Recommended Screenings for a 48-Year-Old Male Annual Exam
For a 48-year-old male, the annual exam should include colorectal cancer screening starting at age 45, lipid screening, blood pressure measurement, and discussion of prostate cancer screening options. 1, 2
Core Laboratory Tests and Measurements
- Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 3
- Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 3
- Lipid profile (total cholesterol, LDL, HDL, and triglycerides) to assess cardiovascular risk - can be performed on non-fasting samples 3, 4
- Hemoglobin A1C to screen for diabetes and prediabetes 3
- Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 3
- Blood pressure measurement at every visit 3
- Height and weight measurements to calculate body mass index (BMI) 5
Cancer Screenings
Colorectal Cancer Screening
- Begin colorectal cancer screening at age 45 with one of the following options 1, 2:
- Annual fecal immunochemical test (FIT)
- Annual high-sensitivity guaiac-based fecal occult blood test (HSgFOBT)
- Multitarget stool DNA test every 3 years
- Colonoscopy every 10 years
- CT colonography every 5 years
- Flexible sigmoidoscopy every 5 years
- All positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy 1
Prostate Cancer Screening
- Discuss prostate cancer screening options with the patient, as this is an age where shared decision-making about PSA testing should begin 2
- For men at average risk, prostate-specific antigen (PSA) testing and digital rectal examination should be offered annually beginning at age 50 1
- For men at higher risk (African American men or those with a family history of prostate cancer), screening discussions should begin at age 45 1
- Use shared decision-making approach to weigh potential benefits against harms of prostate cancer screening 2
Cardiovascular Risk Assessment
- Calculate 10-year atherosclerotic cardiovascular disease risk using pooled cohort equations for adults aged 40-75 years 6
- Based on risk score, patients are grouped as:
- Low risk (<5%)
- Borderline risk (5 to <7.5%)
- Intermediate risk (7.5 to <20%)
- High risk (≥20%) 6
- Statin therapy should be strongly advised for those with risk ≥20%, while it can be considered for those with risk between 5% and <20% 6
- Pay special attention to blood pressure control, as moderate systolic hypertension (140-159 mmHg) significantly increases cardiovascular mortality risk, especially in those with impaired fasting glucose 7
Metabolic Screening
- Screen for diabetes with hemoglobin A1C, especially important for those with BMI ≥25 kg/m² with additional risk factors 3
- Risk factors for diabetes include first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL 3
- For those with prediabetes (A1C 5.7-6.4%), yearly testing is recommended 3
- For those with normal results, repeat testing every 3 years 3
Common Pitfalls to Avoid
- Do not delay colorectal cancer screening beyond age 45, as guidelines have recently lowered the recommended starting age from 50 to 45 2
- Do not fail to repeat abnormal lipid or glucose test results for confirmation before making a diagnosis 2
- Avoid requiring fasting for lipid panels, as nonfasting samples are now considered acceptable and may even be superior for cardiovascular risk prediction 4
- Do not overlook the importance of blood pressure control in patients with impaired fasting glucose, as this combination significantly increases cardiovascular mortality risk 7, 8
- Do not miss the opportunity to provide counseling on diet, physical activity, tobacco cessation, and alcohol use 3