Cancer screening by age and family history

Why screening is offered by age

Most cancers become more common with age, so screening is offered at the ages where finding cancer early does the most good. The UK National Screening Committee recommends a programme only when the benefit to the people screened outweighs harms such as overdiagnosis, false positives and false reassurance [1].

Screening is for people without symptoms. A symptom is a different question, and it needs a doctor whatever your age or your last screening result.

Cancer screening in the UK by age

These are the adult cancer screening programmes the UK recommends, with the ages and intervals used in England. Details vary slightly between the four nations.

• Cervical screening, HPV testing for women aged 25 to 64 every 5 years [2]
• Breast screening, a mammogram every 3 years for women from 50 up to their 71st birthday [3] [4]
• Bowel screening, a home FIT kit every 2 years for people aged 50 to 74 [5]
• Lung screening, a low dose CT scan for people aged 55 to 74 at high risk, usually because of smoking [6]

Cancers without a population programme

There is no screening programme for ovarian cancer, because in a large UK trial screening did not reduce deaths from the disease [7]. For prostate cancer, testing is a personal decision for most men, and our guide to the PSA test sets out the benefits and limits.

For a woman with a very strong family history, or a known gene variant, a specialist may still recommend checks or preventive options outside these programmes.

How a family history changes breast screening

NICE asks doctors to take a family history covering first and second degree relatives, the cancers they had and their ages at diagnosis [8]. A single relative diagnosed with breast cancer after 40 can usually be managed without a specialist referral. A mother or sister diagnosed before 40, a father or brother with breast cancer at any age, two close relatives with breast cancer, or breast and ovarian cancer in the same family are reasons for a specialist assessment [8].

Depending on the result, NICE recommends yearly mammograms from 40 to 49 for women at moderate risk, and yearly MRI from 30 to 49 for women with a known BRCA1 or BRCA2 variant [8]. Genetic testing is offered when the chance of finding a variant in the family is 10% or more, always with genetic counselling first [8].

How a family history changes bowel screening

UK gastroenterology guidelines count a family as moderate risk when one first degree relative had bowel cancer before 50, or two had it at any age, and recommend a single colonoscopy at 55 [9]. Where at least three first degree relatives across two generations were affected, they suggest a colonoscopy every 5 years from 40 until 75 [9].

People with Lynch syndrome, an inherited condition, are offered colonoscopy every 2 years, from 25 or 35 depending on the gene involved [9]. A family history is worth checking with relatives, because the exact ages and types of cancer decide which group you are in.

Limits and risks of screening

No screening test is completely reliable. A cancer can develop between screening rounds, so it still matters to know what is normal for your body and to report changes [4]. Screening can also find cancers that would never have caused harm, which leads to treatment some people did not need, and our guide to screening harms explains how to weigh this.

Earlier or extra screening is not automatically better. Each additional test brings its own false alarms, and some, such as colonoscopy, carry a small risk of bleeding or injury, so a doctor recommends extra checks only where your family history makes the balance favourable [1].

When to see a doctor instead of waiting

A symptom should never wait for a screening invitation. NICE advises urgent assessment for an unexplained breast lump at 30 or over, and a FIT test to guide referral for a change in bowel habit, an abdominal mass, iron deficiency anaemia, or rectal bleeding with other symptoms [10]. A recent normal screening result does not rule these out.

If you are bleeding heavily, have severe pain or feel acutely unwell, call 999 in the UK or the local emergency number.

What to gather before you see a doctor

A clear family history is the most useful thing you can bring. Ask relatives where you can, and write down what you know even if some of it is uncertain.

• Which relatives had cancer, and on which side of the family
• The type of cancer and the age at diagnosis for each
• Any genetic test results in the family, such as a BRCA or Lynch syndrome variant
• Your own screening dates and results, and any symptoms
• Whether you have Jewish ancestry, which NICE notes makes a BRCA variant more likely [8]

How The Wellness can help

A GP appointment gives you time with a GMC registered doctor to go through your history and your family tree, and to agree whether any screening should start earlier or happen more often. When a specialist or genetic assessment is right, we arrange it and bring the letter back into your record.

If you want to understand your inherited risk in more depth, our genome service begins with a conversation about what testing can and cannot tell you. Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia.