What are the recommended routine health screening guidelines for adults?

Recommended Routine Health Screening Guidelines for Adults

Adults should begin colorectal cancer screening at age 45 years with either a high-sensitivity stool-based test or a structural examination, continue through age 75 years if in good health, and have screening decisions individualized between ages 76-85 years based on health status and prior screening history. 1

Cancer Screening Recommendations

Colorectal Cancer Screening

• Begin screening at age 45 years for average-risk adults 1
• Options include:
  • Fecal immunochemical test (FIT) annually 1
  • High-sensitivity guaiac-based fecal occult blood test (HSgFOBT) annually 1
  • Multitarget stool DNA test every 3 years 1
  • Colonoscopy every 10 years 1
  • CT colonography every 5 years 1
  • Flexible sigmoidoscopy every 5 years 1
• Continue screening through age 75 years for those in good health with life expectancy >10 years 1
• Individualize screening decisions for ages 76-85 years based on preferences, life expectancy, health status, and prior screening history 1
• Discourage screening for adults over age 85 years 1
• All positive results on non-colonoscopy tests must be followed up with timely colonoscopy 1

Cervical Cancer Screening

• Begin screening at age 21 years 1
• Ages 21-29: Cytologic examination (Pap test) every 3 years 1
• Ages 30+: Screening every 2-3 years if three consecutive normal/negative results 1
• Option for women 30+: HPV DNA testing plus cytology every 3 years 1
• May discontinue at age 70+ if three or more consecutive normal tests and no abnormal results in preceding 10 years 1
• Continue screening regardless of age in women with history of cervical cancer, in utero DES exposure, or immunocompromised status 1
• No screening needed after total hysterectomy for benign disease 1

Endometrial Cancer Screening

• No routine screening for average-risk women 1
• Women should be informed about risks and symptoms (especially unexpected bleeding/spotting) at menopause onset 1
• High-risk women (known HNPCC genetic mutation carriers or substantial likelihood of being carriers) should consider annual screening beginning at age 35 years 1
• Endometrial biopsy is the standard for evaluation 1

Prostate Cancer Screening

• Offer PSA testing and digital rectal examination annually beginning at age 50 for men with life expectancy of at least 10 years 1, 2
• Begin at age 45 for high-risk men (African American men, men with first-degree relative diagnosed before age 65) 1, 2
• Begin at age 40 for men with multiple first-degree relatives diagnosed before age 65 1
• Use shared decision-making approach to discuss potential benefits and harms 2

Cardiovascular Screening

Lipid Screening

• Begin screening at age 40 for adults without risk factors 3, 4, 2
• Begin screening at age 20 for those with risk factors (diabetes, family history of premature CVD, hypertension, smoking, obesity) 3, 4
• Screening interval: every 5 years for normal results, more frequently for borderline results 3, 4, 2
• Total cholesterol and HDL can be measured on non-fasting samples 3
• Confirm abnormal results with repeat testing 3, 2
• For adults over 75 years, consider discontinuing routine testing if consistently normal lipid levels and no cardiovascular disease 4
• Continue monitoring in patients over 75 who are on statin therapy 4

Diabetes Screening

• Begin A1c testing at age 40-70 years for those with BMI ≥25 kg/m² 3
• Begin testing at age 45 for those without risk factors 3
• More frequent testing for those with diabetes or risk factors 3

Important Considerations and Potential Pitfalls

• Early detection through screening can prevent disease progression and costly health outcomes 5
• Not all screening tests reduce mortality or morbidity; healthcare professionals must evaluate the evidence 6
• False-positive results may cause harm from anxiety and unnecessary procedures 6
• False-negative results may worsen outcomes by leading to delayed diagnosis 6
• Relying on a single measurement for diagnosis or treatment decisions is a common pitfall 3
• Screening all young adults regardless of risk factors may lead to unnecessary testing 3
• Screening bias occurs when the sample of patients used to evaluate a test is not representative of the population to be screened 6
• Length bias results from the fact that indolent disease is more likely to be detected in screening than aggressive disease 6

The most recent guidelines emphasize personalized screening approaches based on individual risk factors, age, and health status, with the goal of maximizing benefits while minimizing harms from unnecessary testing 1, 2.