Updated October 2025

Cancer Prevention

Preventive Care and Cancer Screening: 2024–2025 Updates and Practical Takeaways

Key updates include USPSTF biennial mammography starting at age 40, evolving evidence on life-years gained from screening, and refined guidance for lung and colorectal cancer screening. Evidence underscores benefits with important harms trade-offs; implementation gaps persist, particularly in rural and underserved populations.

Clinical question

What are the most clinically relevant updates in preventive care and cancer screening (2024–2025), and how should they guide practice?

USPSTFbreast cancerlung cancercolorectal cancerscreeningimplementationhealth equity

Key points

USPSTF breast cancer screening shifts earlier

Biennial mammography for women 40–74 shows a moderate net benefit; shared decision-making remains vital for 75+ and high-risk groups ^[1], ^[3].

Life-years gained vary by test

Across 2.1M participants, sigmoidoscopy prolonged life by ~110 days, while FIT and mammography did not show significant gains in RCTs with long follow-up; interpretation requires context of non-mortality benefits and trial-era modalities ^[5].

Lung cancer LDCT remains beneficial

LDCT is associated with a ~20% relative reduction in lung cancer mortality vs CXR (NLST), informing updated ACS guidance and expanded risk considerations ^[12].

Implementation gaps persist

Breast screening rates improved in 2023, while cervical and colorectal fell; tailored remote interventions increase rural screening uptake ^[8], ^[4].

Technology and modality nuances matter

Evidence reviews compare digital breast tomosynthesis vs digital mammography, with differences in detection patterns and recall; outcomes vary by age and risk ^[3].

Evidence highlights

USPSTF now recommends biennial 40–74 y ^[1]

Breast: Start age

CRC sigmoidoscopy +110 days; FIT and mammography no significant gain in RCT meta-analysis ^[5]

Life-years gained

LDCT reduces mortality vs CXR; ACS guideline updated 2023 ^[12]

Lung screening

Breast ↑; cervical and colorectal ↓ in US adults ^[8]

Uptake (2023)

Practice Priorities

What to do differently this year

Concise, action-focused guidance aligned with new evidence and observed utilization trends.

Start routine mammography at 40 and continue biennially through 74

Discuss benefits and harms, especially false positives and overdiagnosis; consider annual screening for very high-risk individuals outside the general-population USPSTF scope, guided by risk models and specialty guidelines ^[1], ^[3].

Use LDCT for eligible adults at elevated lung cancer risk

Confirm smoking exposure criteria and longevity; re-emphasize adherence to annual LDCT and structured nodule follow-up pathways, given mortality benefit and updated ACS considerations on age and cessation duration ^[12].

Reinforce colorectal cancer screening at ≥45

Offer choice of high-sensitivity stool tests vs visual exams. Highlight that RCTs show life-years gained with sigmoidoscopy (~110 days); contextualize limited life-year signals for FIT in trial data while emphasizing strong observational and stage-shift benefits ^[5].

Close care gaps with remote and tailored outreach

Leverage text/phone/web tailored interventions that increase rural screening completion and reduce disparities; integrate navigation for insurance and logistics ^[4], ^[8].

Counsel on prevention beyond screening

Address tobacco cessation, weight management, physical activity, HPV vaccination, and consider chemoprevention when indicated; these measures remain core cancer prevention strategies ^[2].

Evidence Highlights

Key Updates and Effect Sizes

Where evidence is strongest, mixed, or limited—and what it means for clinicians.

Breast Screening (USPSTF 2024)

Recommendation: Biennial mammography, ages 40–74; moderate net benefit ^[1].

Evidence review notes modality differences; DBT may reduce recalls and alter stage distribution vs DM, but mortality impact data remain limited ^[3].

Mortality reduction established historically; ongoing debate on all-cause mortality effects in trials ^[6], ^[5].

Life-Years Gained Meta-analysis (JAMA IM 2024)

Sigmoidoscopy: +110 days estimated lifetime gain; strong RCT base ^[5].

FIT and mammography: no significant lifetime gain in long-term RCTs; interpret with caution due to adherence, crossover, and contemporaneous treatments ^[5].

Estimate pertains to population averages; individual benefit varies by baseline risk and test performance ^[5].

Lung Cancer Screening (ACS 2023)

LDCT efficacy: ~20% relative mortality reduction vs CXR (NLST) underpinning recommendations ^[12].

Updated guidance discusses cessation >15 years, screening past 80, and radiation-risk tradeoffs; shared decision-making emphasized ^[12].

Utilization Trends (2023–2024)

Breast screening up-to-date rates increased; cervical and colorectal decreased, highlighting need for outreach and navigation ^[8].

Remote, tailored interventions improve screening completion in rural populations ^[4].

Harms and Trade-offs

Breast: false positives, overdiagnosis, additional imaging/biopsy; consider DBT to reduce recalls where available ^[1], ^[3].

Lung: false positives, incidental findings, radiation; structured LDCT programs mitigate harms ^[12].

CRC: colonoscopy complications (bleeding/perforation) vs noninvasive test adherence advantages ^[5].

Prevention Beyond Screening

Behavioral: weight control, physical activity, tobacco cessation ^[2].

Chemoprevention: selective use (e.g., aspirin, SERMs/aromatase inhibitors) in appropriate risk groups; balance benefits and bleeding or thrombotic risks ^[2].

References

Source material

Primary literature that informs this article.