Cancer Prevention and Early Detection Nursing CE Course

ive alcohol consumption. Each of these factors will be discussed in this section (ACS, 2023c; American Association for Cancer Research [AACR], 2024; WHO, 2022).

Tobacco Use

Tobacco use is the leading preventable cause of cancer and cancer-related death in the United States. Approximately 34 million adults in the United States smoke cigarettes, and over 1,600 adolescents under the age of 18 initiate smoking each day (ACS, 2025d). Smoking is associated with approximately 81% of lung cancer deaths. It is causally linked to at least 15 cancer types, including cancers of the mouth, throat, larynx, esophagus, pancreas, bladder, kidney, cervix, liver, and stomach. All cancer deaths related to tobacco are avoidable (Siegel et al., 2025).

Tobacco smoke contains more than 7,000 chemicals, with at least 70 identified carcinogens. In addition to active smoking, exposure to secondhand smoke remains a public health threat. Each year, approximately 58 million nonsmokers in the United States are exposed to secondhand smoke, resulting in an estimated 7,300 lung cancer deaths among nonsmokers (ACS, 2024b). Tobacco products—including e-cigarettes, hookahs, and smokeless tobacco—are unsafe alternatives. E-cigarettes (i.e., vapes, vaping) produce aerosols containing nicotine, heavy metals, and volatile organic compounds that are inhaled deep into the lungs. These products can damage lung tissue, increase inflammation, and may contribute to the development of cancer and cardiovascular disease. Even without tobacco content, e-cigarettes are regulated by the FDA as tobacco products due to their potential health risks (ACS, 2024b, 2024e).

People who stop smoking experience immediate and long-term health benefits, including a decreased risk of developing lung cancer. For people already diagnosed with cancer, quitting improves survival and reduces the risk of recurrence by up to 40%. Table 1 outlines the benefits of smoking cessation (ACS, 2025d; Centers for Disease Control and Prevention [CDC], 2024a).

Table 1

Benefits of Quitting Smoking

Time Since Quitting…	Health Benefits
20 minutes	Blood pressure and heart rate begin to decline
12 hours	Carbon monoxide levels normalize
2–12 weeks	Circulation and lung function improve
1–9 months	Coughing and shortness of breath decrease
1 year	Risk of coronary heart disease drops by half
5–10 years	Risk of mouth, throat, and laryngeal cancer declines by 50%
10 years	Risk of dying from lung cancer is 50% lower than that of a smoker
15 years	Risk of coronary heart disease is similar to that of a nonsmoker

(ACS, 2025d; CDC, 2024a)

Clinical Practice Recommendations for Cancer Prevention (ACS, 2024f; Devonish et al., 2022):

• All tobacco products—including cigarettes, cigars, smokeless tobacco, and e-cigarettes—pose serious health risks and are strongly linked to multiple cancer types.
• E-cigarettes are not recommended as a cessation method due to insufficient evidence of long-term safety and effectiveness.
• All healthcare professionals (HCPs) should counsel every tobacco user at every clinical encounter to quit. Culturally sensitive and personalized cessation guidance should be tailored to each patient’s readiness and preferences.
• All adults who smoke should be advised to quit immediately and remain tobacco-free.
• Combining pharmacotherapy with behavioral counseling is the most effective strategy for long-term cessation. Telephone counseling doubles the success rate of quit attempts compared to unassisted quitting.
• Several US Food & Drug Administration (FDA)–approved cessation medications are available:
  • Over-the-counter (OTC): nicotine patches, gum, lozenges
  • Prescription-only: nicotine nasal spray, nicotine inhaler, bupropion (Zyban), and varenicline (Chantix)
  • Oral bupropion (Wellbutrin) or varenicline (Chantix) is preferred, especially when paired with individual or group counseling
• Free national and state resources provide accessible support:
  • 1-800-QUIT-NOW (National Quitline Network)
  • New York State Smokers’ Quitline
  • ACS Quit Services at 1-800-227-2345
• The National Cancer Institute (NCI) quit-smoking app helps users set quit dates, track progress, manage cravings, and receive motivational support.

Elevated BMI and Physical Inactivity

Elevated BMI is a well-established risk factor for at least 13 different cancers, including those of the breast (particularly in postmenopausal females), colon, rectum, endometrium (uterine), esophagus, gallbladder, kidney, liver, and pancreas. Defined by excess fat accumulation in relation to height, obesity is typically diagnosed using BMI. A BMI between 25.0 and 29.9 kg/m² is categorized as overweight, whereas a BMI of 30 kg/m² or above defines obesity. The biologic mechanisms linking elevated BMI to cancer are multifactorial. Excess adipose tissue contributes to chronic low-grade inflammation, increased insulin and insulin-like growth factor (IGF-1) levels, elevated estrogen and other sex hormones, suppressed immune function, and oxidative stress and DNA damage. These metabolic disruptions promote a cellular environment that supports tumor development and progression. The longer a person maintains an elevated BMI, the greater their cumulative cancer risk. Currently, nearly 42% of US adults meet the diagnostic criteria for obesity. Obesity-related cancers account for approximately 40% of all annual cancer diagnoses in the United States (ACS, 2025a; CDC, 2025c; World Cancer Research Fund International, 2023).

Endometrial cancer has the most direct correlation with elevated BMI. More than 80% of endometrial cancer cases worldwide are attributed to excess body weight (Derbyshire et al., 2022). Previously considered a cancer primarily affecting postmenopausal females, endometrial cancer is increasingly being diagnosed in premenopausal populations, paralleling global trends in BMI. A key factor is that estrogen is produced and stored in fat tissue; higher levels of adiposity result in greater estrogen availability (hyperestrogenism), which contributes to endometrial tumorigenesis. Elevated BMI not only raises cancer risk but also negatively affects outcomes for patients already diagnosed, worsening long-term prognosis and complicating treatment response (Derbyshire et al., 2022).

Physical inactivity is a separate and independent risk factor for several cancers, including colon, breast, and endometrial cancer. Regular physical activity helps regulate insulin sensitivity, reduce inflammation, and improve immune surveillance. It also plays a key role in maintaining a lower BMI, which further lowers cancer risk. In combination with exercise, a healthy diet supports cancer prevention by reducing chronic inflammation and modulating metabolic pathways. Dietary patterns associated with a reduced cancer risk emphasize high consumption of fruits, vegetables, whole grains, and legumes, as well as minimal intake of red and processed meats, refined carbohydrates, and sugar-sweetened beverages. Together, weight management, physical activity, and nutrition form a triad of modifiable lifestyle factors that can significantly reduce the risk of cancer and improve outcomes for survivors (ACS, 2025a; CDC, 2025c; WCRF/AICR, 2023).

Clinical Practice Recommendations for Cancer Prevention (ACS, 2025a; WCRF/AICR, 2023):

• Maintain a healthy body weight throughout adulthood, aiming for a BMI between 18.5 and 24.9 kg/m².
• Avoid weight gain in adulthood, especially after age 18.
• Engage in regular physical activity:
  • Aim for at least 150–300 minutes of moderate or 75–150 minutes of vigorous aerobic activity per week.
  • Additional health and cancer prevention benefits are observed at the upper end of this range.
• Include strength-training exercises at least twice per week to maintain muscle mass and metabolic health.
• Reduce sedentary behavior:
  • limit screen time and prolonged sitting
  • incorporate light-intensity movement throughout the day (e.g., walking breaks, stretching, standing)
• Consume a predominantly plant-based diet and consider portion control to prevent overconsumption and support long-term weight maintenance:
  • prioritize vegetables and fruits; consume at least 2.5 cups per day
  • consume whole grains, legumes, and nuts instead of refined products
  • limit red meat (especially processed meats such as cold cuts, hot dogs, bologna, sausage, etc.) and sugar-sweetened beverages
• Set goals, track behaviors, and utilize community resources to support lifestyle changes.
• HCPs should routinely assess physical activity and body weight, provide education, and refer patients to nutrition and exercise programs when appropriate.

