The last two issues covered where personalized cancer immunotherapy is heading and how it can be accessed today. This issue is about what to do this week, while that future arrives.
Three moves. In the order that has the biggest effect on your risk.
1. Screen properly
The screening most people are behind on is not the one they think.
Colonoscopy at 45, not 50. The USPSTF lowered the recommended age to start colorectal cancer screening from 50 to 45 in 2021. Colonoscopy every 10 years is one of the options; stool-based tests and CT colonography are alternatives. The change was driven by rising colorectal cancer rates in younger adults.
Dense breast screening. The FDA rule that took effect September 2024 now requires mammography reports to disclose breast density. If yours came back as dense (roughly 40 percent of women have dense breast tissue), the American College of Radiology recommends supplemental MRI screening beyond the standard mammogram. Abbreviated MRI runs $250 to $850 out of pocket in most centers.
Low-dose CT for anyone with a smoking history. The USPSTF recommends annual low-dose CT for adults age 50 to 80 with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years. The 2021 expansion from 55 to 50 and from 30 to 20 pack-years significantly widened the eligible population. Most primary care physicians will not raise it unless you do.
Galleri (multi-cancer early detection) as an optional add. The Grail Galleri blood test screens for signals across more than 50 cancer types via cell-free DNA methylation patterns. It is not a diagnostic on its own, and it is not currently covered by insurance ($950 out of pocket). The FDA advisory committee reviewed the premarket approval application in September 2026, with Medicare coverage authorized to start in 2028. Worth knowing about, especially if there is significant family history you want to layer another lens on.
2. Reduce the modifiable risk
The Song and Giovannucci analysis in JAMA Oncology 2016 estimated that 20 to 40 percent of cancer cases and roughly half of cancer deaths in US white adults are attributable to modifiable lifestyle factors. The WCRF/AICR 2018 cancer prevention recommendations name the ones with the strongest evidence: keep weight in the healthy range, move daily, eat plant-forward with limited ultra-processed food, keep red meat under 12 ounces a week and avoid processed meat, limit alcohol (any amount raises risk for certain cancers), and if you can breastfeed you should. Smoking cessation is the single largest lifestyle lever if it applies.
None of this is news. But the effect size is larger than most people appreciate, and the compounding across decades is what shifts an individual risk profile.
3. The audit most people skip
The family history audit.
Sit down with parents and siblings, ideally the older generation while you still have them, and write down every cancer that any first-degree or second-degree relative has been diagnosed with. Ages at diagnosis. Cancer types. Whether any pattern has repeated across generations.
If there are red flags, book a genetic counseling appointment. The main red flags are: multiple relatives with the same or related cancer, an unusually early age at diagnosis (breast under 50, colon under 45), a rare cancer type, or a combination of cancers known to cluster genetically (breast and ovarian is the most common, colon and endometrial is another).
Genetic counseling is what gates whether you screen earlier, more often, and with more sensitive modalities. For most people in their 40s, this is one of the most useful medical conversations they can have. Most never do.
What to do this weekend
Book the screening you are behind on. Any one. Even a placeholder appointment three months out counts, because the follow-through is what matters.
Everything on one page. If you want the full personalized screening and lifestyle framework tailored to your quiz responses, the Personalized Healthspan Report has it built in.
Longevity Daily / The Building Decades