Your Comprehensive Guide to Screening
Attributed to Dutch philosopher Desiderius Erasmus, the words "prevention is better than cure" ring as true today as they did back in 1500 C.E., and represent a fundamental principle inherent in our current health and social care strategies.
A crucial part of the prevention process is screening, which you should undergo routinely as an adult to help detect health problems early, when they're easier to combat. However, it can be tricky to know what tests to have and when, and when to note the follow-up test in your calendar, especially when recommendations change frequently.
Jeffery Marcus, M.D., a board-certified OB-GYN and chief medical advisor at Femasys, a biomedical company based in Suwanee, Georgia, said many academic societies have different recommendations but all with the same objective: to catch things early.
"Your provider will choose the recommendations that are the best fit for your personal needs," Marcus said.
But if you don't have a healthcare provider or are unsure where to start, we talked to experts for details on a general overview.
Routine health maintenance
Your doctor likely wants you to keep up with a few steps that aren't exactly screening but are highly recommended to help you maintain a good foundation for your health.
"Flu shots and tetanus shots are just a couple of vaccinations that are important to keep up with. You may also want to be vaccinated against hepatitis B and C and for pneumonia," said Barbara J. Stegmann, M.D., Ph.D., OB-GYN and clinical lead of women's health at Organon, a pharmaceutical company based in New Jersey.
The recommendations for these shots depend on factors such as your job or chances of exposure from family and friends, but your healthcare provider should help you make those decisions.
The Centers for Disease Control and Prevention (CDC) recommends the following vaccines to keep up with throughout your adult life:
- Flu shot, recommended once a year.
- Tetanus, diphtheria and pertussis (Tdap) shot, required if you didn't get this vaccine as a child/adolescent to protect against whooping cough. Also required during each pregnancy.
- Tetanus booster shot, recommended every 10 years.
- Human papillomavirus (HPV) vaccination, for every adult up to age 26 if not vaccinated already (currently advised for all preteens at age 11 to 12 but can be given beginning at age 9).
- Shingles vaccine, recommended for healthy adults ages 50 and older.
- Pneumococcal polysaccharide vaccine, which protects against serious pneumococcal disease, meningitis and bloodstream infections. The vaccine is recommended for all adults 65 years or older, or younger than 65 who have certain health conditions.
- Pneumococcal conjugate vaccine, recommended for all adults with a condition that weakens the immune system. Talk with your healthcare provider to see if you require this vaccine.
This is just a starting list. Certain occupations might require other vaccines, especially if you didn't receive them as a child, such as for COVID-19, hepatitis B, chicken pox, measles, mumps and rubella, and meningococcal. If you've ever had a severe or life-threatening reaction to a previous vaccine, you may need to avoid that vaccination.
General health checks
To lower your risk of developing a chronic condition such as cardiovascular disease or diabetes, your healthcare provider can conduct a few screening tests. These are often carried out in an annual wellness check and look at your diet, physical activity levels, smoking status, body mass index (BMI), blood pressure, cholesterol and blood glucose.
Even if you are healthy and all your tests are within normal ranges, your healthcare provider may recommend regular screening if you have additional risk factors or a family history of cardiovascular disease.
According to the American Heart Association, you should aim to have the following health checks:
- Blood pressure at least once every two years (starting at age 20).
- Cholesterol levels, determined by a fasting lipoprotein profile every four to six years (starting at age 20) for adults at normal risk, more often if a high risk is identified.
- Blood glucose levels every three years from age 45, more often if a high risk is identified.
- BMI at regular health checks/wellness visits.
This seems like a lot of screenings and vaccinations to schedule, but most can and will be covered in an annual wellness check.
Ona Croft, a registered nurse working in general practice in the United Kingdom, said numerous conditions (diabetes, heart disease, cancer, etc.) can be present for a long time without symptoms.