Alcohol

Alcohol is the third most significant preventable cause of cancer, following tobacco use and elevated BMI. According to the ACS (2025a), alcohol is responsible for roughly 6% of all cancer diagnoses and 4% of cancer-related deaths in the United States. Its carcinogenic effects are well established, and it has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC; Gapstur et al., 2023). Cancers associated with alcohol consumption include those of the breast, liver, colon, rectum, mouth, pharynx, larynx, esophagus, stomach, pancreas, and oropharynx. The risk rises with increasing alcohol intake over time, regardless of the type of alcoholic beverage consumed. In other words, it is the amount of alcohol—not whether it is wine, beer, or spirits—that influences cancer risk (ACS, 2025a).

Alcohol promotes cancer through several biologic mechanisms (ACS, 2025a; Gapstur et al., 2023):

• direct irritation of the tissues in the mouth, throat, and esophagus, which makes it easier for other carcinogens—such as those in tobacco smoke—to penetrate cell walls
• conversion to acetaldehyde, a toxic metabolic by-product that can damage DNA and interfere with cellular repair
• increased estrogen levels may contribute to hormone-related cancers such as breast cancer
• impairment of nutrient absorption, especially folate, a B-complex vitamin critical for DNA synthesis and cell repair
• synergistic effects with smoking multiply the risk of cancers of the upper digestive and respiratory tracts

Folate deficiency, in particular, plays a significant role in alcohol-related carcinogenesis. Folate is essential for the production of red blood cells, DNA replication, and cellular repair. The body absorbs folate primarily through the small intestine, and it is stored in the liver. Chronic alcohol use interferes with this process, reducing folate absorption and disrupting the cellular processes that depend on it. A sustained deficiency can impair normal cell development and lead to mutations, thereby increasing the risk of cancer (Shulpekova et al., 2021). The relationship between alcohol and cancer is dose-dependent, meaning the risk increases in proportion to lifetime consumption. Even moderate drinking has been shown to elevate cancer risk, especially for breast and CRCs. Reducing or eliminating alcohol consumption can meaningfully lower the risk of multiple cancer types and improve long-term health outcomes (ACS, 2025a).

Clinical Practice Recommendations for Cancer Prevention (ACS, 2025a; Shulpekova et al., 2021):

• Reinforce that limiting or eliminating alcohol can reduce the risk of developing cancer, particularly when combined with other healthy lifestyle behaviors.
• Females should limit alcohol intake to no more than one standard drink per day.
• Male patients should limit alcohol intake to no more than two standard drinks per day.
• A standard drink is defined as:
  • 12 ounces of beer
  • 5 ounces of wine
  • 1.5 ounces of 80-proof distilled spirits
• Counsel all patients about the link between alcohol and cancer risk.
• Encourage complete abstinence for high-risk individuals (e.g., those with liver disease, breast cancer gene 1 (BRCA1) and BRCA2 mutations, or prior cancers).
• Perform alcohol use screening and provide resources for treatment when appropriate.

UV Radiation

UV radiation—both from the sun and artificial sources, such as tanning beds—is the leading environmental risk factor for skin cancer. It plays a critical role in the development of basal cell carcinoma, squamous cell carcinoma, and melanoma by damaging DNA in skin cells, leading to mutations that promote cancer. Prolonged exposure to UV radiation, especially UVA and UVB rays, accelerates skin aging, impairs immune function, and increases the risk of skin malignancies. UVA rays penetrate deep into the skin, contributing to DNA mutations and aging, while UVB rays are more superficial but more directly linked to sunburn and DNA damage. Both contribute to carcinogenesis, and their effects are intensified by cumulative, unprotected exposure (ACS, 2024c; Curiel-Lewandrowski, 2025; Sathe & Zito, 2025).

The risk of developing UV-related skin cancers increases significantly with certain characteristics and behaviors such as:

• fair skin, light-colored hair, and eyes
• a tendency to burn rather than tan
• a history of blistering sunburns, particularly in childhood
• indoor tanning beds
• residence near the equator or at high altitudes
• immunosuppression (e.g., HIV, post-organ transplant)
• genetic syndromes such as xeroderma pigmentosum
• history of therapeutic ionizing radiation exposure (ACS, 2024g; Sathe & Zito, 2025)

UV radiation can damage unprotected skin in as little as 15 minutes, although visible signs, such as sunburn, may not appear for 12 to 24 hours. A tan, even without a burn, signals skin damage. Moreover, UV rays can penetrate light clothing, windows, and water, and reflect off surfaces like snow, sand, and concrete, making shade and cloud cover unreliable sources of protection (Curiel-Lewandrowski, 2025). Indoor tanning presents an especially high risk. The IARC classifies UV-emitting tanning devices as Group 1 carcinogens, the highest cancer risk category. Regular use is strongly linked to early-onset melanoma, especially in young females (ACS, 2024c; American Academy of Dermatology [AAD], 2023).

Certain individuals are more vulnerable to UV-related skin cancers and require targeted education and surveillance. These groups include the following:

• people with Northern European ancestry and lighter pigmentation
• individuals with a personal or family history of skin cancer
• those who spend significant time outdoors for work or recreation
• organ transplant recipients and immunocompromised individuals
• people with HIV or genetic conditions affecting DNA repair (ACS, 2024c, 2024g; Curiel-Lewandrowski, 2025)

Clinical Practice Recommendations for Cancer Prevention (ACS, 2024c, 2024g; Curiel-Lewandrowski, 2025; Sathe & Zito, 2025):

• Avoid intentional UV exposure, including sunlight and artificial sources like tanning beds and sunlamps.
• Do not use indoor tanning devices.
• Sun safety strategies:
  • limit sun exposure, especially during peak UV hours between 10 a.m. and 4 p.m.
  • seek shade whenever possible when outdoors during high UV times
• Use the “slip, slop, slap, and wrap” approach:
  • slip on protective clothing (long sleeves, long pants, or skirts; darker fabrics offer better protection)
  • slop on broad-spectrum sunscreen (SPF 30 or higher); reapply every 2 hours and after swimming or sweating
  • slap on a wide-brimmed hat (at least 2–3 inches) to protect the face, ears, and neck
  • wrap on UV-blocking sunglasses to protect eyes and surrounding skin
• No sunscreen provides complete protection; combining sunscreen use with clothing and shade is essential for optimal safety.
• Educate patients about the cumulative effects of sun damage and the risks of UV exposure that can begin in childhood.
• Encourage routine skin assessments for individuals with high-risk features (e.g., fair skin, family history, history of sunburns or tanning bed use).
• Advocate for protective behaviors year-round, including on cloudy days and in high-reflectivity environments (e.g., snow, water, sand).
• Reinforce that UV damage can occur even through windows and in shallow water.
• Perform monthly total body skin examinations (TBSEs; refer to the next section).

