Family history: when cancer screening starts earlier

Outside the USPSTF average-risk advice. Our screening planner and age charts use USPSTF grade A and B recommendations only (Method), so they do not move a start age for family history. Use this page to prepare questions for your doctor.

At a glance

Screening start ages with a family history, by cancer, USPSTF compared with specialty groups
Cancer	USPSTF (average risk)	With a family history
Colorectal	From 45 (USPSTF, 2021)	Colonoscopy every 5 years from 40, or 10 years before the relative's diagnosis, if a first-degree relative was diagnosed before 60 or 2 were at any age (USMSTF, 2017)
Breast	Mammogram every 2 years, 40 to 74, also with a first-degree relative (USPSTF, 2024)	Yearly MRI and mammogram, usually from 30, at high risk (such as a lifetime risk of about 20% to 25% or more, or a BRCA gene change) (ACS, 2026)
Prostate	PSA decision at 55 to 69 (grade C) (USPSTF, 2018)	Talk about it at 45 if a father or brother was diagnosed before 65; at 40 if more than one was (ACS, 2023)
BRCA (breast, ovarian)	No start age: a brief family risk check for women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or a related ancestry (grade B) (USPSTF, 2019)

Colorectal cancer

The USPSTF recommends screening from 45 for adults at average risk. It lists a family history of colorectal cancer, even without a known inherited syndrome, among the things that raise risk, and says all adults 45 and older should be offered screening. Its statement does not cover people with a known inherited syndrome such as Lynch syndrome or familial adenomatous polyposis. (USPSTF, 2021) See colorectal cancer screening by age.

In its summary of other groups' advice, the USPSTF statement notes the family-history ages of the US Multi-Society Task Force on Colorectal Cancer, which speaks for three gastroenterology societies. (USPSTF, 2021) Its 2017 advice:

A first-degree relative with colorectal cancer or an advanced adenoma (a higher-risk polyp) diagnosed before 60, or 2 first-degree relatives at any age: colonoscopy every 5 years, starting at 40 or 10 years before the youngest relative's diagnosis, whichever is earlier. (USMSTF, 2017)
One first-degree relative diagnosed at 60 or older: the average-risk test options, starting at 40. (USMSTF, 2017)

How the "10 years before" rule works: if your brother was diagnosed at 45, 10 years earlier is 35, which comes before 40, so the start age under this rule would be 35. The same 2017 paper set 50 as the average-risk start; that part has since moved to 45 in USPSTF and ACS advice, while its family-history rule is the one the 2021 USPSTF statement summarizes. (USMSTF, 2017) (USPSTF, 2021)

The American Cancer Society has no separate schedule for people at increased risk. It says some people with a family history can follow average-risk advice, while others may need colonoscopy only, more often, and possibly before 45, depending on who in the family had cancer and at what age. (ACS, 2026)

Breast cancer

The USPSTF recommends a mammogram every 2 years from 40 to 74 (grade B). It says this applies to women with a first-degree relative with breast cancer, but not to those with a known genetic marker or syndrome, or chest radiation at a young age. (USPSTF, 2024) See breast cancer screening by age.

The American Cancer Society advises a breast MRI and a mammogram every year, typically from 30, for women at high risk, including those who: (ACS, 2026)

have a lifetime risk of about 20% to 25% or more on risk tools based mainly on family history;
have a known BRCA1 or BRCA2 gene change;
have a first-degree relative with a BRCA1 or BRCA2 gene change and have not been tested themselves;
had radiation therapy to the chest before 30.

Medicines that lower breast cancer risk are a separate USPSTF recommendation: medicines to lower breast cancer risk.

BRCA: the family risk check

The USPSTF recommends that clinicians use a brief family risk tool for women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or an ancestry linked to BRCA1 or BRCA2 gene changes. A positive result leads to genetic counseling and, if indicated after counseling, genetic testing (grade B). For women without such a history or ancestry, it recommends against routine assessment, counseling or testing (grade D). (USPSTF, 2019) See BRCA risk assessment.

Prostate cancer

The USPSTF calls PSA screening at 55 to 69 an individual decision (grade C). It names older age, African American race and a family history of prostate cancer as the most important risk factors, but found the evidence inadequate to say whether the benefit differs for these men, or whether starting before 55 helps. (USPSTF, 2018) See prostate cancer screening by age.

The American Cancer Society advises starting the conversation with a doctor about screening at: (ACS, 2023)

50 for men at average risk;
45 for men at high risk, including African American men and men whose father or brother was diagnosed before 65;
40 for men with more than one first-degree relative diagnosed at an early age.

Not only cancer: diabetes

The USPSTF screens adults 35 to 70 with overweight or obesity for prediabetes and type 2 diabetes (grade B). It says clinicians should consider screening earlier in people with a family history of diabetes, a history of gestational diabetes or polycystic ovary syndrome, and in groups with higher rates of diabetes. (USPSTF, 2021) See diabetes screening by age.

What to find out before the visit

The American Cancer Society says cancer in first-degree relatives (parents, brothers, sisters, children) matters most, but more distant relatives can matter too; 2 or more relatives with the same cancer, or a diagnosis at a younger age than usual, is more concerning. (ACS, 2024) So it helps to bring, for each relative who had cancer:

how they are related to you (parent, sibling, child, grandparent, aunt, uncle);
which cancer, or which kind of polyp;
how old they were when it was found;
any genetic test result in the family, such as a BRCA or Lynch syndrome finding.

Only your doctor can say what this means for you.

Questions people ask

At what age should I get a colonoscopy if my parent had colon cancer?

If the parent was diagnosed before 60, the US Multi-Society Task Force advises a colonoscopy every 5 years starting at 40, or 10 years before the age your parent was diagnosed, whichever comes first. If the parent was diagnosed at 60 or older, it says you can use the usual test options, starting at 40. Your doctor sets the plan. (USMSTF, 2017)

My mother had breast cancer. Do I start mammograms earlier?

The USPSTF advice of a mammogram every 2 years from 40 also applies to women whose mother, sister or daughter had breast cancer. The American Cancer Society advises a yearly MRI plus mammogram, usually from 30, for women at high risk, such as a lifetime risk of about 20% to 25% or more on tools that rely mainly on family history. Ask your doctor to estimate your risk, and about a BRCA risk assessment. (USPSTF, 2024) (ACS, 2026) (USPSTF, 2019)

My father had prostate cancer. When should I talk about a PSA test?

The American Cancer Society says to start the conversation at 45 if your father or brother was diagnosed before 65, and at 40 if more than one of them was. The USPSTF found the evidence inadequate to say whether starting before 55 helps men at higher risk. (ACS, 2023) (USPSTF, 2018)

Does a grandparent or cousin with cancer count?

Close (first-degree) relatives, meaning parents, brothers, sisters and children, matter most, but more distant relatives can matter too. The American Cancer Society says 2 or more relatives with colorectal cancer, or a relative diagnosed younger than usual, is more concerning than 1. (ACS, 2024)

Does diabetes in my family change when I get tested?

The USPSTF screens adults 35 to 70 who have overweight or obesity, and says clinicians should consider screening earlier in people with a family history of diabetes. (USPSTF, 2021)

Family history: when screening starts earlier