Q: I’m due for a check up and I’m not sure what tests to ask for. What do you suggest?
A: The United States Preventative Services Task Force (USPSTF) updates their recommendations for health screening guidelines every year.
These guidelines are widely used (although not all doctors agree with the frequency). Many doctors feel these recommendations are the minimum.
The following are the guidelines for the average person per the USPSTF for 2019.
Breast cancer: The USPSTF advises women should be screened for breast cancer every other year from age 50 to 74, and that screening women from age 40 to 50 is an individual decision (high risk patients should discuss age and frequency with their doctors).
The USPSTF also advises that women who have family members with breast, ovarian, tubal, or peritoneal cancer should be screened for possible BRCA testing and treatment.
Cervical cancer: The USPSTF recommendations for cervical cancer screening for women 21 to 29 yrs. is a PAP smear done every three years.
For women 30 to 65 yrs., either a PAP smear every three years, an hrHPV (high-risk human papilloma virus) screen every five years, or both every five years (unless high risk).
Chlamydia and gonorrhea: Screening tests should be done on all women under 24, and on women over 24 if at high risk.
Osteoporosis screening: This should be done on women 65 or older (younger if high risk or history of previous fracture).
Prostate cancer: The USPSTF recommendations for prostate cancer screening of men are vague. Their prior recommendation were against testing men of any age, but this disagreed with American Urological Association and the American Cancer Society recommendations. Now USPTSF advises “discussion based decisions about periodic PSA screening for men 55-69,” and recommends against routine PSA screening if 70 or older.
Abdominal aortic aneurysm: Male smokers ages 65 to 75 should be screened for this.
Colorectal cancer: All adults should be screened for colorectal cancer. If low risk and asymptomatic, people should be screened between age 50 to 75 (75 to 85 depending on health and life expectancy). The gold standard is a colonoscopy screening every 10 years (if normal). An annual FIT test or a FIT-DNA test every three years may be appropriate for some people, and both are non-invasive.
Blood glucose levels/diabetes: Regarding blood tests, the USPSTF advises checking blood glucose levels to screen for diabetes if 40 to 70 years and overweight or obese, or earlier if high risk or history of abnormal glucose. Screen lipid levels and treat if elevated or at high risk.
Hepatitis C: Do this screening if born between 1945 to 1965, or at high risk.
HIV: Screening should be done on all people ages 15 to 65.
Tb, Hepatitis B, and syphilis: Screening should be done if at high risk.
Lung cancer: Smokers ages 55 to 80 may need an annual lung cancer screening with low dose computed tomography (LDCT) if they have a 30 pack year history of smoking (multiply the number of packs per day by number of years you smoked). Even if you quit smoking within the last 15 years!
Depression, alcoholism, domestic violence, sedentary lifestyle and hypertension: The USPSTF advises screening and treatment for all of these. Screen the BMI for obesity, and refer for intense counseling if BMI is 30 or more, or there are cardiovascular risk factors.
Vaccinations: You should also look at the CDC (Center for Disease Control) 2019 vaccination recommendations for healthy adults, and get any vaccinations that are recommended (if you have no contraindications).
The CDC also has vaccination recommendations for people with chronic illnesses. It is a good idea to look at the diet and exercise recommendations on the American Heart Association website, and review the risk factors for cardiovascular disease.
It is best to prevent illness in the first place, and making healthy lifestyle choices will likely reduce your risks of disease.