What screenings are recommended for a patient?

Recommended Screenings for Adults

Adults should undergo age-appropriate cancer screenings, metabolic assessments, and cardiovascular risk evaluations based on current American Cancer Society and USPSTF guidelines, with colorectal cancer screening beginning at age 45, cervical cancer screening from ages 21-65, breast cancer screening starting at age 40-45, and annual metabolic panels for those with risk factors. 1

Cancer Screenings

Colorectal Cancer

• Begin screening at age 45 with one of several options: annual fecal immunochemical test (FIT), annual high-sensitivity guaiac-based fecal occult blood test, multitarget stool DNA test every 3 years, colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 1, 2
• Continue screening through age 75 for adults in good health with life expectancy greater than 10 years 1
• For ages 76-85, individualize screening decisions based on patient preferences, life expectancy, health status, and prior screening history 1
• Discourage screening in individuals over age 85 1
• All positive non-colonoscopy tests require timely follow-up colonoscopy 1, 2

Breast Cancer (Women)

• Women aged 40-44 should have the opportunity to begin annual mammography screening 1
• Women aged 45-54 should undergo annual mammography 1
• Women aged 55 and older should transition to biennial screening or continue annual screening based on preference 1
• Continue screening as long as overall health is good and life expectancy is at least 10 years 1

Cervical Cancer (Women)

• Begin screening at age 21 with cytology (Pap test) every 3 years for women aged 21-29 1, 3
• For women aged 30-65, screen every 5 years with HPV testing plus cytology (preferred), every 5 years with HPV testing alone, or every 3 years with cytology alone 1, 3
• Stop screening after age 65 if the woman has had at least 3 consecutive negative Pap tests or 2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test in the last 5 years 1, 3
• Do not screen women younger than 21 years 3
• Stop screening in women who have had total hysterectomy with cervix removal for benign indications 1, 3

Lung Cancer

• Screen current or former smokers aged 55-74 with annual low-dose helical CT if they: currently smoke or quit within the past 15 years, have at least 30 pack-year smoking history, receive smoking cessation counseling if current smokers, undergo informed/shared decision-making about screening benefits and harms, and have access to high-quality lung cancer screening centers 1

Prostate Cancer (Men)

• Men aged 50 and older with at least 10-year life expectancy should engage in shared decision-making about PSA testing with or without digital rectal examination 1, 2
• For men at higher risk (African American men or those with family history), begin screening discussions at age 45 2
• Prostate cancer screening should not occur without an informed decision-making process 1

Endometrial Cancer (Women)

• At menopause, inform women about risks and symptoms of endometrial cancer and strongly encourage reporting any unexpected bleeding or spotting 1

Core Laboratory Tests and Metabolic Screening

Cardiovascular Risk Assessment

• Measure blood pressure at every visit 2
• Obtain lipid profile (total cholesterol, LDL, HDL, triglycerides) to assess cardiovascular risk; can be performed on non-fasting samples 2

Diabetes Screening

• Screen with hemoglobin A1C, especially for those with BMI ≥25 kg/m² plus additional risk factors including: first-degree relative with diabetes, high-risk race/ethnicity, history of cardiovascular disease, hypertension, HDL <35 mg/dL, or triglycerides >250 mg/dL 2
• For those with prediabetes (A1C 5.7-6.4%), test yearly 2
• For those with normal results, repeat testing every 3 years 2

Comprehensive Laboratory Assessment

• Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 2
• Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 2
• Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 2

Critical Pitfalls to Avoid

• Do not delay colorectal cancer screening beyond age 45, as guidelines have recently lowered the recommended starting age from 50 2
• Do not fail to confirm abnormal lipid or glucose test results before making a diagnosis 2
• Do not continue cervical cancer screening in women over 65 with adequate prior screening, as this provides no benefit and increases harms 3
• Do not screen for cervical cancer in women under age 21, as harms outweigh benefits 3
• Always follow positive non-colonoscopy colorectal screening tests with timely colonoscopy within 60 days 1
• Provide counseling on diet, physical activity, tobacco cessation, and alcohol use at appropriate intervals 2