Screening and race or ethnicity: what the guidelines say
Most screening ages are the same for everyone. A few guidelines mention race or ethnicity, usually to describe higher risk or to explain a choice of age. This page collects those notes in the guidelines' own terms and adds no ages of its own. The USPSTF describes race and ethnicity as social rather than biological categories that are still often important predictors of health risk, and names structural racism as a source of health inequities. (USPSTF, 2024)
At a glance
| Screening | What the guideline says | Different age? | Source |
|---|---|---|---|
| Breast | Black women are about 40% more likely to die of breast cancer than White women; starting at 40 is a first step, with equitable follow-up and treatment | No: 40 for all | USPSTF, 2024 |
| Prostate (PSA) | No separate recommendation for African American men; inform them of higher risk | No (USPSTF); ACS: talk from 45 | USPSTF, 2018 ACS, 2023 |
| Colorectal | Black adults have the highest incidence and death rates; the start age of 45 applies to everyone | No: 45 for all | USPSTF, 2021 |
| Lung | The lower age (50) and pack-years (20) widen eligibility most for Black and Hispanic adults | No: same criteria | USPSTF, 2021 |
| Diabetes | Consider earlier screening in groups with higher prevalence; BMI 23 or more for Asian Americans | Possibly earlier, at your clinician's judgment | USPSTF, 2021 |
| Glaucoma (Medicare coverage) | Covered yearly for African American adults 50 and older and Hispanic adults 65 and older, among others at high risk | Coverage rule, not a USPSTF age | Medicare.gov |
Breast cancer
The USPSTF recommends a mammogram every 2 years from 40 to 74 for all women. It notes that Black women are more likely to be diagnosed beyond stage 1, more likely to have aggressive triple-negative cancers, and about 40% more likely to die of breast cancer than White women. It calls starting at 40 an important first step that is not enough on its own: people with abnormal results need equitable follow-up, including biopsies, and effective treatment. (USPSTF, 2024)
Prostate cancer
The USPSTF names older age, African American race and family history as the most important risk factors. African American men are more likely to develop prostate cancer and more than twice as likely to die of it as White men. The USPSTF says it cannot make a separate recommendation for African American men because no direct evidence shows whether screening helps them more; models suggest it may, including when starting before 55. It calls it reasonable for clinicians to tell African American men about their higher risk and the possible benefits and harms. (USPSTF, 2018)
The American Cancer Society sets the age for a screening talk at 50 for average risk, 45 for men at high risk, including African American men, and 40 for men at even higher risk. (ACS, 2023) See prostate cancer screening.
Colorectal cancer
Black adults have the highest colorectal cancer incidence and death rates of any group the USPSTF reports, at every age including under 50. The USPSTF found little evidence on screening results by race. Some other groups had recommended starting at 45 for Black adults and 50 for others; the USPSTF's 2021 recommendation starts everyone at 45, including Black adults. (USPSTF, 2021)
Lung cancer
The USPSTF notes that Black people who smoke have a higher lung cancer risk than White people who smoke, especially at lower smoking levels, and that Hispanic people who smoke tend to build up fewer pack-years. Lowering the start age to 50 and the threshold to 20 pack-years in 2021 widened eligibility by 107% for Black adults and 112% for Hispanic adults, compared with 78% for White adults, which may partly reduce racial gaps in who qualifies. (USPSTF, 2021)
Diabetes
The USPSTF recommends screening at 35 to 70 with overweight or obesity. It says to consider screening earlier for people from groups with a higher prevalence of diabetes (American Indian or Alaska Native, Asian American, Black, Hispanic or Latino, and Native Hawaiian or Pacific Islander), or with a family history, past gestational diabetes or polycystic ovary syndrome. For Asian American adults it says a BMI of 23 or more may be the right cut point for overweight. (USPSTF, 2021) Our screening plan uses the 23 cut point in its overweight question.
What this means for you
Race or ethnicity is one factor among several: your family history, health history and preferences also shape your plan; see family history and screening. If one of these notes applies to you, bring it to your doctor; shared decision-making covers how those talks work. This page is educational only, not medical advice.
Questions people ask
When should Black women start mammograms?
At 40, like all women under the USPSTF 2024 recommendation (every 2 years to 74). The USPSTF notes that Black women are about 40% more likely to die of breast cancer than White women, and calls starting at 40 an important first step, along with timely follow-up and treatment. (USPSTF, 2024)
When should Black men start talking about PSA testing?
The American Cancer Society says at 45 for men at high risk, including African American men. The USPSTF makes no separate recommendation for African American men, but says a reasonable approach is to tell them about their higher risk and the possible benefits and harms of screening. (ACS, 2023) (USPSTF, 2018)
Should Black adults start colon screening earlier?
Under the USPSTF, everyone starts at 45, including Black adults. It notes that some other groups had recommended 45 for Black adults while others started at 50; its 2021 recommendation set 45 for all. (USPSTF, 2021)
Why does diabetes screening use a lower BMI for Asian Americans?
The USPSTF says a BMI of 23 or more may be the right cut point for Asian American adults, because BMI can underestimate risk given differences in body composition. (USPSTF, 2021)