Annual Adult Well Exam: Key Assessments, Screenings, and Labs
WOMEN
Ages 20-39
Vital Signs & Measurements
Cancer Screening
- Cervical cancer screening beginning at age 21: Pap test every 3 years (ages 21-29) 2, 3
- Clinical breast examination every 3 years 3
- Breast self-examination is optional; educate about breast symptoms and prompt reporting 3
Laboratory Testing
- Lipid screening if at increased risk of coronary heart disease 4
- STI screening (chlamydia, gonorrhea, syphilis) for high-risk sexually active women using urine or self-collected vaginal swabs 1, 4
- HIV screening for all women 4
Behavioral & Psychosocial Screening
- Tobacco, alcohol, and drug use screening 1, 4
- Depression and anxiety screening 1, 4
- Intimate partner violence screening 1, 4
Counseling
- Reproductive life planning and contraception counseling 1
- Folic acid 400-800 mcg daily for all women of reproductive age 3, 4
- Immunization review and updates 1
Ages 40-49
Vital Signs & Measurements
Cancer Screening
- Annual mammography starting at age 40 (or women may choose to begin between ages 40-44) 2, 3
- Annual clinical breast examination prior to mammography 3
- Cervical cancer screening: Pap test every 3 years 2, 3
Laboratory Testing
- Lipid screening for all women ages 40-75 5
- STI screening based on sexual activity and risk factors 1
- HIV screening 4
Behavioral & Psychosocial Screening
- Tobacco, alcohol, and drug use screening 1
- Depression screening 1
- Intimate partner violence screening 1
Counseling
Ages 50-64
Vital Signs & Measurements
Cancer Screening
- Annual mammography (ages 45-54), then transition to biennial screening at age 55 or continue annually 2, 3
- Colorectal cancer screening starting at age 45-50: Choose annual FIT, colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 2, 3
- Cervical cancer screening at age 30-65: HPV/Pap co-testing every 5 years (preferred) or Pap test alone every 3 years 2, 3
Laboratory Testing
Behavioral & Psychosocial Screening
Counseling
- Aspirin 75 mg daily for women ages 55-79 when stroke reduction benefits outweigh GI bleeding risk 4
- Immunization updates 1
Ages 65+
Vital Signs & Measurements
Cancer Screening
- Discontinue cervical cancer screening after age 65 if three consecutive normal tests in past 10 years 2, 3, 1
- Continue mammography biennially as long as overall health is good and life expectancy ≥10 years 2, 3
- Continue colorectal cancer screening through age 75; individualize for ages 76-85 based on health status and prior screening 2
Laboratory Testing
Bone Health
- Osteoporosis screening (DEXA scan) for all women age 65 and older 4
Behavioral & Psychosocial Screening
MEN
Ages 20-39
Vital Signs & Measurements
Physical Examination
- Examination for cancers of thyroid, testicles, lymph nodes, oral cavity, and skin every 3 years 3
Laboratory Testing
Behavioral & Psychosocial Screening
Counseling
Ages 40-49
Vital Signs & Measurements
Physical Examination
- Annual examination for cancers of thyroid, testicles, lymph nodes, oral cavity, and skin 3
Laboratory Testing
Behavioral & Psychosocial Screening
Counseling
Ages 50-69
Vital Signs & Measurements
Cancer Screening
- Colorectal cancer screening starting at age 45-50: Choose annual FIT, colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 2, 3, 5
- Prostate cancer screening (PSA and DRE) starting at age 50 for men with ≥10-year life expectancy after shared decision-making discussion 2, 3, 5
- Lung cancer screening with low-dose CT annually for men ages 55-74 with ≥30 pack-year smoking history who currently smoke or quit within past 15 years 2, 5
Physical Examination
- Annual examination for cancers of thyroid, testicles, lymph nodes, oral cavity, and skin 3
Laboratory Testing
Vascular Screening
- One-time abdominal aortic aneurysm screening ultrasound for men ages 65-75 who have ever smoked 5
Behavioral & Psychosocial Screening
Counseling
- Immunization updates 5
Ages 70+
Vital Signs & Measurements
Cancer Screening
- Continue colorectal cancer screening through age 75; individualize for ages 76-85 based on health status and prior screening 2
- Prostate cancer screening only if life expectancy >10 years 3
- Continue lung cancer screening through age 80 if meets criteria 2, 5
Laboratory Testing
Behavioral & Psychosocial Screening
Counseling
- Immunization updates 5
Key Caveats
All positive non-colonoscopy colorectal screening tests require timely colonoscopy follow-up 3. Women who have had total hysterectomy with cervix removal for benign reasons may discontinue cervical cancer screening 1. Screening decisions for adults ages 76-85 should be individualized based on patient preferences, life expectancy, health status, and prior screening history 2.