What health screenings are recommended for adults?

Recommended Health Screenings for Adults

Adults should undergo regular health screenings based on age, gender, and risk factors, including colorectal cancer screening beginning at age 45, breast cancer screening at age 45, cervical cancer screening from age 21-65, blood pressure screening, diabetes screening for overweight adults aged 40-70, and lipid screening for men over 35 and women over 45. 1

Cancer Screenings

Colorectal Cancer Screening

• Begin at age 45 for average-risk adults (qualified recommendation) 1
• Strong recommendation for screening at age 50 and older 1
• Options include:
  • Fecal immunochemical test (FIT) annually
  • High-sensitivity guaiac-based fecal occult blood test annually
  • Multitarget stool DNA test every 3 years
  • Colonoscopy every 10 years
  • CT colonography every 5 years
  • Flexible sigmoidoscopy every 5 years 1
• Continue screening through age 75 for those in good health with life expectancy >10 years 1, 2
• Individualize decisions for ages 76-85 based on health status and prior screening 1
• Discontinue screening after age 85 1, 2

Breast Cancer Screening

• Begin at age 45 for women of average risk 1
• Annual mammography for women aged 45-54 1
• Biennial screening (or option to continue annually) for women 55 and older 1
• Optional screening between ages 40-44 based on individual preference 1
• Continue screening as long as overall health is good and life expectancy is 10+ years 1

Cervical Cancer Screening

• Begin at age 21 1
• Ages 21-29: Pap test every 3 years 1
• Ages 30-65: Pap test and HPV DNA test every 5 years (preferred) or Pap test alone every 3 years 1
• Stop screening after age 65 if adequate prior screening with negative results 1
• Discontinue screening for women who have had a total hysterectomy for non-cancerous conditions 1

Lung Cancer Screening

• Annual low-dose CT scan for adults aged 55-74 who:
  • Currently smoke or have quit within the past 15 years
  • Have at least a 30 pack-year smoking history
  • Receive evidence-based smoking cessation counseling (if current smokers)
  • Have undergone informed decision-making about benefits and harms 1, 3

Prostate Cancer Screening

• Informed decision-making for men aged 50+ with at least 10-year life expectancy 1
• Begin discussions earlier (age 45) for high-risk men including African Americans and those with family history 1
• No routine screening without informed decision-making process 1

Cardiovascular Screenings

Blood Pressure Screening

• Screen all adults for hypertension 1
• Annual screening for high-risk individuals (African Americans, high-normal BP, obese/overweight, age >40) 1
• Every 3-5 years for low-risk adults aged 18-39 with no risk factors 1

Diabetes Screening

• Screen adults aged 40-70 who are overweight or obese 1
• Refer patients with abnormal glucose levels to intensive behavioral counseling for diet and physical activity 1

Lipid Disorders Screening

• Screen men aged >35 and women aged >45 1
• Earlier screening for those with other cardiovascular risk factors 1
• Primary goal is identifying persons whose near-term risk of coronary heart disease is high enough to justify intensive interventions 1

STI Screenings

Chlamydia and Gonorrhea

• Screen sexually active women <25 years 1
• Screen older women at increased risk 1

HIV and Hepatitis C

• Test persons with HIV at least annually for hepatitis C 1
• Assess transgender clients for STD/HIV risks based on current anatomy and sexual behaviors 1

Special Considerations

Endometrial Cancer

• Inform women about risks and symptoms at menopause 1
• Encourage reporting of unexpected bleeding or spotting 1
• Begin screening at age 35 for women at high risk due to hereditary nonpolyposis colon cancer-associated genetic mutations 1

Screening Cessation

• Stop screening when life expectancy is less than 10 years 2
• Consider prior screening history when deciding to discontinue screening 2
• Weigh benefits against harms as age increases - screening benefits diminish while risks increase 2

Common Pitfalls to Avoid

• Overscreening older adults with limited life expectancy, which can lead to unnecessary procedures and anxiety 2, 4
• Underscreening high-risk populations who may benefit from earlier or more frequent screening 2
• Failing to follow up on positive screening tests with appropriate diagnostic testing 1
• Not considering patient preferences when selecting screening methods 1
• Misinterpreting screening benefits due to lead-time and length-time biases 3

Remember that the number needed to screen to prevent one death can be substantial - for example, approximately 418 people need to be screened for dyslipidemia to prevent one death over 5 years, and 1374 people need to undergo hemoccult testing to prevent one death from colon cancer over 5 years 5.