Your 40s and 50s: A Physician’s Guide to Cancer Screenings by Age

Submitted by Dr. Nitish Manning on January 21, 2019

Last week we talked about kicking off adulthood with suggested cancer screenings (and healthy habits), but for those who are considered “middle aged,” now’s time to concentrate on the cancer screenings that are right for you, as they could truly save your life.

My recommendations are below.

Cancer Screenings, 40 and 50

In Your 40's

Men/women:

  • Colon cancer screening: recommended if your family or genetic history indicates higher risk.  You may want to discuss with your primary care physician about early screening and/or genetic testing.

Women:

  • Cervical cancer screening: pap smear with HPV co-testing every five years (preferred) or pap smear alone every three years. A new alternative for screening to discuss with your primary care physician is high-risk HPV screening alone every five years.
  • Breast cancer screening: annual or biennial mammogram recommended if your family or genetic testing indicates higher risk.  You may want to discuss with your primary care physician about early screening.  Some individuals may benefit from genetic testing if their family history indicates higher risk as well.

Men:

  • Prostate cancer screening is not indicated, but if you have symptoms or are considered high risk (if you are African-American or have a first-degree relative with prostate cancer), you may want to discuss with your primary care physician about early screening.

In Your 50's

Men/Women:

  • Colon cancer screening: colonoscopy (preferred) every three, five or 10 years pending results and family history.  Alternatives are yearly fecal occult blood test or fecal immunochemical testing, flexible sigmoidoscopy every five years pending results, or Cologuard (stool DNA testing) every three years pending results.
  • Lung cancer screening: recommended for individuals 55-80 years with at least a 30-pack per year smoking history who are either currently smoking or who have quit within the past 15 years.  This test is done annually with a low dose contrast CT chest scan if you are a current smoker or until you have been a nonsmoker for 15 years.

Women:

  • Cervical cancer screening: pap smear with HPV co-testing every five years (preferred) or pap smear alone every three years.  A new alternative for screening to discuss with your primary care physician is high-risk HPV screening alone every five years.
  • Breast cancer screening with a recommend yearly mammogram.  Some women may be recommended to have whole breast ultrasound supplemental screening if you are considered to have dense breasts.  This should be discussed with your primary care physician.

Men:

  • Prostate cancer screening starting at age 55, you should have a discussion with your primary care physician about early screening if you have symptoms or are considered high risk (if you are African-American or have a first-degree relative with prostate cancer).  Men 55-69 years old, discuss with your primary care physician about the risks versus benefits for screening with the blood test called prostate specific antigen (PSA) and digital rectal exam (DRE).  This is usually done every one-to-two years.

The following cancers do not currently have any specific recommendations or testing for screening. So no matter your age, you should discuss family history with your physician and be very aware of related symptoms:

  • Bladder cancer
  • Oral cancer
  • Ovarian or uterine cancer-however, pending positive family or genetic history, you may want to discuss genetic testing with your primary care physician.
  • Pancreatic cancer-however, pending positive family or genetic history, you may want to discuss genetic testing with your primary care physician
  • Skin cancer- however, an individual with skin findings, positive family history or significant risk factors may want to discuss screening with a primary care physician or dermatologist
  • Testicular cancer
  • Thyroid cancer

Many patients are understandably apprehensive about testing for fear of the results, but there is some relief in being aware of your results—which are most often normal. Besides, early results can mean early intervention and therefore much better outcomes from treatment.

All adults should have a yearly check-up with a primary care physician. It is a great time to discuss all screening tests that are right for you and your health history (as well as your family’s health history). If you do not have a primary care physician, you can find one here.

Dr. Nitish J. Manning is a member of Currituck Internal Medicine and Family Practice, a part of Chesapeake Regional Medical Group. She earned her medical degree from Eastern Virginia Medical School (EVMS) in Norfolk, Va., her master’s degree in medical science from the Drexel University College of Medicine in Philadelphia, Pa. and a bachelor’s degree in biology from Richard Stockton State College of New Jersey, Pomona, N.J. She completed her internship and residency at EVMS Ghent Family Medicine and served as the Geriatric Chief resident. Dr. Manning is a member of the American Academy of Family Physicians and the American College of Physicians.