What are the guidelines for annual wellness screenings in adults?

Annual Wellness Screening Guidelines for Adults

Adults should receive risk-stratified preventive screenings based on age, with blood pressure checked at every visit, cardiovascular risk assessment beginning at age 35-45, cancer screenings initiated between ages 21-50 depending on the specific cancer, and diabetes screening for those aged 40-70 years who are overweight or obese. 1

Cardiovascular Screening

Blood Pressure:

• Screen all adults at every clinical visit regardless of age 2
• Annual screening for high-risk individuals (African American, high-normal blood pressure, obese/overweight, age >40 years) 1
• Screen every 3-5 years for low-risk adults aged 18-39 years with no risk factors 1
• Confirm hypertension diagnosis outside the clinical setting before initiating treatment 1

Lipid Screening:

• Begin screening men at age 35 and women at age 45 3
• Measure total cholesterol and HDL cholesterol 3
• Non-fasting samples are acceptable 3
• Repeat every 5 years for average-risk individuals 3
• Consider more frequent screening (annually or every 6-12 months) as patients approach age 40 2

Diabetes Screening

• Screen adults aged 40-70 years who are overweight or obese (BMI ≥25 kg/m²) 1
• Use hemoglobin A1C or fasting glucose 2
• Refer patients with abnormal glucose to intensive behavioral counseling 1
• Screen earlier if additional risk factors present (family history, sedentary lifestyle) 3

Cancer Screening

Colorectal Cancer:

• Begin screening at age 45 for all average-risk adults 1, 2
• Continue through age 75 in adults with good health and life expectancy >10 years 1
• Screening options include:
  • Annual fecal immunochemical test (FIT) 1
  • Colonoscopy every 10 years 1
  • CT colonography every 5 years 1
  • Flexible sigmoidoscopy every 5 years 1
  • Multitarget stool DNA test every 3 years 1
• All positive non-colonoscopy tests require timely colonoscopy follow-up 1
• Ages 76-85: individualize based on patient preferences, life expectancy, health status, and prior screening history 1
• Age >85: discourage continued screening 1

Breast Cancer (Women):

• Women aged 40-44 may begin annual mammography if they choose 1
• Women aged 45-54 should undergo annual mammography 1
• Women aged ≥55 should transition to biennial screening or continue annually based on preference 1, 4
• Continue screening as long as overall health is good and life expectancy ≥10 years 1, 4
• Clinical breast examination every 3 years for ages 20-39, then annually starting at age 40 3

Cervical Cancer (Women):

• Begin screening at age 21 1, 4
• Ages 21-29: Pap test every 3 years 1
• Ages 30-65: HPV test plus Pap test every 5 years (preferred) OR Pap test alone every 3 years (acceptable) 1
• Stop screening at age >65 if ≥3 consecutive negative Pap tests OR ≥2 consecutive negative HPV+Pap tests within the last 10 years, with most recent test within last 5 years 1, 4
• Stop screening after total hysterectomy 1
• New sexual partners do NOT restart screening after age 65 4

Lung Cancer:

• Screen adults aged 55-74 (or 55-80 per some guidelines) with low-dose CT annually 1, 2, 4
• Eligibility criteria:
  • ≥30 pack-year smoking history 1, 2, 4
  • Currently smoke OR quit within past 15 years 1, 2, 4
  • Must receive smoking cessation counseling if current smoker 1
  • Requires informed/shared decision-making discussion 1
  • Access to high-volume, high-quality screening and treatment center 1

Prostate Cancer (Men):

• Begin shared decision-making discussion at age 50 for men with ≥10-year life expectancy 1, 3
• Higher-risk men (African descent, first-degree relative diagnosed before age 65) should begin discussion at age 45 3
• Screening involves PSA testing with or without digital rectal examination 1, 3
• Do not screen without informed decision-making process 1

Sexually Transmitted Infection Screening

Chlamydia and Gonorrhea:

• Screen all sexually active women younger than 25 years (not ≤25) 1, 5
• Screen older women at increased risk 5
• Among women aged 15-24 with opposite-sex partners in past year, only 37.5% were tested for chlamydia 6

HIV:

• Screen all patients aged 15-65 years regardless of risk 5
• Screen younger and older patients at increased risk 5
• All pregnant women should be tested 5

Hepatitis C:

• Screen persons at increased risk 5
• Test persons with HIV infection at least annually 1

Syphilis and Hepatitis B:

• Screen persons at increased risk 5
• All pregnant women should be tested 5

Additional Preventive Services

Endometrial Cancer:

• No routine screening for average-risk women 3
• At menopause, inform women about risks and symptoms; encourage reporting of unexpected bleeding or spotting 1
• Any postmenopausal bleeding warrants prompt investigation 4

Osteoporosis:

• Evaluate risk factors: smoking, low body weight, chronic glucocorticoid use, excess alcohol 4
• Consider bone-density testing even before age 65 in high-risk individuals 4

Immunizations:

• Annual influenza vaccine 2, 4
• Pneumococcal vaccines (PPSV23 and PCV13 when indicated) 4
• Recombinant herpes-zoster vaccine 4
• Tetanus every 10 years 2
• HPV vaccine for appropriate age groups 7

Common Pitfalls

• Do not continue cervical cancer screening after age 65 in adequately screened women, even with new sexual partners 4
• Confirm hypertension diagnosis outside the office before treatment to avoid white-coat hypertension misdiagnosis 1
• All positive stool-based colorectal cancer tests require colonoscopy follow-up—they are not diagnostic 1
• Screening decisions after age 75 should be based on life expectancy ≥10 years, not age alone 1, 4
• Lower-income individuals and those with unstable insurance coverage have consistently lower screening rates across all services 6