What are the recommended age‑appropriate preventative screening tests and intervals for a healthy adult without known disease?

Age-Appropriate Preventative Screening for Healthy Adults

For healthy adults without known disease, begin cardiovascular screening at age 18, cancer screening at age 21 (cervical) or 40-45 (breast/colorectal), and continue age-stratified screening through age 75, with individualized decisions thereafter based on life expectancy exceeding 10 years.

Cardiovascular Risk Screening

Blood pressure measurement should occur at every clinical visit for all adults starting at age 18. 1, 2 Annual screening is reasonable, though the optimal interval remains uncertain. 3

Lipid Screening

• Begin lipid profile screening at age 40 for men and women, with repeat testing every 5 years if normal. 3, 1
• The American Heart Association recommends annual or every 6-12 months screening, particularly as patients approach age 40. 1
• For adults ages 21-39 with cardiovascular risk factors, screening may be initiated based on clinical judgment. 3

Diabetes Screening

• Screen adults aged 35-70 years who have overweight or obesity (BMI ≥25 kg/m²) using fasting plasma glucose, HbA1c, or oral glucose tolerance test. 3, 1
• Repeat screening every 3 years if initial results are normal. 3, 4
• For adults 18-34 with BMI ≥25 kg/m² and additional risk factors, consider earlier screening. 1

Cancer Screening

Cervical Cancer

Women should begin cervical cancer screening at age 21, regardless of sexual activity or HPV vaccination status. 5

• Ages 21-29: Screen every 3 years with cervical cytology alone. 5
• Ages 30-65: Screen every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with cotesting (hrHPV + cytology). 5
• After age 65: Discontinue screening if adequate prior screening (three consecutive normal cytology results in past 10 years) and not otherwise at high risk. 3, 5
• After hysterectomy: Do not screen women who had hysterectomy with cervix removal for benign indications. 5

Breast Cancer

Women at average risk should begin annual mammography at age 40. 6

• Annual screening provides the greatest mortality reduction (40% reduction possible), earlier stage diagnosis, and better treatment options compared to longer intervals. 6
• Continue screening past age 74 without an upper age limit, unless severe comorbidities limit life expectancy to less than 10 years. 6, 7
• Clinical breast examination recommendations vary, but the American Cancer Society suggests every 3 years for ages 20-39 and annually after age 40. 3

Colorectal Cancer

Begin colorectal cancer screening at age 45 for average-risk adults. 3, 2

Acceptable screening options include:

• Annual fecal immunochemical test (FIT) 3, 1
• Colonoscopy every 10 years 3, 1
• Flexible sigmoidoscopy every 5 years 3
• CT colonography every 5 years 3, 2

Continue screening through age 75. For ages 76-85, individualize decisions based on patient preferences, life expectancy, health status, and prior screening history. 3 Discontinue screening after age 85. 3

Prostate Cancer

For men aged 55-69 years, engage in shared decision-making about PSA screening, discussing potential benefits and harms before proceeding. 3, 8

• The net benefit is small; approximately 1.3 deaths prevented per 1,000 men screened over 13 years. 8
• Harms include false positives, biopsy complications, and treatment-related erectile dysfunction (67% of men) and urinary incontinence (20% of men). 8
• For African American men or those with first-degree relatives diagnosed before age 65, begin screening discussions at age 45. 3
• Do not screen men aged 70 years and older, as harms outweigh benefits. 3, 8
• Critical pitfall: Do not order PSA testing at age 48 for average-risk men without informed discussion, as it provides no benefit and leads to overtreatment. 2

Lung Cancer

For adults aged 55-80 years with at least 30 pack-year smoking history who currently smoke or quit within the past 15 years, screen annually with low-dose CT. 1

Laboratory Screening by Age

Ages 18-39

• Complete blood count (CBC) to screen for anemia, infection, and blood disorders 1
• Comprehensive metabolic panel (CMP) to assess kidney and liver function 1
• HbA1c if BMI ≥25 kg/m² with additional risk factors 1

Ages 40-64

• Annual blood pressure and lipid profile 1
• Fasting glucose or HbA1c 1
• CMP and urinalysis if clinically indicated 1

Ages 65+

• Annual blood pressure, lipid panel, and fasting glucose or HbA1c 1, 4
• Comprehensive metabolic panel including creatinine with eGFR to monitor renal function 4
• Thyroid-stimulating hormone (TSH) 4
• Urinalysis to screen for proteinuria and hematuria 4

Critical Pitfalls to Avoid

• Do not continue cervical cancer screening after age 65 in women with adequate prior screening, as this provides no benefit and causes unnecessary harm. 5
• Do not delay colorectal cancer screening past age 45, as this is critical for mortality reduction. 2
• Do not perform PSA screening without shared decision-making, especially in men under 55 or over 70 years. 3, 8
• Do not order routine comprehensive metabolic panels or CBCs without clinical indication in younger adults, as this leads to false positives and unnecessary follow-up. 2
• Do not discontinue breast cancer screening at age 74 if the patient has good health and life expectancy exceeding 10 years. 6