Skin Self-Examination and Early Detection. While UV protection is essential, early detection remains a cornerstone of skin cancer control. The US Preventive Services Task Force (USPSTF, 2023) has issued an “I” statement, indicating that current evidence is insufficient to determine whether visual skin examinations by HCPs effectively reduce skin cancer–related morbidity or mortality in asymptomatic individuals without a personal history of skin cancer. The USPSTF recommendation applies specifically to adults and adolescents who are not experiencing skin-related symptoms and who have no previous history of precancerous or cancerous lesions. Therefore, TBSEs are not routinely included in annual physical exams by nondermatology providers. This neutral stance should not be confused with discouragement of skin exams. Instead, it reflects the need for more rigorous research, particularly randomized controlled trials, to assess the long-term benefit of visual screening in reducing deaths from skin cancer. Importantly, the USPSTF recommendation does not extend to higher-risk groups, including individuals with a prior skin cancer diagnosis. In such cases, clinical judgment remains paramount (USPSTF, 2023).

Although the USPSTF (2023) does not endorse self-examinations as a preventive measure due to insufficient evidence, several authoritative organizations—including the AAD, the ACS, and the Melanoma Research Alliance—advocate for monthly skin self-exam as a practice strategy for early detection. Self-examinations enable individuals to become familiar with their skin’s appearance and identify changes early (AAD, 2023; ACS, 2024g; Melanoma Research Alliance, n.d.). The AAD (2023) recommends monthly checks in a well-lit room, using both a full-length and a handheld mirror. Tools such as body mapping diagrams or mobile apps can be helpful in tracking moles and identifying new or changing lesions. Patients are encouraged to bring their skin maps or digital images to clinical appointments (AAD, 2023). Resources such as the AAD’s “SPOT Skin Cancer” campaign offer free tools, including body maps and educational guides, to help patients learn and maintain this important self-care practice (AAD, 2022). To perform a thorough self-examination, patients should be taught to (AAD, 2022, 2023):

1.            Examine the entire body (front and back) in a full-length mirror.

2.           Inspect underarms, forearms, and palms.

3.           Check the legs, between the toes, and the soles of the feet.

4.          Use a hand mirror to examine the scalp, neck, and back.

5.          Examine the buttocks and genital area using mirrors as needed.

Refer to the Skin Cancer Nursing CE course for more information on this topic.

Human Papillomavirus

HPV is one of the most common sexually transmitted infections and a leading cause of several types of cancer. Nearly all cervical cancers are attributed to HPV, and the virus also plays a substantial role in oropharyngeal, anal, vulvar, vaginal, and penile cancers. In the United States alone, more than 35,000 new cases of HPV-related cancers are diagnosed each year. HPV is so prevalent that approximately 80% of individuals will contract it at some point in their lives. Although many HPV infections resolve without clinical consequence, persistent infection with a high-risk HPV type can lead to the development of precancer and invasive malignancy. The virus spreads through intimate skin-to-skin contact and often remains asymptomatic, making prevention through vaccination critically important (ACS, 2024d; CDC, 2025a).

The Gardasil 9 vaccine is currently the only FDA-approved HPV vaccine available in the United States. It protects against nine HPV types—seven of which are high-risk cancer-causing strains and two of which cause genital warts. When administered before exposure, Gardasil 9 can prevent over 90% of HPV-related cancers, as well as most precancerous lesions and genital warts. The vaccine is most effective when given prior to the onset of sexual activity and initial exposure to HPV (ACS, 2024d; CDC, 2025a). The HPV vaccine has an excellent safety profile and is a powerful tool in cancer prevention. HCPs play a crucial role in promoting HPV vaccination by educating patients and caregivers, dispelling myths, and ensuring timely administration. Their role is especially critical in schools, pediatric practices, and community health settings where vaccine outreach and compliance can make a population-level impact.

Clinical Practice Recommendations for Cancer Prevention (ACS, 2024d; CDC, 2024b, 2024c, 2025a):

• The CDC (2021, 2024b, 2024c) and the Advisory Committee on Immunization Practice (ACIP) recommend routine vaccination at ages 11–12, although it may begin as early as age 9.
  • Dose schedule:
    • 2-dose series (0, 6–12 months) for individuals initiating the series before their 15th birthday
    • 3-dose series (0, 1–2, 6 months) for those starting at age 15 through 26, and for immunocompromised persons at any eligible age
    • Catch-up vaccination is recommended through age 26
    • For adults aged 27–45, vaccination may be offered under shared clinical decision-making but is not routinely recommended.
• The ACS (2024d) fully endorses the CDC/ACIP recommendations for routine vaccination at age 11–12, with flexibility to start at age 9 for higher uptake.
  • Recommends vaccination for all persons between the ages of 9 and 12 and catch-up through age 26
• Vaccinating individuals prior to exposure to the virus is significantly more effective at preventing HPV-related cancers than vaccinating adults.
• The HPV vaccine (Gardasil 9) protects against nine HPV types, including high-risk strains that cause over 90% of cervical, anal, vulvar, vaginal, penile, and oropharyngeal cancers.
• HCPs, especially nurses, should provide vaccine counseling, address common myths and misconceptions, and ensure that patients complete their vaccine series.
• HPV vaccination is a safe and evidence-based cancer prevention tool that should be routinely offered in pediatric, school-based, and adolescent health settings.

Please refer to the Human Papillomavirus (HPV) Nursing CE course for more information on this topic.

 

Nonmodifiable Risk Factors

Nonmodifiable cancer risk factors are inherent traits or conditions that individuals cannot change but that significantly influence their likelihood of developing cancer. Among these, advancing age is the most important. As individuals grow older, their risk of cancer increases substantially due to the cumulative effects of cellular damage over time and the declining efficiency of DNA repair mechanisms. According to the NCI (2025a), cancer incidence rises from fewer than 26 cases per 100,000 individuals under age 20 to approximately 350 cases per 100,000 among those aged 45–49. It exceeds 1,000 cases per 100,000 in those aged 60 and older. This age-related rise in risk reflects a lifetime of exposure to carcinogens, increased oxidative stress, and age-related changes in immune surveillance and gene regulation (GBD 2019 Cancer Risk Factors Collaborators, 2022; Yarbro et al., 2018).

Family history and inherited genetic mutations are also key nonmodifiable factors. Individuals with a strong family history of certain cancers—especially when diagnosed at a young age—may be at higher risk due to shared genetic variants or inherited cancer syndromes. For example, mutations in BRCA1 and BRCA2 genes dramatically increase the risk of breast and ovarian cancers, whereas Lynch syndrome (caused by mutations in mismatch repair genes) is linked to elevated risks of CRC, endometrial, and other cancers. These mutations disrupt critical biologic functions, such as DNA repair, apoptosis, and cell cycle regulation, thereby creating conditions for unchecked cellular proliferation (NCI, 2025b; Yarbro et al., 2018).

Another nonmodifiable factor is inherited immune system dysfunction or immunosuppression due to genetic or medical conditions. Individuals born with immune deficiencies or those who undergo long-term immunosuppressive therapy following organ transplantation are more vulnerable to certain cancers, including lymphomas and virus-associated malignancies like Kaposi sarcoma. In these populations, impaired immune surveillance reduces the body’s ability to identify and eliminate abnormal cells before they develop into cancer. Cancer is ultimately a disease of genetic mutations, and although many mutations are acquired over a lifetime, a portion are inherited and unavoidable. These inherited mutations can occur in several classes of genes that regulate cellular behavior, including proto-oncogenes, tumor suppressor genes, and DNA repair genes. Proto-oncogenes, when mutated, become oncogenes that drive excessive cell growth. Tumor suppressor genes, such as TP53, normally act as brakes on cell division; however, when inactivated, they allow uncontrolled proliferation. Defects in DNA repair genes, such as those associated with Lynch syndrome or ataxia-telangiectasia, prevent the correction of DNA replication errors, allowing mutations to accumulate over time (Yarbro et al., 2018).