"Screening enables us to identify these conditions before symptoms develop, allowing people to implement changes or commence treatment at an earlier point in the disease," Croft explained. "In diabetes, this might be irreparable damage to the nerves and blood vessels. In heart disease, this might be preventing atherosclerosis. In cancer, this might prevent metastases. In other words, carrying out a simple blood pressure and cholesterol check every few years can make a real difference to long-term health complications."
Despite the fact that regular dental examinations and good oral hygiene can prevent most dental diseases, more than 100 million Americans fail to see a dentist each year, according to the American Dental Association. With that in mind, Croft noted there's no one-size-fits-all schedule for visiting the dentist.
"You may need to see the dentist anything from every three months to every two years," she said. "It all depends on the state of your dental health."
It's important to know you might have a dental problem without presenting symptoms. A regular trip to the dentist—every six months is recommended—is a proactive way of preventing oral problems from developing.
Sexual health screening for all adults
If you are sexually active, screening for sexually transmitted diseases (STDs) is essential.
"It's recommended for anyone who has had unprotected sex or thinks they might have an STD, regardless of age," Croft said.
For HIV, the CDC recommends the following:
- All adults and adolescents ages 13 to 64 should be tested at least once for HIV in their life.
- People who engage in sexual behaviors that carry a risk of infection should get tested for HIV at least once a year.
- People who share injection drug equipment should get tested for HIV at least once a year.
- All sexually active gay, bisexual and other men who have sex with men should be tested for HIV annually and may benefit from more frequent testing (e.g., every three to six months).
- If living with HIV, you should get tested at least once a year for hepatitis C.
For other STDs, the CDC recommends:
- All sexually active women younger than age 25 should be tested for gonorrhea and chlamydia every year.
- Women older than 25 with risk factors, such as new or multiple sex partners or a sex partner who has an STD, should be tested for gonorrhea and chlamydia annually.
- Every woman should be tested for syphilis, HIV, hepatitis B and hepatitis C in early pregnancy.
- If you have regular oral or anal sex, especially with new or multiple sexual partners, you should talk with your healthcare provider about throat and rectal testing options.
It's advised that sexually active women, or all women older than age 21, have annual pelvic and breast exams.
"These exams are done every year by your OB-GYN and are important even if you don't need a Pap smear or mammogram," Stegmann said.
Cervical cancer screening
Speaking of Pap smears, the American College of Obstetricians and Gynecologists (ACOG) recommends a woman see her OB-GYN at least once a year for well-woman care.
"For cervical cancer screening, the ACOG recommends starting at the age of 21, regardless of when you begin having sex," Marcus explained.
"The frequency and type of testing for cervical cancer has undergone the biggest changes in screening over recent years," Stegmann noted. "We used to recommend yearly Pap smears, but guidelines have changed with the addition of HPV testing."
Currently, Stegmann said women should follow these guidelines:
- From the ages of 21 to 29, Pap smears should be carried out every three years.
- Some women ages 25 to 29 may elect for HPV screening, but the ACOG recommends Pap smears over HPV testing in this age group.
- From the ages of 30 to 65, there are three testing options:
- Pap and HPV testing (also called co-testing) every five years
- Pap only, every three years
- HPV testing only, every five years
- HPV testing for people younger than 25 is not generally recommended, because an HPV infection often clears on its own and a positive test at that age can lead to unnecessary testing and personal stress.
- If you've had a hysterectomy which removed your cervix, your healthcare provider may elect to stop screening, but you should consult with them to determine your individual risk.
- After the age of 65, you may be able to stop screening if your results have been negative for many years.
- Even if you do not need to continue with cervical cancer screening, you should still have routine visits to your doctor to ensure other problems do not arise.
If you're concerned about how and when to get the correct tests, your OB-GYN can help arrange your screening.
"Pap smears are usually done in an office setting by your healthcare provider," Marcus said. "These screens are usually free if done during the recommended intervals and if you have insurance. The best thing to do is check with your healthcare provider to understand what is covered by your plan or what the cost is going to be if you're uninsured."
