What medical tests are recommended for routine health screening?

Recommended Medical Tests for Routine Health Screening

Routine health screening should include comprehensive cardiovascular assessment, cancer screening based on age and gender, diabetes screening, and infectious disease testing as appropriate for the individual's risk factors.

Cardiovascular Disease Screening

Blood Pressure Screening

• Perform annual blood pressure checks for all adults 1
• For patients with diabetes, annual screening is recommended as part of cardiovascular risk assessment 1

Lipid Testing

• Fasting lipid profile should be performed every 6-12 months in all adults 1
• Standard lipid profile should include total cholesterol, HDL, LDL, and triglycerides 2, 3
• Consider enhanced lipid profile including apolipoprotein B and lipoprotein(a) for higher risk individuals 4
• For patients with diabetes, lipid testing should be performed every 6-12 months, with consideration for testing 1-3 months after starting or modifying antiretroviral therapy 1

Glucose Testing

• Fasting glucose and/or HbA1c should be performed every 6-12 months in all adults 1
• For patients with diabetes, regular monitoring of blood glucose is essential for disease management 1
• Consider threshold cutoff of 5.8% for HbA1c screening 1

Cardiac Testing

• For individuals with symptoms or signs of cardiac disease or abnormal resting ECG, exercise ECG testing with or without echocardiography may be used as initial test 1
• Coronary artery calcium measurement is reasonable for cardiovascular risk assessment in adults with diabetes ≥40 years of age 1
• Pharmacologic stress echocardiography or nuclear imaging should be considered in individuals with resting ECG abnormalities 1

Heart Failure Screening

• For patients with diabetes, measure B-type natriuretic peptide (BNP) or N-terminal pro-BNP 1
• Echocardiography is recommended for those with abnormal BNP levels 1

Peripheral Artery Disease Screening

• Screen individuals with diabetes who are ≥65 years, have microvascular disease, foot complications, or end-stage organ damage 1
• Consider screening anyone with diabetes duration ≥10 years 1
• Screen with ankle-brachial index testing 1

Cancer Screening

Breast Cancer

• Women aged 40 and older should receive annual mammography 1
• Clinical breast examination should be performed annually for women aged 40 and older, and every 3 years for women aged 20-39 1
• Women at high risk (BRCA mutation carriers, those treated with chest radiation for Hodgkin disease) should receive annual mammography and MRI starting at age 30 1

Cervical Cancer

• Screening should begin approximately 3 years after onset of vaginal intercourse but no later than age 21 1
• Perform annually until age 30 with conventional cervical cytology or every 2 years until age 30 with liquid-based cytology 1
• After age 30, screening may continue every 2-3 years for women with 3 consecutive normal/negative results 1
• HPV DNA testing with cytology is reasonable for screening women 30 years and older as an alternative to cytology alone, with testing every 3 years 1

Colorectal Cancer

• Begin screening at age 50 for average-risk individuals using one of these options 1:
  • Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
  • Flexible sigmoidoscopy every 5 years
  • Annual FOBT/FIT plus flexible sigmoidoscopy every 5 years
  • Double-contrast barium enema every 5 years
  • Colonoscopy every 10 years
• More intensive surveillance is recommended for individuals at increased or high risk 1

Prostate Cancer

• For men aged 50 and older with at least a 10-year life expectancy, offer prostate-specific antigen (PSA) test and digital rectal examination (DRE) annually after informed decision-making 1
• Men at higher risk, including those of African descent and men with a first-degree relative diagnosed at a young age (≤65 years), should begin testing at age 45 1

Endometrial Cancer

• At menopause, women should be informed about risks and symptoms of endometrial cancer and encouraged to report unexpected bleeding or spotting 1

Skin Cancer

• As part of a periodic health examination, include examination for skin cancer 1
• Counsel patients on avoiding sun exposure and wearing protective clothing 1

Infectious Disease Screening

HIV Testing

• All patients should be assessed for transmitted drug resistance with an HIV genotype test upon initiation of care 1
• CD4 cell count and percentage, plasma HIV RNA level, and serologic testing for HIV should be performed 1
• Coreceptor tropism assay is recommended prior to prescribing a CCR5 entry inhibitor 1
• Tropism testing should be performed prior to initiating a CCR5 antagonist antiretroviral drug 1

Sexually Transmitted Infections

• Perform annual syphilis serology in patients at risk for STDs 1
• Perform annual gonorrhea and chlamydia testing in patients at risk for STDs 1
• Perform annual trichomoniasis testing in all women 1
• More frequent testing may be indicated in patients at high risk for STDs 1

Hepatitis Testing

• Perform annual hepatitis C testing in patients at risk (e.g., injection drug users and MSM) 1
• Screen for hepatitis B and A 1

Tuberculosis Screening

• Perform tuberculin skin test (TST) or interferon-gamma release assay (IGRA) at baseline and annually in patients at risk for tuberculosis 1

Special Considerations for High-Risk Populations

Patients with Diabetes

• Comprehensive cardiovascular risk assessment is essential 1
• Regular monitoring of blood glucose, lipids, blood pressure, and kidney function is recommended 1
• Screen for peripheral artery disease and heart failure 1

Patients with HIV

• Regular monitoring of CD4 count, viral load, and screening for opportunistic infections 1
• Comprehensive metabolic panel and lipid testing 1
• Age-appropriate cancer screening as for general population 1

Patients with Genetic Disorders

• For patients with DNA repair disorders, specific cancer screening protocols should be followed based on the genetic condition 1
• These may include more frequent or earlier screening for specific cancers associated with the genetic disorder 1

Common Pitfalls and Caveats

• Single stool sample collected during digital rectal examination is not an adequate substitute for recommended at-home FOBT procedure 1
• Toilet-bowl FOBT tests are not recommended 1
• There is no justification for repeating FOBT in response to an initial positive finding 1
• HbA1c testing may be affected by certain hemoglobinopathies and should be interpreted with caution in these cases 1
• HIV viral load may be transiently increased by vaccinations and intercurrent illnesses 1
• Screening recommendations should be adjusted based on individual risk factors and family history 1