What are the recommended screenings and vaccinations for women and men during annual physical exams?

Annual Physical Exam Screenings and Vaccinations

Women Ages 20-39

Cancer Screening

• Cervical cancer screening should begin approximately 3 years after initiating vaginal intercourse, but no later than age 21, performed annually with conventional Pap tests or every 2 years with liquid-based Pap tests 1, 2
• Clinical breast examination (CBE) should be performed every 3 years as part of periodic health examination 1, 2
• Breast self-examination (BSE) is optional; women should be educated about breast symptoms and the importance of prompt reporting of any new changes 1, 2
• No mammography is indicated at this age 2

Cancer-Related Checkup

• Examination for cancers of the thyroid, ovaries, lymph nodes, oral cavity, and skin should be performed every 3 years 1, 2

Health Counseling

• Counseling about tobacco use, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental/occupational exposures should be provided 1, 2

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Women Ages 40-49

Breast Cancer Screening

• Annual mammography should begin at age 40 1, 3
• Annual clinical breast examination should be performed prior to mammography 1, 3
• BSE remains optional with education about breast symptoms 1

Cervical Cancer Screening

• Continue annual Pap tests with conventional method or every 2 years with liquid-based tests 1

Cancer-Related Checkup

• Annual examination for cancers of the thyroid, ovaries, lymph nodes, oral cavity, and skin 1

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Women Ages 50-64

Breast Cancer Screening

• Annual mammography 1, 3
• Annual clinical breast examination 1, 3

Colorectal Cancer Screening (Starting at Age 50)

Choose one of the following options 1, 3:

• Annual fecal immunochemical test (FIT) or high-sensitivity guaiac-based fecal occult blood test (gFOBT) 1, 3
• Colonoscopy every 10 years 1, 3
• Flexible sigmoidoscopy every 5 years 1, 3
• CT colonography every 5 years 1, 3
• Double-contrast barium enema every 5 years 1
• Stool DNA test (interval uncertain) 3

Critical pitfall to avoid: Single stool sample collected during digital rectal examination is NOT adequate; proper FOBT requires collecting 2 samples from 3 consecutive specimens at home 1, 3

Cervical Cancer Screening

• At or after age 30, women with 3 consecutive normal tests may be screened every 2-3 years with Pap test alone, or every 3 years with HPV DNA test plus Pap test 1, 3

Cardiovascular Screening

• Annual blood pressure measurement 3
• Fasting lipid profile every 6-12 months 3
• Fasting glucose test every 6-12 months 3

Bone Health

• Consider bone densitometry (DEXA scan) for women at risk for premature bone loss, including postmenopausal status, family history of osteoporosis, low body weight, smoking, or certain medications 3

Vaccinations

• Annual influenza vaccine 3
• Tetanus-diphtheria booster if not received in past 10 years 3

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Women Ages 65+

All Screenings Above, Plus:

• Women aged 70+ with 3 or more normal Pap tests and no abnormal tests in the last 10 years may choose to stop cervical cancer screening 1
• Women who have had total hysterectomy (with cervix removal) for benign reasons may discontinue cervical cancer screening 3
• Pneumococcal vaccine as recommended by current guidelines 3

Endometrial Cancer Awareness

• At menopause, women should be informed about risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting 1, 3

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Men Ages 20-49

Cancer-Related Checkup

• Examination for cancers of the thyroid, testicles, lymph nodes, oral cavity, and skin every 3 years from ages 20-39, then annually after age 40 1

Health Counseling

• Counseling about tobacco use, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental/occupational exposures 1

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Men Ages 50-69

Prostate Cancer Screening

• The PSA test and digital rectal examination (DRE) should be offered annually starting at age 50 for men with life expectancy of at least 10 years, after discussing benefits and limitations to allow informed decision-making 1, 3
• Men at higher risk (African-American or family history of early prostate cancer) should begin screening at age 45 1

Colorectal Cancer Screening (Starting at Age 50)

Choose one of the following options 1, 3, 4:

• Annual FIT or high-sensitivity gFOBT 1, 3, 4
• Colonoscopy every 10 years 1, 3, 4
• Flexible sigmoidoscopy every 5 years 1, 3
• CT colonography every 5 years 1, 3, 4
• Double-contrast barium enema every 5 years 1

Critical pitfall: Toilet bowl FOBT tests are not recommended 1, 3

Cardiovascular Screening

• Blood pressure screening 4
• Lipid screening for men 40-75 years 4

Abdominal Aortic Aneurysm Screening

• One-time screening ultrasonography for men 65-75 years who have ever smoked 4

Lung Cancer Screening

• Low-dose CT for men 55-69 years with at least 30-pack-year smoking history who currently smoke or quit within past 15 years 4

Vaccinations

• Annual influenza vaccine 4
• Tetanus-diphtheria booster if not received in past 10 years 4
• Pneumococcal vaccine at age 65+ 4

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Men Ages 70+

Continue Appropriate Screenings Based on Life Expectancy

• Colorectal cancer screening should continue until at least age 75 4
• Prostate cancer screening only if life expectancy exceeds 10 years 1
• Lung cancer screening continues through age 80 if smoking criteria met 4

Additional Considerations

• Depression screening annually 3
• All positive results on non-colonoscopy colorectal screening tests require timely colonoscopy follow-up 3