While nonmodifiable factors cannot be changed, their presence can inform clinical decisions about screening, surveillance, and risk-reducing interventions. Genetic counseling and testing are recommended for individuals with strong family histories or known hereditary cancer syndromes. Understanding these fixed risk factors allows HCPs to personalize prevention strategies and initiate earlier detection protocols, ultimately improving outcomes (GBD 2019 Cancer Risk Factors Collaborators, 2022; Yarbro et al., 2018).

The Role of Nurses in Cancer Prevention and Early Detection

Nurses, including advanced practice registered nurses (APRNs), are essential contributors to cancer prevention and early detection across the care continuum. Serving in diverse health care settings—from primary care to oncology specialty clinics—they are uniquely positioned to assess cancer risk, provide patient education, and implement timely interventions that support improved health outcomes. As frontline providers, nurses frequently serve as the first point of contact for patients, enabling them to identify risk factors and promote evidence-based lifestyle changes. In primary prevention, nurses educate patients about modifiable behaviors that influence cancer risk, administer vaccines such as HPV and hepatitis B, and support sustainable health behaviors. They also offer tailored guidance on nutrition, physical activity, and sun safety, empowering patients to make informed decisions that reduce cancer risk. In secondary prevention, nurses play a critical role in promoting and facilitating cancer screening. They help patients understand the purpose and timing of screening exams, clarify the benefits of early detection, and reinforce adherence to evidence-based guidelines. By addressing common barriers such as fear, misinformation, or limited health literacy, nurses enhance compliance with screening recommendations and increase the likelihood of early diagnosis (Yarbro et al., 2018).

Beyond education and prevention counseling, nurses are trained to perform comprehensive assessments that detect early warning signs of cancer. Their clinical expertise allows them to identify symptoms that may indicate malignancy, recognize patients with hereditary cancer syndromes or significant family histories, and initiate appropriate referrals for diagnostic evaluation or genetic counseling. For those already diagnosed with cancer, nurses are central to symptom management, care coordination, and emotional support throughout the treatment journey. In survivorship, they continue to monitor for recurrence, manage late or long-term effects, and reinforce health maintenance strategies (Yarbro et al., 2018).

Nursing practice standards emphasize the importance of competency in cancer prevention and control. The Oncology Nursing Society’s Scope and Standards of Practice encourages continuing education in cancer risk assessment, screening interpretation, and personalized prevention strategies. Additionally, nurses play a pivotal role in delivering culturally responsive care, ensuring that prevention messaging and care plans are adapted to the unique values, beliefs, and health practices of diverse populations. Outside of clinical settings, nurses contribute to public health through outreach and advocacy. They participate in community-based initiatives to increase awareness, reduce disparities, and expand access to screening and prevention services. Collaborating with schools, faith-based groups, and local organizations, nurses extend their impact by organizing health education sessions, facilitating low-cost screening events, and connecting individuals to needed resources. Through these roles, nurses not only support individual patients but also advance broader population-level cancer control efforts (Lubejko et al., 2019; Yarbro et al., 2018).

Cancer Risk Assessment

Cancer risk assessment is a personalized process that evaluates an individual’s likelihood of developing cancer based on a combination of intrinsic and extrinsic factors. This assessment is essential to guiding preventive strategies, screening recommendations, and, in some cases, referrals for genetic counseling or prophylactic interventions. A comprehensive cancer risk assessment begins with a detailed review of the patient’s medical, surgical, family, and social history. Particular attention is given to family history, ideally including a three-generation pedigree that documents cancer diagnoses, age at diagnosis, and affected relatives. This information helps identify features consistent with hereditary cancer syndromes, such as hereditary breast and ovarian cancer (HBOC) or Lynch syndrome, both of which may warrant heightened surveillance or genetic testing (ACS, 2023c; NCI, 2024b).

Additional components of a complete assessment include the following:

• reproductive and medication history, such as the use of hormone replacement therapy (HRT)
• lifestyle factors, including tobacco use, alcohol consumption, diet, and physical activity
• environmental and occupational exposures
• history of previous cancer screenings, such as mammograms, colonoscopies, Pap tests, or LDCT scans

Together, these elements provide a comprehensive view of the patient’s modifiable and nonmodifiable risk factors. Risk estimates may vary over time, depending on changes in health status, exposures, or the discovery of new family history information (ACS, 2023c; NCI, 2024b).

Cancer Risk Assessment Tools

A variety of cancer risk prediction models are available to help HCPs and patients estimate cancer risk and guide individualized screening recommendations. These tools are based on population data, epidemiologic modeling, and clinical criteria and can be either site-specific or generalized. Some are suitable for use in the general population, while others are specifically designed to identify individuals with hereditary cancer predispositions.

It is essential to note that different models employ varying sets of criteria and datasets, which may yield different risk estimates for the same individual. Furthermore, most tools provide risk projections rather than definitive predictions, and estimates may change as more personalized data (e.g., genetic testing or evolving medical history) becomes available. A few examples of cancer risk-assessment tools are outlined in Table 2 (ACS, 2023c; NCI, 2025b).

             

Table 2

Cancer Risk Assessment Tools

 

Tool	Cancer Type	Description
Gail Model	Breast Cancer	estimates a female’s 5-year and lifetime risk of developing breast cancer widely used in clinical practice but not appropriate for those with BRCA mutations or a history of prior breast cancer
Breast Cancer Risk Assessment Tool (BRISK)	Breast Cancer	calculates a female’s estimated risk of invasive breast cancer over 5 years and to age 90 not validated for BRCA mutation carriers or those with a history of breast cancer
Colorectal Cancer Risk Assessment Tool (CCRISK)	CRC Cancer	estimates 5-year and lifetime CRC risk for individuals aged 45–85 who are White, Black, Asian American/Pacific Islander, or Hispanic/Latino not validated for Indigenous populations
PREMM5	Hereditary Lynch Syndrome Predictor	clinical prediction model that estimates the likelihood of a germline mutation in Lynch syndrome–associated genes (e.g., MLH1, MSH2, MSH6, PMS2, EPCAM) used to guide referral for genetic testing

(ACS, 2023c; Dana-Farber Cancer Institute, n.d.; NCI, 2024b, n.d.)

Online Tools and Clinical Resources

The NCI Division of Epidemiology and Genetics (n.d.) offers several validated cancer risk calculators for HCPs and the public. These include models for breast and CRC, as well as tools for lung cancer risk estimation based on age, smoking history, and comorbidities. Additionally, newer tools are emerging that incorporate genetic and molecular data to refine risk predictions for hereditary cancer syndromes. Health care institutions, such as the Dana-Farber Cancer Institute and Johns Hopkins Medicine, have developed proprietary online risk calculators for site-specific cancers, including prostate cancer and BRCA-related breast and ovarian cancers, providing tools to support shared decision-making between patients and HCPs. These tools are not only useful in specialty oncology settings but are also valuable for primary care and preventive medicine, where early identification of high-risk individuals can facilitate timely referrals and interventions (Dana-Farber Cancer Institute, n.d.; Johns Hopkins Medicine, n.d.). Cancer risk assessment is a cornerstone of personalized cancer prevention and early detection. When performed systematically and supplemented with validated risk prediction tools, it allows HCPs to tailor education, counseling, and screening recommendations to each individual. Nurses, particularly APRNs, are uniquely positioned to implement these assessments, interpret findings, and collaborate with patients on proactive cancer risk management strategies (Yarbro et al., 2018).

