Conference Coverage

PUPC Recap—Evidence-Based Cancer Screening in Primary Care: Breast, Cervical, and Colorectal Updates for Clinicians

Edited by:
Ashton L. Stahl

Key Highlights

  • Start breast cancer screening with 2D or 3D mammography at age 40 every 1 to 2 years through age 74.
  • For dense breasts, especially BI-RADS category C or D, 3D mammography may be preferable.
  • Average-risk cervical cancer screening can include clinician-collected HPV testing every 5 years or HPV self-testing every 3 years when appropriate.
  • Stop cervical cancer screening at age 65 in average-risk patients with adequate prior normal screening.
  • Colorectal cancer screening should begin at age 45, continue through age 75, and any positive screening test should be followed by a colonoscopy.

Primary care clinicians play a central role in aligning cancer screening with patient risk, age, preferences, and current guideline-based care. In this Practical Updates in Primary Care presentation, Jeanne M. Ferrante, MD, MPH, and Nell Maloney Patel, MD, FACS, FASCRS, review breast, cervical, and colorectal cancer screening with a focus on practical implementation in routine primary care. For breast and cervical cancer, physicians need to understand the burden of disease, apply screening recommendations in average-risk women, interpret breast density categories, offer HPV self-testing when appropriate, and recognize when screening can be discontinued.

For breast cancer screening, clinicians should start mammography at age 40 and continue every 1 to 2 years through age 74 for average-risk patients. Mammography may be performed with either 2D mammography or 3D digital breast tomosynthesis. Clinicians should also recognize BI-RADS categories and breast density language on mammography reports, since dense breasts (particularly categories C and D) may reduce mammographic sensitivity and make 3D mammography preferable. For average-risk women, however, there is insufficient evidence for or against routine supplemental ultrasound or breast MRI. Physicians should also discourage screening clinical breast examinations and breast self-examinations due to false-positive findings, downstream invasive diagnostic procedures, and no improvement in 5-year survival.

Cervical cancer screening guidance highlights the growing role of human papillomavirus (HPV)-based strategies. For average-risk patients, options include clinician-collected HPV testing every 5 years or self-testing for HPV in the office or at home every 3 years, when appropriate. Vaginal HPV self-collection is not for everyone; it is acceptable for people with a cervix who are of screening age, using primary HPV testing, asymptomatic, not pregnant, not at high risk, and without abnormal uterine bleeding or discharge. Patients preparing for self-collection should not be menstruating and should avoid vaginal products, vaginal contraceptives, or condoms for 2 days before collection. If HPV 16/18 is positive, a colposcopy is recommended. For other high-risk HPV-positive results, clinician-collected samples may be referred to Pap testing, while self-collected positive results may require the patient to return for pelvic examination and Pap testing. Screening can stop at age 65 in average-risk women with adequate prior normal screening, and routine annual pelvic or bimanual screening examinations are not recommended.

For colorectal cancer, screening should start at age 45, despite some controversy, continue through age 75, and be individualized between ages 75 and 85, using risk-adjusted decision-making. Screening options include stool-based, visual, and blood-based tests, each with distinct benefits and limitations. Patients should understand the available options so they can choose the test they are most likely to complete. Regardless of the initial modality, any positive stool, blood-based, flexible sigmoidoscopy, or CT colonography finding should be followed by a colonoscopy.

Together, these updates reinforce the importance of a structured, patient-centered approach to cancer screening in primary care. By applying age- and risk-based recommendations, avoiding low-value screening practices, and ensuring timely follow-up of abnormal results, clinicians can help improve screening adherence while minimizing unnecessary testing and downstream harms. Clear communication about screening options, particularly for HPV self-collection and colorectal cancer testing, can support shared decision-making and help patients complete the screening strategy most appropriate for their risk profile and preferences.

Reference

Ferrante JM, Patel NM. Screening Smarter: Putting Evidence-Based Cancer Prevention Into Primary Care Practice. Presented at: Practical Updates in Primary Care; 2026. https://www.hmpglobalevents.com/pupc