He added that specific health clinics sometimes offer free screens to patients, and Medicare and Medicaid may also cover Pap smears and mammograms.
Breast cancer screening
Croft said every woman should carry out monthly breast exams, which become even more important after the age of 50, according to Stegmann.
"The ACOG reports that over 70 percent of breast cancers in women over the age of 50 are found by the woman herself," Stegmann noted. "So if you feel or see something in your breast that concerns you, make sure to consult with your doctor as soon as possible about the next steps."
"For women with average breast cancer risk, the ACOG recommends screening mammography for breast cancer every one to two years starting at age 40 and no later than age 50," Marcus explained. Screening should continue until at least age 75.
Prostate cancer screening
For men, recommendations for prostate cancer screening are slightly less prescriptive. The American Cancer Society (ACS) recommends that men should have a chance to make an informed decision with their healthcare provider about whether to be screened for prostate cancer.
Prostate cancer screening involves measuring levels of a protein called prostate-specific antigen (PSA), which are usually higher when prostate cancer is present. However, interpreting the results is not that simple. PSA levels can also increase because of noncancerous conditions, such as benign prostatic hyperplasia (BPH), prostatitis or the use of certain medications. An incorrect diagnosis or unnecessary treatment can lead to life-changing side effects such as impotence and incontinence.
With this in mind, the ACS recommends discussing the pros and cons of prostate cancer screening with your healthcare provider at the following ages:
- Age 50 for men with average risk
- Age 45 for men at high risk
- Age 40 for men at very high risk
If both you and your healthcare provider believe your risk of prostate cancer warrants going ahead with screening, you'll typically undergo PSA testing and a digital rectal exam (DRE).
If your screening shows no evidence of prostate cancer, your doctor may advise you to rescreen on the following basis:
- Men who have a PSA of less than 2.5 nanograms per milliliter (ng/mL) should schedule a screening every two years.
- Men who have a PSA of 2.5 ng/mL or higher should schedule a screening annually.
Colorectal cancer screening
Regardless of gender, colorectal cancer screening should begin at age 45 for people with no risk factors, Stegmann said.
"This can be a colonoscopy, or some providers can perform a newer test that checks for DNA in your stool," Stegmann said.
Stool-based tests include:
- Highly sensitive fecal immunochemical test (FIT), recommended annually
- Highly sensitive guaiac-based fecal occult blood test (gFOBT), recommended annually
- Multitarget stool DNA test (mt-sDNA), recommended every three years
Visual colorectal examinations include:
- Colonoscopy, recommended every 10 years
- CT colonography, recommended every five years
- Flexible sigmoidoscopy (FSIG), recommended every five years
Your doctor can recommend the best test and frequency of screening for you. For people considered high risk for colorectal cancer, screening may start at a younger age and be scheduled more frequently.
The ACS recommends that everyone in good health with a life expectancy of more than 10 years continue regular colorectal cancer screening to the age of 75.
Abdominal aortic aneurysm (AAA) screening
Although AAA screening is probably one of the lesser-known screenings, it is essential.
An abdominal aortic aneurysm is a swelling in the aorta, the main blood vessel that runs from the heart down through the chest and stomach. If not noticed early, it can be extremely dangerous. In 2019, AAAs were the cause of 9,904 deaths, with 59 percent happening to men. Seventy-five percent of all AAAs occur in people with a history of smoking.
The American College of Cardiology and the American Heart Association both recommend a one-time screening for AAA with physical examination and ultrasonography for:
- Men ages 65 to 75 who have ever smoked
- Men 60 years or older who have a parent or sibling diagnosed with AAA
Screening doesn't have to be overwhelming. Many tests can be done during your annual wellness check, and your doctor will advise you and help schedule any additional screenings you may need.
The vital thing to remember is not to skip it. Remember our old friend Erasmus. Screening can potentially be lifesaving and it's one of the most proactive ways you can take charge of your own health.