When Adult Children Should Begin Cancer Screening

This page is for adult children whose parent has cancer. It explains the standard screening schedule and when family history changes it.

When a parent is diagnosed with cancer, adult children often want a screening plan the same week. Work in two steps. First, find out what the standard schedule would be at your age. Then find out whether your family history moves it.

For most adults at average risk, the defaults are:

• Colorectal cancer: begin at 45. ACS lists colonoscopy every 10 years, an at-home stool test each year or every 3 years depending on the test, and other options.
• Breast cancer: the USPSTF recommends mammography every other year from 40 to 74. The American Cancer Society says women 40 to 44 can choose yearly mammograms, women 45 to 54 should have them yearly, and women 55 and older can switch to every other year.
• Cervical cancer: begin at 21. The USPSTF says every 3 years at ages 21 to 29, then every 3 or 5 years depending on the test.
• Lung cancer: annual low-dose CT from 50 if you have a 20 pack-year history (for example, a pack a day for 20 years) and smoke now or quit within 15 years, per the USPSTF.
• Prostate cancer: a talk with your clinician, not an automatic test. ACS says to start that talk at 50 for average risk, and at 45 for African American men or men whose father or brother had prostate cancer before 65.

Most adult children of someone with cancer will be on exactly this schedule.

Two things can move your dates. One is the relative's age at diagnosis. The other is the pattern across the family. ACS says screening advice for people with a family history depends on who in the family had cancer and how old they were. Do not guess from a rule of thumb. Ask your clinician.

Colorectal. ACS says people with a family history of colorectal cancer are not at average risk. Some can follow the standard schedule and some need to start earlier. Your clinician can tell you which group you are in.

Breast. ACS says women whose lifetime breast cancer risk is about 20% to 25% or higher by a risk tool, or who have a known BRCA1 or BRCA2 gene change, should have a breast MRI and a mammogram every year, typically starting at 30. Ask your clinician to work out your risk.

Everything else. For most other cancers there is no earlier-start protocol, because there is no screening test to start earlier. A parent with pancreatic, kidney, or brain cancer does not translate into a screening schedule for you. It may translate into a genetic counseling referral.

According to the National Cancer Institute, up to 10 percent of cancers may be caused by inherited genetic changes. NCI says genetic counseling and testing generally begin with a family member who has had cancer.

One reason is that a test in a person with cancer can find the specific change in the family. If you test first and nothing is found, NCI says the result can be an "uninformative negative." That means it does not rule out an inherited cause.

NCI lists features that may point to an inherited cancer syndrome. They include several relatives with the same or related cancers, cancer in both of a pair of organs (both breasts, for example), rare cancers such as male breast cancer, and membership in a group known to carry certain variants. NCI says genetic testing is recommended for anyone diagnosed with triple-negative breast, ovarian, pancreatic, or metastatic prostate cancer, male breast cancer, or colorectal cancer before 50.

After a parent's diagnosis, the impulse is to test everything. Talk to your clinician before you buy any test.

Multi-cancer detection blood tests are a newer version of the same impulse. NCI states that whether these tests are effective for screening is unknown and needs to be assessed through randomized trials. No such test has FDA approval. Ask your clinician before you pay for one.

Neither replaces the tests your clinician recommends for your age and family history, such as colonoscopy, mammography, cervical testing, or lung CT.

Go to your primary care appointment with the family history written down: relative, cancer type, exact age at diagnosis, which side. Ask for a formal risk assessment rather than a general impression. Ask specifically whether you meet criteria for genetic counseling. Ask for your starting age and interval for each test in writing.

Then follow the schedule you agree on. If you notice new symptoms such as blood in your stool, a lump, or a cough that will not go away, do not wait for a scheduled test. Call your clinician. Call 911 or go to the nearest emergency department for black or tarry stool, blood in vomit or vomit that looks like coffee grounds, or bleeding that will not stop.

• NCI: What cancer screening tests check for cancer?
• USPSTF: Colorectal, Breast, Cervical, Lung and Prostate Cancer Screening recommendations
• American Cancer Society guidelines for the early detection of cancer
• NCI: Genetic testing for inherited cancer risk (fact sheet)