At what age should annual routine laboratory tests start?

Annual Routine Laboratory Testing: Age-Based Recommendations

For average-risk adults, annual routine laboratory testing should begin at age 50 with fasting glucose and lipid profiles, though cancer-related checkups including physical examination should start at age 20. 1

Cancer Screening and Physical Examination (Starting Age 20)

The American Cancer Society recommends that cancer-related checkups begin at age 20 for both men and women, which should include examination for cancers of the thyroid, testicles, ovaries, lymph nodes, oral cavity, and skin, as well as health counseling about tobacco, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental and occupational exposures. 1

• For women aged 20-39, clinical breast examination should be performed at least every 3 years as part of a periodic health examination. 1
• Cervical cancer screening should begin at age 21 (approximately 3 years after initiating sexual activity, but no later than age 21), with Pap testing every year using conventional tests or every 2 years with liquid-based tests. 1, 2, 3

Age 40: Breast Cancer Screening

Women should begin annual mammography at age 40 years, with clinical breast examination performed annually prior to mammography. 1, 4

• The ACR and Society of Breast Imaging emphasize that annual screening starting at age 40 provides the greatest mortality reduction (up to 40%), diagnosis at earlier stage, better surgical options, and more effective treatment. 4
• Delaying screening until age 45 or 50 results in unnecessary loss of life and adversely affects minority women in particular. 4

Age 50: Comprehensive Metabolic and Cancer Screening

At age 50, multiple annual laboratory tests and cancer screenings should be initiated:

Metabolic Screening

• Fasting glucose: Perform every 6-12 months in all patients. 1
• Fasting lipid profile: Perform every 6-12 months in all patients. 1

Colorectal Cancer Screening

Begin at age 50 with one of the following options: 1, 5

• Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT) 1, 5
• Colonoscopy every 10 years (first-tier recommendation) 1, 5
• Flexible sigmoidoscopy every 5 years 1
• Double-contrast barium enema every 5 years 1

The U.S. Multi-Society Task Force ranks colonoscopy every 10 years and annual FIT as first-tier tests based on performance features, costs, and practical considerations. 5

Prostate Cancer Screening (Men)

PSA testing and digital rectal examination should be offered annually starting at age 50 for men with at least a 10-year life expectancy, after discussing potential benefits and known harms. 1

• Men at high risk (African American men or those with first-degree relatives diagnosed before age 65) should begin testing at age 45. 1
• Men with multiple first-degree relatives diagnosed before age 65 should begin at age 40. 1

Special Populations Requiring Earlier Testing

African Americans

African American men should begin prostate cancer screening at age 45 due to higher risk. 1

Colorectal cancer screening may be considered at age 45 in African Americans based on limited evidence supporting earlier screening in this population. 5

High-Risk Individuals

For patients with family history of colorectal cancer or advanced adenoma in a first-degree relative diagnosed before age 60, colonoscopy should begin at age 40 or 10 years before the youngest affected relative's diagnosis age, whichever is earlier, and be repeated every 5 years. 5

Age 65 and Beyond

Continue annual screening as appropriate based on life expectancy:

• Mammography should continue without an upper age limit unless severe comorbidities limit life expectancy. 4
• Cervical cancer screening can be discontinued at age 65 if there have been 3 consecutive negative Pap tests within the past 10 years with the most recent test within 5 years. 6, 3
• Colorectal cancer screening discontinuation should be considered at age 75 for those up to date with prior negative screening, or continued up to age 85 for those without prior screening depending on comorbidities. 5
• Bone densitometry should be performed in postmenopausal women aged 65 years and older. 1
• Abdominal ultrasonography should be performed once in men aged 65-75 who have ever smoked (screening for abdominal aortic aneurysm). 1

Annual Monitoring Components

Depression screening should be performed annually in all patients using conventional mental health interview or standardized tests. 1

Blood pressure checks should be performed annually in all patients. 1

Common Pitfalls to Avoid

• Do not screen women under age 21 for cervical cancer, regardless of sexual activity, as cervical cancer incidence is extremely low in this age group. 2, 3
• Avoid over-screening with annual Pap tests after initial normal results; 3-year intervals (or 5-year intervals with HPV co-testing after age 30) are evidence-based and safe. 3
• Do not delay colorectal cancer screening past age 50 in average-risk individuals, as this is when incidence begins to rise significantly. 5
• Ensure adequate documentation of screening history before discontinuing any cancer screening, particularly in older adults, as self-reports are often inaccurate. 6, 3