What lab screenings are recommended for routine physical exams, grouped by age?

Routine Laboratory Screening by Age Group

For routine physical exams, laboratory screening recommendations vary significantly by age, with younger adults requiring minimal testing focused on cardiovascular risk factors, while older adults need more comprehensive screening including cancer markers and metabolic panels.

Ages 18-39 Years

Essential Annual Tests

• Blood pressure measurement at every visit 1, 2
• Lipid profile (total cholesterol, LDL, HDL, triglycerides) annually or every 6-12 months, particularly as patients approach age 40; non-fasting samples are acceptable 1, 2

Baseline Laboratory Panel

• Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 1, 2
• Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 1, 2
• Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 1, 2

Metabolic Screening (Risk-Based)

• Hemoglobin A1C if BMI ≥25 kg/m² with additional risk factors (first-degree relative with diabetes, high-risk race/ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, or physical inactivity) 1, 2
• If prediabetes (A1C 5.7-6.4%), repeat yearly 1
• If normal results, repeat every 3 years 1, 2

Cancer Screening

• No routine cancer screening labs in this age group 2
• Cancer-related checkup every 3 years (ages 20-39) includes physical examination of thyroid, testicles, lymph nodes, oral cavity, and skin 2

Ages 40-49 Years

Annual Laboratory Tests

• Blood pressure measurement at every visit 1
• Lipid profile annually to assess cardiovascular risk 1
• Hemoglobin A1C for diabetes screening, especially if BMI ≥25 kg/m² with risk factors 1

Baseline Screening

• CBC with differential 1
• Comprehensive metabolic panel 1
• Urinalysis with albumin-to-creatinine ratio 1

Cancer Screening

• Colorectal cancer screening begins at age 45 with annual fecal immunochemical test (FIT), or colonoscopy every 10 years, or CT colonography every 5 years 3, 1
• Women: Mammography annually starting at age 40 3
• Women: Pap test with HPV co-testing every 5 years (ages 30-65, preferred) or Pap test alone every 3 years 3

Ages 50-64 Years

Annual Laboratory Tests

• Blood pressure measurement 3, 1
• Fasting lipid profile every 6-12 months 3, 1
• Fasting glucose or hemoglobin A1C every 6-12 months 3, 1

Comprehensive Screening Panel

• CBC with differential 1
• Comprehensive metabolic panel 1
• Urinalysis 1

Cancer Screening

• Colorectal cancer screening: Annual FIT, or colonoscopy every 10 years, or flexible sigmoidoscopy every 5 years 3, 1
• Men: Prostate cancer screening discussion at age 50 (age 45 for African American men or those with family history) using shared decision-making about PSA testing and digital rectal examination 3, 1
• Women: Annual mammography 3
• Women: Pap test with HPV co-testing every 5 years or Pap test alone every 3 years until age 65 3

Additional Screening

• Fecal occult blood testing (FOBT) annually starting at age 50 3

Ages 65-74 Years

Annual Laboratory Tests

• Blood pressure measurement 3, 4
• Lipid panel to assess cardiovascular risk 4
• Fasting blood glucose or HbA1c 4

Comprehensive Panel

• Complete blood count if clinically indicated 4
• Comprehensive metabolic panel 1
• Urinalysis if clinically indicated 4

Cancer Screening

• Colorectal cancer screening continues until at least age 75 for those with life expectancy >10 years: annual FIT, colonoscopy every 10 years, or CT colonography every 5 years 4, 5
• Men: Prostate cancer screening individualized through shared decision-making with PSA testing for those with at least 10-year life expectancy 4
• Lung cancer screening with low-dose CT for those aged 55-74 with at least 30 pack-year smoking history who currently smoke or quit within past 15 years 3, 4
• Women: Mammography for those with life expectancy >5 years 5

Special Screening

• One-time abdominal ultrasound for abdominal aortic aneurysm in men aged 65-75 who have ever smoked 4, 5
• Bone density testing should be considered in men with risk factors for osteoporosis 4

Ages 75+ Years

Annual Laboratory Tests

• Blood pressure measurement 4
• Lipid panel (individualized based on life expectancy and treatment goals) 4
• Fasting blood glucose or HbA1c 4

Selective Laboratory Testing

• Complete blood count if clinically indicated 4
• Urinalysis if clinically indicated 4

Cancer Screening (Life Expectancy-Based)

• Colorectal cancer screening only if life expectancy >10 years 4, 5
• Prostate cancer screening only through shared decision-making if life expectancy >10 years 4
• Lung cancer screening with low-dose CT for those aged 55-80 with at least 30 pack-year smoking history who currently smoke or quit within past 15 years 4
• Women: Mammography discontinued if life expectancy <5 years 5

Geriatric-Specific Assessments

• Cognitive screening using validated tools such as MoCA 4
• Depression screening 3, 4

Common Pitfalls to Avoid

• Do not delay colorectal cancer screening beyond age 45, as guidelines have lowered the recommended starting age from 50 to 45 1
• Do not perform annual Pap tests in women of any age; the recommended interval is every 3-5 years depending on age and testing method 3
• Do not continue cancer screening in patients with limited life expectancy (<5-10 years), as survival benefit is not seen 4, 5
• Do not fail to repeat abnormal lipid or glucose results for confirmation before making a diagnosis 1
• Do not order unproven screening tests such as routine urinalysis, complete blood count, or comprehensive metabolic panels in young, asymptomatic adults without risk factors 6, 7
• Avoid over-screening in patients with significant comorbidities or limited life expectancy 4