more breast cancers but did not lower breast cancer deaths, probably because of competing causes of death — raising the possibility that the extra cancers were overdiagnosed.

    Harms of Screening: Age to Start or Stop ScreeningUS Preventive Services Task Force (USPSTF) 2024

  • Breast cancer remains common after 75 and breast cancer mortality rises with age, but no screening trial included women of 75 or over, and modelling and observational evidence disagree about the benefit.

    Suggestions for Practice Regarding the I StatementUS Preventive Services Task Force (USPSTF) 2024

  • In men 70 and over, trials show no reduction in prostate cancer deaths from PSA screening; harms are greater than in younger men (false positives, biopsy and treatment harms); and overdiagnosis is commonest because of competing causes of death.

    Benefits of Early Detection and Treatment; Harms of Early Detection and TreatmentUS Preventive Services Task Force (USPSTF) 2018

  • The harms of screening, diagnostic tests and treatment come soon after screening, while any benefit generally comes years later, because screen-detected prostate cancer may take years or decades to progress, if it does at all.

    USPSTF AssessmentUS Preventive Services Task Force (USPSTF) 2018

  • Lung screening trials enrolled generally healthy people, so their balance of benefit and harm may not hold for people with other illnesses.

    Screening Eligibility, Screening Intervals, and Starting and Stopping AgesUS Preventive Services Task Force (USPSTF) 2021

Drug doses

Not covered in this summary — see the original guideline.

When to refer

Red flags

Not covered in this summary — see the original guideline.

Recent updates

References

Cited in this summary, followed by other guidelines on this topic.

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