What are the recommended laboratory tests for asymptomatic patients over 50 years old?

Recommended Laboratory Tests for Asymptomatic Patients Over 50 Years Old

For asymptomatic adults over 50, the essential laboratory tests include fasting glucose or HbA1c every 6-12 months, fasting lipid profile every 6-12 months, and colorectal cancer screening starting at age 50 through age 75. 1

Core Metabolic Screening

Diabetes Screening:

• Perform fasting glucose and/or HbA1c every 6-12 months in all patients over 50 1
• HbA1c may be used for screening with a threshold cutoff of 5.8% 1
• If diabetes is diagnosed, HbA1c should be performed every 6 months 1

Lipid Screening:

• Perform fasting lipid profile every 6-12 months in all patients over 50 1
• This screening is critical for cardiovascular risk assessment and guides statin therapy decisions 2

Cancer Screening

Colorectal Cancer Screening (Age 50-75):

• Begin screening at age 50 for all average-risk individuals 1, 3
• Choose one of these evidence-based options with proven mortality reduction 1, 3:
  • Fecal immunochemical test (FIT) annually 1, 3
  • Colonoscopy every 10 years 1, 3
  • High-sensitivity guaiac-based fecal occult blood test (gFOBT) every 2 years 1, 3
  • Flexible sigmoidoscopy every 10 years plus FIT every 2 years 1, 3
• Do not use blood-based tests (such as Septin9 assay) for colorectal cancer screening—they lack evidence for mortality benefit 3

Age-Specific Colorectal Screening Decisions:

• Ages 50-75: Screen all patients 1, 3
• Ages 76-85: Individualize based on prior screening history, life expectancy >10 years, and overall health status 1, 3
• Age 85+: Stop screening—harms outweigh benefits regardless of prior screening history 3

Prostate Cancer Screening:

• Do not perform routine PSA testing in asymptomatic men with life expectancy <10 years 1
• For men who choose screening, consider PSA testing with shared decision-making, recognizing that population-based screening reduces prostate cancer mortality by 25% but requires screening 570 men and treating 18 to prevent one death 1
• Men with PSA >1 ng/ml at age 40 or >2 ng/ml at age 60 are at increased risk of metastasis or death from prostate cancer 1

Breast Cancer Screening (Women):

• Perform mammography annually in all women age ≥50 years 1
• Some authorities recommend starting at age 40 based on individual risk/benefit assessment 1

Cervical Cancer Screening (Women):

• Perform Pap smear annually after 2 normal tests documented during the first year following initial screening 1

Infectious Disease Screening

Sexually Transmitted Infections (if at risk):

• Syphilis serology annually in patients at risk for STDs 1
• Gonorrhea and chlamydia testing annually in patients at risk 1
• Hepatitis C testing annually in patients at risk (injection drug users, men who have sex with men) 1
• More frequent testing may be indicated in high-risk patients 1

Tuberculosis Screening:

• Perform tuberculin skin test (TST) or interferon-γ release assay (IGRA) at baseline and annually in patients at risk for tuberculosis 1

Additional Screening Tests

Blood Pressure:

• Perform annually in all patients 1

Depression Screening:

• Perform annually in all patients using conventional mental health interview or standardized test 1

Bone Densitometry:

• Perform baseline exam in postmenopausal women and men age ≥50 years 1
• Risk factors for premature bone loss include white race, small body habitus, sedentary lifestyle, cigarette smoking, alcoholism, phenytoin therapy, corticosteroid therapy, hyperparathyroidism, vitamin D deficiency, thyroid disease, and hypogonadism 1

Abdominal Ultrasonography:

• Perform once in men aged 65-75 years who have ever smoked (screening for abdominal aortic aneurysm) 1, 2

Ophthalmologic Exam:

• Exam with tonometry is advised every 2-3 years in all patients ≥50 years 1

Critical Pitfalls to Avoid

• Never use blood-based tests for colorectal cancer screening—they lack mortality benefit evidence 3
• Do not continue colorectal cancer screening past age 75 in patients with adequate prior screening history 3
• Avoid screening if life expectancy is <10 years due to comorbidities—screening is unlikely to provide benefit 1, 3
• All positive stool-based tests require follow-up colonoscopy—this is non-negotiable 3, 4
• Do not screen for colorectal cancer in symptomatic patients (rectal bleeding, unexplained weight loss, narrowed stools)—these patients require immediate diagnostic colonoscopy regardless of screening test results 4