Cancer Screening

Cancer screening involves interventions implemented after a disease has begun but before symptoms appear (i.e., in the asymptomatic stage of disease). Secondary prevention aims to identify cancer early in its development, thereby reducing morbidity and mortality and improving outcomes. Based on the biologic and clinical understanding that a long incubation period is required for the development of malignant tumors, screening is recommended when there is substantial evidence that early diagnosis and treatment of asymptomatic disease will reduce mortality or disease severity. The sooner a cancer is detected, the more effective the treatment will be. Developments in early detection and screening practices have generated highly specialized techniques that can identify tissue changes, cancer precursors, and early-stage tumors. Early detection dramatically increases the chances of successful treatment and the potential for a cure. Millions of cancer patients could be saved from premature death and suffering if they had timely access to early detection and treatment (AACR, 2024; NCI, 2024a; Yarbro et al., 2018).

As with all medical interventions, screening does confer some risks. HCPs must ensure that patients are fully informed and understand the benefits and risks of cancer screening and their odds of developing cancer. The decision to perform routine screening tests should be based on whether the test is adequate to detect a potentially curable cancer in an otherwise asymptomatic person and is cost-effective. Screening decisions should be based on an individual’s age, sex, family history of cancer, ethnic group or race, previous iatrogenic factors (prior radiation therapy), and history of environmental carcinogens. In cases of diagnosed cancer, continued surveillance and screening remain essential for the early detection of new and recurrent cancers (AACR, 2024; NCI, 2024a; Yarbro et al., 2018).

Various cancer screening guidelines have been developed by credible organizations and are based on clinical research evidence and expert consensus. While there are some variations, the guidelines are relatively consistent in their recommendations. The ACS is one of the most widely utilized, comprehensive, evidence-based resources for cancer care. The ACS publishes an annual report that summarizes recommendations for cancer screening, which will be discussed in this section (ACS, 2023c, 2025c).

Breast Cancer

Aside from skin cancers, breast cancer remains the most common cancer among females in the United States, comprising nearly 30% of all new female cancer diagnoses in 2025. The ACS estimates that approximately 316,950 new cases of invasive breast cancer will be diagnosed in 2025, 59,080 cases of ductal carcinoma in situ (DCIS), and 42,680 deaths (ACS, 2025b). Among females, breast cancer is the second leading cause of cancer mortality after lung cancer. The lifetime risk of invasive breast cancer remains around 13%, or 1 in 8 (National Breast Cancer Foundation, 2025). Over the past decade, the incidence of invasive breast cancer has risen by roughly 1% per year, while mortality rates have been gradually declining, reflecting improvements in early detection and treatment. Screening plays a pivotal role. Cancers detected through routine mammography tend to be smaller and confined to the breast, which significantly improves survival odds (ACS, 2023b, 2023c, 2025e).

An independent risk factor of breast cancer is breast density. Females with dense breasts are at higher risk of breast cancer since dense breast tissue appears more glandular and fibrous than fatty tissue and can obscure tumors on mammograms. Both dense tissue and cancerous tumors can appear white on the mammography images, making it more difficult to decipher normal findings from cancer (Susan G. Komen, n.d.). Evidence supports beginning screening mammography at age 40 and continuing annually rather than biennially. Starting earlier and screening yearly yields the greatest mortality reduction, particularly in premenopausal patients. For postmenopausal patients, annual screening yields no significant benefit over biennial screening, except for those on HRT. Females aged 55 and older may choose between yearly or biennial mammograms, based on their personal preference and health context. There is no set age to stop screening; females 75 and older may continue if their health status and life expectancy warrant it (ACS, 2023b, 2023c, 2025e).

To optimize mammogram accuracy, timing is important. Individuals should avoid screenings in the week before or during the menstrual cycle and refrain from using deodorants, sprays, or powders before the exam. All patients should be informed about the benefits, limitations, and risks of mammography before starting screening. Regular breast self-awareness—recognizing one’s normal texture—and timely reporting of changes such as lumps, skin alterations, or nipple discharge are essential components of early detection (ACS, 2023b, 2023c, 2025e).

Summary of Breast Cancer Screening Recommendations

According to the ACS (2023b, 2023c), females at average risk for breast cancer—defined as those without a personal history of breast cancer, a confirmed genetic mutation (e.g., BRCA1 or BRCA2), or a history of chest radiation at a young age—should follow an age-based screening protocol as follows (ACS, 2023b, 2023c):

• Females aged 40 to 44 should have the option to begin annual mammography based on individual preference and risk-benefit discussions with their HCP.
• For those aged 45–54, annual mammography is recommended.
• For those aged 55 and older, the recommendation is to transition to mammograms every two years or continue with annual screenings, depending on personal preference and health status.
• Screening should continue as long as the patient is in good health and is expected to live at least 10 more years.

Patients at higher-than-average risk for breast cancer should begin enhanced screening earlier and more frequently. This includes annual magnetic resonance imaging (MRI) scans, typically combined with mammography, starting at age 30. High-risk factors include any of the following (ACS, 2023b, 2023c, 2025c):

• a lifetime breast cancer risk of at least 20%, based on models such as the Gail or Tyrer-Cuzick tools
• a known BRCA1 or BRCA2 mutation
• those with a first-degree relative with a BRCA1 or BRCA2 mutation who have not undergone genetic testing themselves
• a history of radiation therapy to the chest between ages 10 and 30 (e.g., treatment for Hodgkin lymphoma)
• a personal or family history of Li–Fraumeni syndrome, Cowden syndrome, or Bannayan–Riley–Ruvalcaba syndrome, or a first-degree relative with one of these genetic conditions

For females meeting any of the aforementioned criteria, annual screening with both mammography and breast MRI is recommended, beginning at age 30 and continuing as long as they remain in good health. Note that patients who have not undergone genetic testing but who have a first-degree relative with a BRCA mutation are advised to follow the high-risk screening protocol. These dual-modality screenings offer increased sensitivity for early breast cancer detection in high-risk populations (ACS, 2023b, 2023c, 2025c).

The USPSTF (2024) breast cancer screening guidelines have some important variations from the ACS recommendations, which are as follows:

• Biennial screening mammography is recommended for females aged 40–75 years (Grade B).
• There is insufficient evidence to assess the balance of benefits and harms of screening mammography for females aged 75 years or older.
• There is insufficient evidence to support the routine use of supplemental screening for breast cancer using breast sonography or MRI in females with dense breasts on an otherwise negative screening mammogram.

Lung Cancer

Lung cancer is the second most commonly diagnosed cancer among all sexes and continues to be the leading cause of cancer-related death (Siegel et al., 2025). According to the ACS, an estimated 226,650 new cases of lung cancer will be diagnosed in 2025, and approximately 124,730 deaths are expected, accounting for nearly one in five cancer deaths. Although lung cancer primarily affects individuals aged 65 and older, incidence rates have declined in recent years due to reduced smoking rates and progress in early detection and treatment. Despite these advancements, lung cancer still causes more deaths each year than breast, prostate, and pancreatic cancers combined (ACS, 2025h; Siegel et al., 2025).

While tobacco is the most significant risk factor for lung cancer, including active smoking and prolonged exposure to secondhand smoke, non–smoking-related risk factors are also substantial and include the following (CDC, 2025b; Siegel et al., 2025):

• Radon exposure: Radon, a naturally occurring radioactive gas released from soil and rock, is the second leading cause of lung cancer overall and the primary cause among nonsmokers in the United States. It is colorless, odorless, and tasteless, making it difficult to detect without proper testing.
• Occupational and environmental exposures: Carcinogens such as asbestos, diesel exhaust, arsenic, beryllium, cadmium, silica, and nickel compounds are known to increase the risk of lung cancer. Long-term exposure to these substances often occurs in industrial and construction settings.
• Radiation therapy to the chest: Prior therapeutic radiation—especially in individuals treated for breast cancer or Hodgkin lymphoma—increases the long-term risk of developing lung cancer.
• Genetic and familial factors: A family history of lung cancer may also increase susceptibility, particularly when combined with other exposures.

