While the pandemic stopped many of us from safely giving our loved ones hugs, it also interrupted life-saving medical care and routine healthcare appointments, like cancer screenings.
A 2022 report by the American Association for Cancer Research says the pandemic resulted in nearly 10 million missed cancer screenings from January 2020 to July 2020. Per a Prevent Cancer Foundation survey released last summer, annual physicals, mammograms, Pap/HPV tests and skin checks were among the top missed appointments during the pandemic.
These delays could be deadly; researchers predict an additional 2,500 deaths due to breast cancer because of missed screenings.
The AACR report also notes that these delays exacerbated existing racial, gender and class disparities around cancer diagnosis and treatment.
One thing is certain: Cancer screening saves lives, especially for older patients and those with specific risk factors. When used effectively, early detection of precancerous lesions or early-stage cancers can help doctors stop the spread of the disease and treat it with less aggressive interventions.
Here’s a comprehensive guide on who should get screened for some of the most globally common cancers, and when.
Who decides how screenings work?
You’ll need different cancer screenings depending on your age, sex and specific risk factors.
The U.S. Preventive Service Task Force (USPSTF), an independent volunteer panel of expert physicians, makes evidence-based recommendations on clinical preventive services, including screenings for diseases like cancer. The task force isn’t a government agency, and its findings aren’t binding, but its recommendations are considered the gold standard in preventive medicine.
Dr. Carol M. Mangione, USPSTF vice chair and a professor of medicine and public health at UCLA, says the team takes an individual look “at each type of cancer” to determine screening recommendations.
At times, screening for certain cancers can actually be detrimental to healthy, low-risk people. Screening can lead to overdiagnosis and unnecessary interventions, which come with their own risks and adverse effects. (For instance, an “unnecessary surgery” could cause issues in the moment or down the road.)
After balancing the benefits and harms of preventative interventions, the task force assigns each intervention a grade, which it reevaluates periodically as methods and treatments evolve. An A or B grade means a screening is recommended, while a C grade means it is recommended for certain patients based on consultation with their doctor. A D grade is “not recommended.” An I grade, for “insufficient,” means there isn’t enough evidence for the USPSTF to issue a recommendation one way or the other.
USPSTF recommendations pertain to asymptomatic persons without specific risk factors. Patients with a family history of a certain cancer, or those with a particular risk factor like smoking, should follow recommendations from their primary care provider.
If you’re headed back to the doctor and want to know about routine screenings, here’s a list of important cancer screenings recommended by the USPSTF. These procedures are endorsed by other major medical organizations, like the Centers for Disease Control and Prevention and the American Cancer Society.
Who: Cisgender women and some intersex and trans people, 21 to 65 years
When: Every three years
Cervical cancer, which occurs in the lower part of the uterus where it connects to the vagina, is caused by various strains of the human papillomavirus (HPV). Though it was once a leading cause of death in women, the Pap smear, a simple screening procedure, has dramatically decreased rates of cervical cancer.
Women 21 to 65 should get screened every three years with cervical cytology, aka a Pap smear or Pap test, in which a small number of cells are collected from the cervical wall and inspected under a microscope to detect abnormalities. Women above 30 should also get a separate test for high-risk HPV (hrHPV) every five years.
The USPSTF recommends against cervical cancer screening for women under 21, women who have had a hysterectomy and women older than 65 years.
Read the full recommendations on cervical cancer screenings from the USPSTF.
Cost: This screening is generally covered by insurance. The Affordable Care Act mandates that health insurers cover women’s preventive healthcare, including cervical cancer screening, though the law doesn’t cover plans that were in place before 2011.
Most insurance providers cover an annual gynecology exam for women. Still, check with your insurance provider ahead of time. Out-of-pocket costs range, but clinics like Planned Parenthood may offer low-cost or free screenings near you.
For: All adults 45 to 75 years; selectively for adults 76 to 85 years
When: Every 10 years for colonoscopy, more frequently for other tests
Colorectal cancer, which can start in the colon or rectum, affects more than 200,000 people in the US each year and disproportionately affects African Americans, especially Black men.
Colorectal screenings can be done with a colonoscopy, where a small camera on a flexible tube is inserted into the rectum. The camera allows the doctor to see the entire inside of the colon, which helps them find and remove polyps, which are small growths on the colon wall. Polyps are typically noncancerous but over time could turn into cancer. Regular screening can catch those polyps early, so they can be monitored or removed.
That dual use makes colonoscopy the gold standard for screening, explains Dr. Stephen Szabo, an oncologist and director of the Division of Community Oncology at Emory University School of Medicine. “It’s a screening procedure, and it’s also therapeutic,” he says. “Once you’ve taken the polyp away, it won’t develop into cancer.”
Colonoscopies are recommended every 10 years for people who don’t have increased risk for colorectal cancer.
Other screenings for colorectal cancer include stool tests, where a sample of fecal matter is tested for blood or altered DNA, and sigmoidoscopy, a less invasive version of colonoscopy that only looks at the lower part of the large intestine. At-home DNA test kits like Cologuard are endorsed as a screening method for healthy, low-risk people, and can be done every three years following a negative result. Positive results are typically followed by a colonoscopy.
Read the full recommendations on colorectal cancer screenings from the USPSTF.
Cost: These screenings are generally covered by insurance. The ACA requires insurers to cover colorectal cancer screening, though this doesn’t apply to plans in place before 2011 and may not cover all types of screenings.
The cost of a colonoscopy without insurance can be upward of $1,000, but there are several financial assistance programs that can lower costs. At-home tests like Cologuard are available out of pocket for around $600; they may be covered by your insurance, but check if your insurer will also cover the follow-up colonoscopy if your test comes back positive.
