What screenings are recommended for a generally healthy adult during an annual physical examination?

Annual Physical Examination Screenings for Healthy Adults

For a generally healthy adult, the annual physical should focus on evidence-based preventive screenings rather than comprehensive laboratory testing, with specific recommendations varying by age, sex, and risk factors.

Core Vital Signs and Measurements

• Blood pressure screening should be performed annually for adults at increased risk (African American, high-normal blood pressure, obese/overweight, age >40 years), or every 3-5 years for low-risk adults aged 18-39 years with no risk factors 1
• Height, weight, and BMI calculation should be documented at every visit 2, 3

Laboratory Screening Tests

Diabetes Screening

• Screen adults aged 40-70 years who are overweight or obese with fasting glucose or hemoglobin A1C 1
• Begin screening at age 35 and repeat every 3 years if normal for adults without additional risk factors 3
• Annual testing is recommended for adults with BMI ≥25 kg/m² plus one or more risk factors (first-degree relative with diabetes, high-risk ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, PCOS, physical inactivity) 3
• Yearly testing for patients with prediabetes (A1C 5.7-6.4%) 3

Lipid Screening

• Screen men aged 40-75 years with fasting lipid profile every 6-12 months; insufficient evidence supports screening younger men 1, 3, 4
• Lipid profile should include total cholesterol, LDL, HDL, and triglycerides 2, 3

Other Laboratory Tests

The evidence does not support routine comprehensive laboratory panels for asymptomatic healthy adults 5, 6. However, specific tests may be indicated:

• Thyroid-stimulating hormone (TSH) is recommended particularly for women and older adults 2, 3
• Complete blood count and comprehensive metabolic panel are listed in some guidelines but lack strong evidence for routine use in truly asymptomatic adults 2, 3

Cancer Screening

Breast Cancer (Women)

• Women aged 45-54 should undergo annual mammography; women aged 40-44 may choose to begin annual screening 1
• Women aged ≥55 should transition to biennial mammography or continue annually based on preference, continuing as long as life expectancy exceeds 10 years 1
• Women who received chest radiation between ages 10-30 should begin annual breast MRI plus mammography at age 25 or 8 years after radiation, whichever occurs last 1

Cervical Cancer (Women)

• Begin screening at age 21 with Pap test every 3 years through age 29 1
• Women aged 30-65 should undergo HPV/Pap co-testing every 5 years (preferred) or Pap test alone every 3 years (acceptable) 1
• Women aged >65 with ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV/Pap tests within 10 years (most recent within 5 years) may discontinue screening 1

Colorectal Cancer

• Begin screening at age 45 with one of several options 1:
  • Annual fecal immunochemical test (FIT), or
  • High-sensitivity guaiac-based fecal occult blood test (HSgFOBT) annually, or
  • Multitarget stool DNA test every 3 years, or
  • Colonoscopy every 10 years, or
  • CT colonography every 5 years, or
  • Flexible sigmoidoscopy every 5 years
• Continue screening through age 75 in adults with good health and life expectancy >10 years 1
• Individualize screening for ages 76-85; discourage screening after age 85 1

Prostate Cancer (Men)

• Men aged ≥50 with at least 10-year life expectancy should engage in shared decision-making regarding PSA testing after receiving information about benefits, risks, and uncertainties 1
• Men at higher risk (African descent, first-degree relative diagnosed before age 65) should begin discussion at age 45 1

Lung Cancer

• Annual low-dose CT screening for adults aged 55-80 years who currently smoke or quit within 15 years AND have ≥30 pack-year smoking history, with access to high-quality screening centers and smoking cessation counseling 1

Abdominal Aortic Aneurysm

• One-time screening ultrasonography for men aged 65-75 years who have ever smoked 3, 4

Physical Examination Components

The comprehensive head-to-toe physical examination lacks evidence for routine use in asymptomatic adults 5, 6. Focus instead on:

• Visual acuity and fundoscopic examination (with specialist referral if needed) 2
• Cardiac auscultation for murmurs, gallops, or rubs 2
• Lung auscultation for abnormal breath sounds 2
• Skin examination for suspicious lesions, particularly in areas of prior radiation exposure 1, 2
• Neurological examination including sensory testing and deep tendon reflexes for at-risk populations 2

Preventive Health Counseling

• Tobacco cessation counseling for all tobacco users 2, 3
• Diet and nutrition guidance emphasizing cardiovascular health 2, 3
• Physical activity recommendations (at least 150 minutes moderate-intensity weekly) 2, 3
• Alcohol and substance use assessment and counseling 2, 3
• Mental health screening for depression, anxiety, and disordered eating 2, 3

Special Considerations for Older Adults (≥65 years)

• Annual cognitive screening for early detection of mild cognitive impairment or dementia 1
• Bone densitometry for postmenopausal women and men aged ≥50 years 3
• Functional performance assessment 3

Common Pitfalls to Avoid

Do not order comprehensive laboratory panels (CBC, CMP, urinalysis) routinely in truly asymptomatic adults without specific indications, as this practice lacks evidence and leads to false-positive results and unnecessary follow-up 5, 6. The widespread belief among physicians that annual comprehensive examinations detect subclinical illness is not supported by evidence 6.

Avoid single-sample fecal occult blood testing performed during digital rectal examination in the office—this is inadequate and not recommended 1.