Summary of Lung Cancer Screening Recommendations

People at increased risk of lung cancer, primarily those with a history of smoking, may benefit from annual lung cancer screening tests. The ACS (2023d) and the USPSTF (2021b) recommend yearly screening for lung cancer using LDCT in individuals who meet all the following criteria:

• aged 50–80 years
• currently smoke or have quit within the past 15 years
• have at least a 20-pack-year smoking history (refer to Box 1)

In addition, the USPSTF (2021b) recommends that people who undergo screening also:

• receive smoking cessation counseling if they are current smokers, and
• are informed about the potential benefits, limitations, and harms of screening with LDCT scans, and
• have access to a high-volume, high-quality lung cancer screening and treatment center

Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability to undergo curative lung surgery. Smoking cessation counseling is of utmost importance for current smokers, who should be informed of their ongoing risk of lung cancer and adverse health outcomes with continued smoking. Screening should not be viewed as an alternative to smoking cessation. All current smokers should be assessed for readiness to quit and referred to smoking cessation programs (ACS, 2023d; USPSTF, 2021b).

Box 1

Calculating Pack-Years based on Smoking History

 

A pack-year is defined as one pack of cigarettes per day per year. This is calculated by multiplying the number of packs of cigarettes smoked each day by the number of years smoked. For example, a person who smoked three packs per day for 10 years (3 × 10 = 30) has 30 pack-years of smoking history. Similarly, a person who smoked one pack of cigarettes per day for 30 years or two packs per day for 15 years would also have a 30 pack-year smoking history.

 (ACS, 2023d, 2025c)

Colorectal Cancer

Excluding skin cancers, CRC is the third most common cancer diagnosed among adults. The lifetime risk of developing CRC is about 1 in 24 for males and 1 in 26 for females. The ACS estimates there will be 107,320 new cases of colon cancer and 46,950 new cases of rectal cancer in 2025. Since the mid-1980s, the overall rate of CRC diagnoses in the United States has steadily declined, largely due to increased uptake of screening and positive changes in lifestyle behaviors that influence cancer risk. Between 2012 and 2021, CRC incidence rates fell by approximately 1% annually; however, among individuals younger than 50, the incidence has actually risen by about 2.4% per year during the same period. CRC remains a major cause of cancer-related deaths in the United States, ranking as the second leading cause of cancer death overall. In 2025, CRC is expected to be responsible for approximately 52,900 deaths (ACS, 2025g; Siegel et al., 2025).

While death rates have declined significantly among older adults, driven by improvements in screening and treatment, the trend is different for younger populations. In adults under age 55, mortality has been increasing by about 1% per year since the mid-2000s. This shift may be related to the rising incidence in this age group and delayed diagnoses due to lower screening rates. Screening plays a critical role in reducing both incidence and mortality by allowing for early detection and removal of precancerous polyps and by identifying cancer at an earlier, more treatable stage. Advances in surgical techniques, chemotherapy, immunotherapy, and targeted therapies have also contributed to improved patient outcomes over recent decades (ACS, 2025g; Siegel et al., 2025).

Summary of CRC Screening Recommendations

The ACS guideline for CRC screening recommends that average-risk adults aged 45 years and older undergo regular screening. Screening can be performed via a high-sensitivity stool-based test or a structural (visual) exam (e.g., colonoscopy) based on personal preferences and test availability. All positive results on noncolonoscopy screening tests should be followed by a timely colonoscopy (ACS, 2024a). Recommendations for individuals at average risk include the following:

• Begin regular screening at age 45. Individuals with good health and a life expectancy of 10 years or more should continue through age 75.
• For individuals aged 76–85, screening decisions should be personalized, considering the patient’s health, prior testing, and individual preferences.
• Screening is not advised past age 85.

Individuals at elevated or high risk of CRC should start screening before age 45. These individuals often require more frequent screening, and colonoscopy is typically the recommended test of choice. The ACS (2024a) defines high-risk as those with at least one of the following:

• a strong family history of CRC or certain polyps
• personal history of CRC
• inflammatory bowel disease (e.g., ulcerative colitis or Crohn’s disease)
• confirmed or suspected hereditary syndromes, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colon cancer [HNPCC])
• personal history of radiation to the abdominal or pelvic region

 

The USPSTF (2021a) CRC screening guidelines make the following recommendations, which are relatively consistent with ACS guidelines:

• Screen all adults aged 50–75 years for CRC (Grade A).
• Screen adults aged 45–49 years for CRC (Grade B).
• Selectively screen adults aged 76–85 years for CRC, considering the patient’s overall health, prior screening history, and patient’s preferences (Grade C).

There are multiple options for CRC screening, all of which are associated with a significant reduction in cancer incidence through the early detection and removal of adenomatous polyps and precancerous lesions. There are several test options for CRC screening, which include (ACS, 2024a; USPSTF, 2021a):

Stool-based tests:

• A fecal immunochemical test (FIT) is performed every year.
• A high‐sensitivity guaiac‐based fecal occult blood test (HSgFOBT) is performed every year.
• A multitarget stool DNA test (mt‐sDNA) is performed every 3 years.

Visual (structural) exams of the colon and rectum

• A colonoscopy is performed every 10 years.
• A CT colonography (virtual colonoscopy) is performed every 5 years.
• A flexible sigmoidoscopy (FSIG) is performed every 5 years (ACS, 2024a).

Cervical Cancer

Cervical cancer is most often diagnosed in female patients between the ages of 35 and 44, and it is rare in individuals younger than 20. About 22% of cases occur in those over age 65, most often in individuals who were not adequately screened earlier in life. In 2025, it is estimated that 13,360 patients in the United States will be diagnosed with invasive cervical cancer, and about 4,320 will die from the disease. Additionally, nearly 200,000 patients are expected to be diagnosed with cervical intraepithelial neoplasia (CIN), a condition involving abnormal changes in cervical cells that may lead to cancer. CIN is categorized by severity; CIN I reflects mild or low-grade lesions, while CIN III indicates severe abnormalities with the greatest risk of progressing to cervical cancer if not treated. CIN II and CIN III are commonly grouped as both require careful monitoring or treatment to prevent disease progression (ACS, 2025b, 2025f).

HPV is responsible for over 90% of cervical cancers. Both HPV vaccination and regular cervical cancer screening have significantly contributed to a decline in cervical cancer incidence and mortality. These tools make cervical cancer one of the most preventable forms of cancer. Historically, Pap tests played a critical role in reducing cervical cancer deaths by identifying abnormal cervical cells before they became malignant. Now, HPV testing—which detects high-risk HPV strains most likely to cause cancer—offers an additional and often preferred screening option. This test can be performed independently (primary HPV testing) or in conjunction with a Pap test (cotesting; ACS, 2024d; CDC, 2025a).

Recent data from the HPV Vaccine Impact Monitoring Project (HPV-IMPACT) by Gargano and colleagues (2025) shows a significant decline in the rates of CIN II or higher and CIN III or higher among young adults. Among patients aged 20–24 who were screened, the incidence of CIN II lesions decreased by 79% and CIN III lesions by 80% between 2008 and 2022. These trends validate the HPV vaccine’s preventive impact and reinforce the importance of following recommended screenings (Gargano et al., 2025). The ACS (2021, 2025f) emphasizes that regular screening—regardless of the test used—is crucial for early detection and prevention (ACS, 2021, 2025c, 2025f; CDC, 2025a).