For: Cisgender women and some intersex and trans people, 45 to 74 years
When: Biennial (every other year)
Recommendations for breast cancer screening have changed in recent years. There is still some disagreement on when women should start getting biennial mammograms, essentially an X-ray of the breast tissue used to find potentially cancerous lumps.
The American Cancer Society recommends all women begin biennial mammograms at age 45. The USPSTF recommends all women begin screening at 50, noting that women between 40 and 49 should decide with their doctor based on individual risk.
Why the slight difference in recommendations for average-risk women? A half-century of frequent and early breast cancer screenings have led to concerns about overdiagnosis. This occurs when a patient is diagnosed with breast cancer even though the detected mass would not have progressed to symptomatic cancer in their lifetime. This in turn can lead to unnecessary invasive surgeries and other treatments, as well as the profound stress caused by a cancer diagnosis. Because age is the single most important risk factor for breast cancer, the benefits of screening outweigh the costs as women grow older.
Women with a close family history of breast cancer, or who have the BRCA1 or BRCA2 gene mutations linked to higher risk of breast and ovarian cancer, should consult with their PCP about how often to screen.
“If you know you have those genes, or have a mother or sister with breast cancer, you’re at much higher risk, so you’re outside of the normal breast cancer screening recommendations,” says Mangione.
What about breast exams by hand? Research hasn’t shown a clear benefit for self–breast exams, and the American Cancer Society recommends against clinicians doing breast exams. But at-home breast exams can’t hurt, says Szabo, because they help you notice any changes in your body over time. “It’s your way of knowing about your body,” he says, “whether you’re looking for cancer or something else.”
Read the USPSTF’s latest recommendations on breast cancer screenings.
Cost: Per the ACA, health insurers must cover biennial mammograms for women 50 years and older, and for younger women on recommendation from their doctor. Be sure to check which kind of mammogram you’re getting ahead of time. Newly introduced 3-D mammograms are more effective in catching breast cancer in women 65 and older, but this new technology may not be fully covered by your insurance provider.
Out-of-pocket costs for 2-D mammograms range from $150 to $250. Low-cost or free breast exams are also offered through the National Breast and Cervical Cancer Early Detection Program.
For: Adults 50 to 80 who have a 20–pack year smoking history and currently smoke OR who quit heavy smoking in the last 15 years
Though lung cancer can occur in people who never or very rarely smoked, around 80 percent of lung cancer deaths are thought to result from smoking. This makes smoking the single most important factor in determining whether to screen for lung cancer.
The term pack year is specific: It measures the amount someone has smoked over a lengthy period of time by multiplying the number of packs smoked daily by the number of years a person smoked. A 20–pack year could mean smoking one pack a day for 20 years, or smoking two packs a day for 10 years.
Lung cancer screening is done with a CT scan, which shows your medical provider the inside of your body. The scan takes a few minutes, and the doctor evaluates images for any signs of early cancer in the lungs.
For populations not in this group, the risks of screenings — including overdiagnosis and radiation from routine CT scans — outweigh the benefits.The USPSTF recommends against screening for the general population, as well as people who quit smoking over 15 years ago or who have developed a health problem that limits willingness or the ability to have curative lung surgery.
Experts also recommend against screening patients over 80, because life expectancy and lung cancer survival rate begin to converge at this age. Still, certain individuals over 80 may benefit from ongoing screening.
Read the full recommendations on lung cancer screening from the USPSTF.
Cost: For people who meet high-risk criteria, lung cancer screening is covered by Medicare and most private insurance plans. This guide from the American Lung Association can help determine whether you qualify. Out-of-pocket costs for lung cancer screening average about $600, but costs range widely depending on where you go for screening.
Why is the list of cancer screenings so short?
You may be wondering: That’s it? Many people assume the more screening, the better. But it’s not quite that simple, says Mangione.
“You need to see if the screening test makes a difference in detecting cancer, and if there’s a difference in mortality,” she explains.
In some cases, screening tests aren’t effective at catching cancer early, and can lead to false positives and unnecessary treatment. Only a small number in those instances lead to lives saved from catching cancer early. Pancreatic cancer, which has a low survival rate, doesn’t have a very effective screening test. It can find lesions on the pancreas but can’t readily tell whether they’re precancerous. For this reason, the USPSTF gives the screening a D rating, meaning it only recommends people with genetic risk factors or a family history of pancreatic cancer get screened.
Another interesting case is skincare screening, which involves a full-body examination by a dermatologist. The USPSTF has concluded there isn’t enough evidence for or against this type of screening, with Mangione stressing that this applies to a healthy, asymptomatic adult.
Experts recommend keeping track of any changes in your skin, like suspicious moles, and adhering to healthy skincare habits, like regular sunscreen use and limiting direct sun exposure.
If a patient is worried about an issue, “a primary care doctor can help determine whether they need to see a dermatologist and consider getting a biopsy done,” Mangione says. If you’re worried, you can also book an appointment directly with a dermatologist to get a skin check.
Will cancer screenings get better?
Yes. Cancer screening recommendations will change over time, especially as more effective tests make preventive screenings more useful in general populations, says Szabo. Many current tests are limited by the nature of imaging, he adds. By the time a test detects the cancer, there are typically already millions of cancerous cells in the body.
Not too far into the future, he hopes, medical providers should be able to “draw someone’s blood” and “pick up cancers so small that we’ll be able to make better interventions.”
In the meantime, follow the recommended screenings for your age group. Stay on schedule to stay one step ahead of the diagnosis that no one ever wants to hear.