Various expert guidelines don’t always align with each other. Some doctors may unnecessarily screen for conditions like prostate and lung cancer, according to a 2024 study in the Annals of Internal Medicine. Having screening tests you do not need can cause problems like anxiety or lead to additional testing or treatments with their more costs and risks. A lot of testing decisions in the current age boil down to the individual: their overall health, risk factors, and their own personal feelings about screening. This guide can help you put things in perspective.
Colorectal Cancer Screening
The gold standard screening is colonoscopy, where a doctor looks at the inside of your colon with a small internal camera. It’s typically done every 10 years between ages 45 and 75 (but more often if your doctor finds potentially cancerous polyps). There’s also flexible sigmoidoscopy, which examines only the lower part of your colon; it’s often done every five years. In addition, there are stool tests that should be done every one to three years. If these disclose suspicious issues, you’ll still need a colonoscopy.
What to know: Whichever method you and your doctor decide on, the U.S. Preventive Services Task Force (USPSTF, an independent panel of disease prevention experts) and the American Cancer Society (ACS) recommend that you screen for colorectal cancer until age 75. Between 76 and 85, talk with your doctor about whether to continue, based on your overall health and screening history. If you are over age 75 and healthy, the benefits of colorectal screening usually outweigh its risks. A 2021 study in JAMA Oncology disclosed that the likelihood of dying from colorectal cancer was more than a third lower in people over 75 who’d had a colonoscopy or a sigmoidoscopy than it was in those who didn’t have these tests. Screening isn’t recommended after age 85, but talk with your doctor about your needs.
Bone Density Scan
A bone density, or DEXA, scan is a low-dose X-ray that measures your bone strength and checks for osteopenia (low bone density) or osteoporosis (softening of bones).
What to know: Experts recommend that all women 65 or older have a baseline scan, and ongoing follow-ups as needed—like repeat testing within two years if the test shows osteoporosis. General consensus does not routinely recommend the scan for men, but groups like the Bone Health Osteoporosis Foundation and the American College of Physicians (ACP) advise that men ages 70 and older have one. Robert Adler, MD, chief of endocrinology and metabolism at the Richmond Veterans Affairs Medical Center in Virginia, recommends that most men have a baseline scan around 80, and that those with risk factors such as a past fracture do this earlier.
Mammogram
Doctors use these X-rays of the breast to look for early signs of breast cancer.
What to know: For older women at normal risk, the medical experts recommend getting a mammogram every two years from age 50 until 74—and then stopping. One group advises that women do this annually at age 45 and every two years after 55, but one may do it annually if preferred. Breast cancer is one of the leading causes of death in women over the age of 75, but there are nuances: In a 2023 study, roughly half of women in that age group whose breast cancers were found with the test were “overdiagnosed”—their cancers were so slow-growing that they didn’t end up causing problems in their lifetime. So, it is important to go over your health with your doctor when deciding, and to get a second opinion if you’re diagnosed with breast cancer.
PSA Testing
This blood test measures the amount of prostate-specific antigen protein; high levels of this substance may suggest prostate cancer.
What to know: The American Urological Association recommends shared decision-making—where you discuss pros and cons with your doctor—until age 69. There is less agreement after that. In men with less than a 10-to-15-year life expectancy, the downsides of continuing PSA screenings likely outweigh possible benefits. There’s a greater risk of overtreatment—treating a cancer that may never cause illness in a person’s lifetime —in older men, which can cause unpleasant side effects like bladder, bowel, and sexual function problems.
Pap Test
Here, doctors take a sample of women’s cervical cells to check for microscopic abnormalities that may lead to cancer.
What to know: The American College of Obstetricians and Gynecologists advises a Pap test every three years, or a Pap plus a human papillomavirus test or an HPV-only test (the preferred option) every five years, until age 65 for those women with a cervix. After that, the groups advise stopping if one have had a decade of negative screening results. But it is wise to continue for up to a decade if one is not up to date with these screenings by age 65. A 2023 study found that nearly 1 in 5 new cervical cancers are in women ages 65 and older. These women also had more advanced cancers, and higher death rates, than younger women.
Coronary Calcium Screening
This imaging test measures calcified plaque in arteries. (Too much plaque can restrict blood flow to the heart and cause a stroke or heart attack.)
Who should consider it: People between ages 40 and 70 at increased risk for heart disease, with at least one risk factor (obesity; past tobacco use; a history of high cholesterol, high blood pressure, or diabetes; or a family history of heart disease). Some people who are younger than 40 but have high cholesterol in their family may want this screening. These tests are becoming more common all the time, are relatively inexpensive but they aren’t covered by all insurers.
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