Summary of Cervical Cancer Screening Recommendations

ACS recommendations for cervical cancer screening are as follows (ACS, 2021, 2025f):

• Cervical cancer screening should begin at age 25. Screening is not recommended for individuals under 25, even if they are sexually active.

• For females between the ages of 25 and 65, the preferred method is primary HPV testing every 5 years. If primary HPV testing is unavailable, acceptable alternatives include:
  • Co-testing (HPV test and Pap test) every 5 years
  • Pap test alone every 3 years
• For individuals older than 65, screening may be discontinued if they have had 10 years of regular screenings with normal results and no history of CIN II or higher in the past 25 years.
• Individuals who have had a total hysterectomy (removal of the uterus and cervix) do not need screening, unless the surgery was for cervical cancer or precancer.
• Individuals who have undergone a supra-cervical hysterectomy (i.e., the cervix remains in place) should continue screening according to the guidelines for their age.

• HPV vaccination does not eliminate the need for screening. Vaccinated people should follow the same age-based screening recommendations.

The USPSTF (2018a) cervical cancer screening recommendations were last updated in 2018 and are currently undergoing revision. The 2018 guidelines have some core differences from the ACS recommendations; as these include the following:

• Cervical cancer screening is recommended for females aged 21 to 29 years every 3 years with cervical cytology alone.
• For females aged 30 to 65 years, screening is recommended every 3 years with cervical cytology alone, every 5 years with HPV testing alone, or every 5 years with co-testing.
• Screening for cervical cancer in females younger than 21 years is not recommended.
• Screening for cervical cancer in females who had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (CIN II or CIN III) or cervical cancer is not recommended.

Prostate Cancer

Other than skin cancer, prostate cancer is the most common cancer diagnosed in males in the United States, with an estimated 313,780 new cases and 35,770 deaths predicted in 2025. The lifetime risk of prostate cancer is about 1 in 8, and it most commonly affects older, non-Hispanic Black patients. The incidence of prostate cancer is almost 70% higher in Black patients than in White patients, and about 6 in 10 prostate cancers are diagnosed in those aged 65 and older. Prostate cancer incidence rates have shifted significantly over time, largely influenced by the use of PSA testing. A notable decline in new diagnoses occurred between 2007 and 2014, corresponding to the reduced use of PSA screening following recommendations from the USPSTF. However, since 2014, incidence rates have been rising again, with an average annual increase of 3%. Between 2017 and 2021, rates rose by about 2.4% per year for localized cases and 4.8% per year for advanced-stage disease. While prostate cancer is the second-leading cause of cancer death, mortality rates have dropped substantially, falling from a peak of 39.3 deaths per 100,000 males in 1993 to 18.7 per 100,000 in 2022. This decline is attributed to earlier detection and improvements in treatment. Still, the rate of decline has slowed—from 3.6% annually between 1993 and 2012 to just 0.5% per year after 2012—likely due in part to the rise in late-stage diagnoses (ACS, 2025b, 2025i).

Prostate cancer screening remains a subject of ongoing debate, primarily due to uncertainties around the balance of benefits and harms. The two primary screening methods are the PSA blood test and the digital rectal exam (DRE). While some studies suggest that screening may reduce mortality from prostate cancer, expert consensus remains divided due to concerns about overdiagnosis and overtreatment, especially for slow-growing cancers. A key limitation of PSA-based screening is that it cannot reliably distinguish between aggressive cancers and indolent tumors unlikely to impact long-term health. Consequently, some patients may benefit from early treatment, while many others may be exposed to unnecessary biopsies, treatment-related complications, and anxiety, without added survival benefit. These concerns have led to evolving guidelines that emphasize shared decision-making rather than routine, population-wide screening (ACS, 2023a, 2025c; Siegel et al., 2025).

Summary of Prostate Cancer Screening Recommendations

The ACS (2023a) continues to recommend that prostate cancer screening should be a personalized decision, made in consultation with an HCP, and guided by personal factors, health status, and life expectancy. All individuals should have the opportunity to discuss the potential benefits, risks, and uncertainties of prostate cancer screening with their HCP before deciding to be tested. According to the ACS (2023a), the discussion about when to start screening should start at:

• Age 50 for those at average risk who are expected to live at least 10 more years.
• Age 45 for those at higher risk, including African Americans and those with a first-degree relative (parent or sibling) diagnosed with prostate cancer before age 65.
• Age 40 for those at highest risk, including those with multiple first-degree relatives diagnosed with prostate cancer at an early age.
• Those who have no symptoms and are unlikely to live at least 10 more years (due to age or health conditions) are not advised to undergo prostate cancer screening.

For those who opt for screening, it should begin with a PSA test. A DRE may be added, but is not required.

• Follow-up PSA screening frequency may follow the timelines below:
  • PSA below 2.5 ng/mL: screening may be repeated every 2 years
  • PSA of 2.5 ng/mL or more: annual testing is recommended

 

The USPSTF (2018b) prostate cancer screening guidelines were last updated in 2018 and are currently undergoing revision. The guidelines are less specific than the ACS but make the following recommendations:

• For males aged 55–69 years, the decision to undergo periodic PSA-based screening should be an individual one, based on shared clinical decision-making and a discussion of the potential harms and benefits of screening with HCPs (Grade C).
• Males aged 70 years and older should not be screened for prostate cancer (Grade D).

Endometrial Cancer

In 2025, the ACS projects that 69,120 individuals will be diagnosed with endometrial cancer and that an estimated 13,860 deaths will occur from the disease. Despite advancements in cancer screening, the ACS has maintained its position—first stated in 2001—that there is insufficient evidence to support routine screening for endometrial cancer in patients at average risk. The ACS advises that at the time of menopause, all female patients should be counseled about the risk factors and warning signs of endometrial cancer. In particular, they should be encouraged to promptly report any unexpected vaginal bleeding or spotting to their HCP, as these are common early symptoms of the disease. When clinical symptoms suggest possible endometrial pathology, an endometrial biopsy is the standard diagnostic approach. However, this test is not recommended for routine use in asymptomatic individuals and should only be performed when there is a clear clinical indication, such as abnormal bleeding (ACS, 2025b; ACS, 2025c; Siegel et al., 2025).

Risks and Limitations of Cancer Screening

Cancer screening plays a vital role in early detection and improved outcomes; however, it is essential to acknowledge that no screening test is without limitations or risks. While advances in screening technologies have contributed to decreased mortality for certain cancers, screening is not universally applicable to all cancer types. Moreover, even for cancers with established screening guidelines, the decision to undergo testing must consider potential harms, uncertainties, and patient preferences. A key limitation is the absence of effective screening tools for some of the most lethal cancers. Ovarian cancer, for example, has one of the lowest survival rates among gynecologic malignancies. Less than half of patients diagnosed with ovarian cancer survive beyond five years, and only about 20% are diagnosed at an early stage when the disease is localized. Despite its high mortality rate, no professional organization currently recommends routine ovarian cancer screening for patients at average risk. Available tools, such as pelvic exams, transvaginal ultrasound (TVUS), and cancer antigen 125 (CA-125) testing, have not demonstrated sufficient accuracy or a survival benefit in this population. As a result, these methods are generally reserved for those with a strong family history or carrying high-risk genetic mutations, such as BRCA1 or BRCA2 (ACS, 2025c; Siegel et al., 2025).

