What screenings are recommended for a patient of unspecified age and medical history?

Recommended Screenings for Adults

All adults should undergo age-appropriate cancer screenings, cardiovascular risk assessments, and metabolic disease testing based on established age thresholds, with colorectal cancer screening beginning at age 45, cervical cancer screening at age 21, breast cancer screening at age 40-45, and diabetes/lipid screening starting at age 40-45 or earlier if risk factors are present. 1, 2

Cancer Screenings by Age and Type

Colorectal Cancer

• Begin screening at age 45 years for all average-risk adults with one of the following options: annual fecal immunochemical test (FIT), multitarget stool DNA test every 3 years, colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 3, 1, 4
• Continue screening through age 75 years for all adults in good health 3
• Ages 76-85 years: Individualize screening decisions based on prior screening history, overall health status, and life expectancy greater than 10 years; adults who have never been screened are more likely to benefit 3
• After age 85 years: Discontinue screening 3
• All positive results on non-colonoscopy screening tests must be followed with timely colonoscopy 3, 1

Breast Cancer (Women)

• Ages 40-44 years: Women may begin annual mammography screening based on individual preference 3, 2
• Ages 45-54 years: Annual mammography screening 3, 1
• Age 55 years and older: Continue screening every 1-2 years as long as overall health is good and life expectancy is at least 10 years 3

Cervical Cancer (Women)

• Ages 21-29 years: Screen every 3 years with cervical cytology (Pap test) alone 3, 5
• Ages 30-65 years: Screen every 5 years with HPV testing plus Pap test (preferred) OR every 3 years with Pap test alone (acceptable) 3, 5
• After age 65 years: Discontinue screening if the patient 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 3, 5
• After total hysterectomy: Discontinue screening if the cervix was removed and there is no history of high-grade precancerous lesion or cervical cancer 3, 5

Lung Cancer

• Ages 55-74 years (or 55-80 years): Annual low-dose helical CT screening for adults who currently smoke or quit within the past 15 years AND have at least a 30 pack-year smoking history AND receive smoking cessation counseling if current smokers 3, 2
• Screening requires access to a high-volume, high-quality lung cancer screening and treatment center 3

Prostate Cancer (Men)

• Age 50 years and older: Engage in shared decision-making discussion about PSA testing with or without digital rectal examination for men with at least 10-year life expectancy 3, 2
• Screening should not occur without an informed decision-making process that includes discussion of potential benefits, risks, and uncertainties 3

Endometrial Cancer (Women)

• At menopause: Inform women about risks and symptoms of endometrial cancer (particularly unexpected bleeding or spotting) and encourage immediate reporting of these symptoms 3, 1
• Routine screening with endometrial biopsy or ultrasound is not recommended for average-risk women 3

Cardiovascular and Metabolic Screenings

Blood Pressure

• All adults age 18 years and older: Measure blood pressure at every clinical visit 3, 2
• Annual screening is reasonable, though optimal interval is uncertain 3

Lipid Screening

• Ages 40-75 years: Screen with fasting lipid panel (total cholesterol, HDL, LDL, triglycerides) 3, 1, 2
• Repeat every 5 years if normal, more frequently if borderline or high-risk 3, 2
• Ages 21-39 years: Screen based on clinical judgment and cardiovascular risk factors 3

Diabetes Screening

• All adults age 45 years and older: Screen with fasting plasma glucose, 2-hour oral glucose tolerance test, or HbA1c; repeat at minimum 3-year intervals if normal 1, 2
• Adults with BMI ≥25 kg/m² (or ≥23 kg/m² in Asian Americans): Screen at any age if one or more additional risk factors present, including first-degree relative with diabetes, high-risk race/ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, physical inactivity, or insulin resistance 1
• Women with history of gestational diabetes: Lifelong testing at least every 3 years 1
• Adults with prediabetes (HbA1c 5.7-6.4%): Test annually 1

Additional Age-Specific Considerations

Young Adults (Ages 18-39)

• Complete blood count (CBC) to screen for anemia, infection, and blood disorders 2
• Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 2

Middle-Aged Adults (Ages 40-64)

• Annual blood pressure measurement and lipid profile screening 2
• Fasting glucose or HbA1c screening 2

Older Adults (Ages 65+)

• Annual blood pressure, lipid panel, and fasting blood glucose or HbA1c 2
• Comprehensive metabolic panel and urinalysis if clinically indicated 2
• Cognitive screening using validated tools and depression screening 2

Risk-Based Screenings

Sexually Transmitted Infections

• Women at risk for STIs: Annual screening including syphilis serology, gonorrhea, and chlamydia testing 1

Abdominal Aortic Aneurysm

• Men ages 65-75 years with smoking history: One-time screening 6

Critical Pitfalls to Avoid

• Do not use single-panel guaiac FOBT during digital rectal examination due to low sensitivity 4
• Recognize ethnicity-specific BMI thresholds for diabetes screening (≥23 kg/m² for Asian Americans versus ≥25 kg/m² for others) 1
• HbA1c may be unreliable in conditions affecting red blood cell turnover (pregnancy, hemoglobinopathies, recent blood loss) 1
• Do not perform routine endometrial screening with ultrasound or biopsy in average-risk women; instead, educate about symptoms and ensure prompt evaluation of abnormal bleeding 3, 1
• Cancer screening benefit requires adequate life expectancy: Generally at least 5-10 years for most cancer screenings to provide mortality benefit 6