The Cancer Tests You Need

If you pay attention to the headlines and are proactive about your health, you’d be forgiven for being a little confused when a routine cancer screening suddenly goes out of vogue. Do you skip it? Or play it safe? This month the American College of Physicians recommended against pelvic exams, which are a regular part of any woman’s trip to the gynecologist, arguing that available data doesn’t support the need. Many disagreed, saying even benign growths are best caught early. Since the rules tend to flip-flop, here’s the latest from U.S. health authorities.

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PROSTATE CANCER

[X] Old Thinking: Men age 50 and older should get a PSA test combined with a rectal exam. Men over 75 should not.

[check] New Rule: The U.S. Preventive Services Task Force (USPSTF) recommends against PSA tests for most men, saying they provide little benefit and lead to overdiagnosis. Another option is the digital rectal exam, in which a doctor inserts a finger into the rectum to feel for abnormalities. The American Cancer Society (ACS) says men of average risk should have a conversation with their doctor about screening at age 50.

SKIN CANCER

[X] Old Thinking: Most dermatologists and the ACS recommend screening.

[check] New Rule: While it can’t hurt, the USPSTF says there’s not enough evidence to recommend regular screening. If you’re fair-skinned you are at higher risk for melanoma, and the ACS recommends checking yourself for skin changes once a month and supports doctor checks too.

LUNG CANCER

[X] Old Thinking: There is insufficient evidence that screening smokers for lung cancer provides any benefit.

[check] New Rule: In 2013 the USPSTF recommended a CT scan for heavy smokers over 55 who had smoked for 30 years or more–even if they have quit.

BREAST CANCER

[X] Old Thinking: Women should start getting yearly mammograms at age 40.

[check] New Rule: In 2009 the USPSTF recommended women get mammograms starting at age 50, arguing that too much screening was leading to overdiagnosis and unnecessary biopsies. Groups like the ACS still recommend yearly mammograms for women age 40 and up. Knowing your family history will help you and your doctor decide when you should start getting screened.

COLON CANCER

[X] Old Thinking: Anyone age 50 or older should get a colonoscopy once a year.

[check] New Rule: The USPSTF recommends screening for men and women ages 50 to 75. It recommends against screening for people age 76 and older. Some people who have a family history or genetic risks may want to consider getting screened earlier.

CERVICAL CANCER

[X] Old Thinking: The USPSTF recommends screening for cervical cancer with a Pap smear every three years for women ages 21 to 65.

[check] New Rule: The recommendation still stands, but for those who want less screening, the USPSTF says women ages 30 to 65 can choose to undergo a combination of Pap smear and HPV test every five years instead.

Sources: U.S. Preventive Services Task Force; American Cancer Society; National Cancer Institute; American College of Physicians