One of the most common risks across all screening modalities is the possibility of a false-positive result. This occurs when a test identifies an abnormality that appears cancerous but is ultimately found to be benign. Such results often lead to further diagnostic procedures, which can be costly, invasive, and anxiety-inducing. In some cases, these follow-up tests may involve surgery or biopsies that carry risks of infection, bleeding, or other complications. False-negative results present another concern. These occur when a screening test fails to detect cancer, giving patients false reassurance and potentially delaying diagnosis and treatment. For instance, while LDCT is a recommended tool for lung cancer screening in high-risk individuals, it may miss certain cancers. Similarly, mammography, while effective at reducing breast cancer mortality, does not detect all tumors and may yield false-negative findings, especially in patients with dense breast tissue. Overdiagnosis is another significant concern with cancer screening. Overdiagnosis refers to the detection of cancers that would not have caused harm during a person’s lifetime, leading to overtreatment with potentially aggressive, unnecessary treatments and side effects (ACS, 2023c, 2025c; Yarbro et al., 2018).

Given the nuanced risks and benefits of cancer screening, nurses play a vital role in supporting informed and shared decision-making. Their responsibilities extend beyond delivering clinical information—they must help patients understand the potential outcomes, limitations, and uncertainties associated with various screening options. This includes addressing misconceptions, clarifying medical terminology, and guiding patients through the emotional and practical aspects of decision-making. These conversations are especially important because all screening tests carry some degree of risk. Some may require further diagnostic procedures, which can vary in invasiveness and risk of complications. Others may detect conditions that would not have caused harm. HCPs help patients weigh these possibilities against their values, preferences, and tolerance for uncertainty and cost (Lubejko et al., 2019; Yarbro et al., 2018).

Regardless of the chosen screening path, nurses are responsible for ensuring that patients are adequately informed and empowered to make decisions that align with their personal health goals. Individualized discussions are essential to help patients understand that while early detection can be beneficial, it is not without trade-offs. Early detection does not always translate into improved outcomes, and overdiagnosis and overtreatment remain real concerns. Ultimately, effective nurse-led education and counseling enable patients to make informed choices, grounded in evidence, personal values, and a clear understanding of both the potential benefits and limitations of cancer screening (Lubejko et al., 2019; Yarbro et al., 2018).

Barriers to Cancer Screening

Despite the well-documented benefits of early cancer detection, many individuals face significant obstacles that prevent timely and appropriate screening. These barriers are complex, multifactorial, and influenced by a combination of socioeconomic, structural, psychological, and behavioral factors. Socioeconomic status is one of the strongest predictors of participation in screening. Individuals with lower income levels are less likely to undergo recommended screenings, often due to competing financial priorities, limited access to preventive care, and fewer health literacy resources. Similarly, age and marital status play important roles—older adults may assume screening is no longer necessary, while unmarried individuals may lack social support or reminders to prioritize preventive care. Accessibility to health care services remains a persistent challenge. Individuals living in rural or underserved areas may have limited access to primary HCPs or specialty services such as mammography or colonoscopy. Even when services are available, transportation barriers, long travel distances, or lack of reliable public transit can prevent patients from keeping appointments. Insurance coverage and associated out-of-pocket expenses further contribute to disparities (Hallgren et al., 2023).

Psychosocial barriers are also prevalent. Patients often experience anxiety about screening procedures, potential pain or discomfort, or fear of receiving a cancer diagnosis. These emotional responses can be powerful deterrents, particularly when compounded by a lack of knowledge or misinformation about the benefits of screening. Other behavioral barriers include forgetfulness, low motivation, or the belief that screening is unnecessary in the absence of symptoms. Moreover, health behaviors such as smoking are inversely associated with screening adherence. Current smokers are statistically less likely to engage in preventive care, including cancer screening, despite their increased risk of multiple cancer types (Hallgren et al., 2023).

Addressing these barriers requires a coordinated, culturally competent approach from the health care system. Nurses play a crucial role in overcoming these challenges by assessing individual risk, providing tailored education, reducing misinformation, and connecting patients with supportive resources, such as financial counseling, transportation assistance, or patient navigation services. Reducing barriers to screening is not just about increasing compliance—it’s about improving outcomes. Early detection significantly increases the chances of successful treatment and survival. Developing risk profiles and screening guidelines enhances screening efficacy, reducing health care costs and unnecessary spending. Nurses are uniquely positioned to empower patients with the knowledge, tools, and support necessary to overcome screening obstacles and adopt lifelong cancer prevention strategies. By fostering awareness, addressing barriers, and delivering compassionate, evidence-based care, nurses serve as powerful agents of change in reducing cancer incidence and improving outcomes across the lifespan (AACR, 2024; ACS, 2025c; Lubejko et al., 2019; NCI, 2024a).

Recognizing Early Signs and Symptoms of Cancer

One of the most crucial responsibilities in early detection is recognizing signs and symptoms that may indicate an underlying malignancy. The presentation of cancer varies widely depending on the type, its biologic behavior, and the organ system involved. Some cancers present with obvious physical signs, while others remain asymptomatic until they are advanced. In many cases, early symptoms are vague or easily attributed to benign conditions, which can delay diagnosis and treatment (ACS, 2020; Lubejko et al., 2019; Yarbro et al., 2018).

Certain “red flag” symptoms should always prompt further evaluation. These include the following:

• unintentional weight loss
• persistent fatigue
• night sweats
• unexplained lymphadenopathy
• unusual bleeding, persistent bruising, or discharge
• chronic pain without a clear cause (ACS, 2020; Yarbro et al., 2018)

In cancers such as leukemia and lymphoma, patients may experience systemic symptoms, including drenching night sweats, frequent infections, fatigue, and bruising. Other malignancies present more locally, such as changes in bowel or bladder habits, breast lumps, persistent cough, or skin changes. HCPs must remain vigilant and conduct thorough histories and physical assessments when such concerns arise. The following is a summary of organ-specific signs and symptoms that may raise suspicion for cancer and warrant prompt diagnostic evaluation (ACS, 2020; Yarbro et al., 2018):

• oral cavity: nonhealing ulcers, white (leukoplakia) or red (erythroplakia) patches, fixed nodules
• nasopharynx: persistent nasal congestion, epistaxis, unilateral hearing loss, cervical lymphadenopathy
• larynx: unexplained hoarseness lasting more than two weeks
• breast: firm or immobile lump, nipple retraction, bloody or purulent discharge, peau d’orange appearance, skin ulceration
• lung: persistent cough, hemoptysis, dyspnea, recurrent pneumonia or bronchitis, chest pain
• stomach: epigastric discomfort, early satiety, unintentional weight loss, dysphagia
• colon and rectum: change in stool caliber (e.g., pencil-thin stools), blood in stool (bright red or melena), tenesmus, anemia, abdominal pain
• skin: new or changing moles, lesions that bleed or fail to heal, irregular borders or pigmentation
• bladder: hematuria, dysuria, urgency, frequent urination without infection
• cervix: postcoital bleeding, dyspareunia, foul-smelling or purulent vaginal discharge, abnormal Pap smear
• prostate: difficulty initiating urination, weak stream, nocturia, incomplete bladder emptying
• testicles: painless lump or swelling, testicular asymmetry, inguinal or scrotal mass

When warning signs are identified, HCPs play a crucial role in ensuring that patients receive appropriate diagnostic testing and timely specialist referrals. Their ability to identify risk factors, recognize early symptoms, and promote health literacy is critical to reducing the cancer burden and improving outcomes. By staying current with cancer screening guidelines and maintaining vigilance for subtle warning signs, HCPs empower patients to take proactive steps in safeguarding their health (Lubejko et al., 2019; Yarbro et al., 2018).

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