Screening guide by age

What is it?

This guide brings together the routine screening tests that MedlinePlus and USPSTF mention for adults by age and sex. MedlinePlus advises visiting a health care provider from time to time even if you are in good health, in order to detect health problems, estimate the risk of future problems, encourage a healthy lifestyle, update vaccines and preventive services, and get to know your care provider.

The US Preventive Services Task Force (USPSTF) publishes a list of Grade A and B recommendations, and says these are the services the Task Force recommends be applied most strongly in preventive care, and that their net benefit to patients is high or moderate.

Why it matters

Some tests target people without symptoms; for example, USPSTF recommends screening for prediabetes and type 2 diabetes in non-pregnant adults aged 35 to 70 who are overweight or obese and have no diabetes symptoms (Grade B).

USPSTF says that clinicians should offer or refer people found to have prediabetes to effective preventive interventions, including lifestyle interventions: diet or physical activity or both (see healthy nutrition and physical activity).

MedlinePlus ties the timing and frequency of some tests to risk factors, advising earlier or more frequent screening where there is a family history, or conditions such as diabetes, heart disease and kidney disease.

Key points

Blood pressure (hypertension) — ages 18 to 39: according to MedlinePlus (the women's and men's 18–39 pages), it is measured at least once every 3 to 5 years. Age 40 and over: at least once a year (the 40–64 and 65-and-over pages).

MedlinePlus advises more frequent measurement with diabetes, heart or kidney disease, overweight or obesity, a first-degree relative with hypertension, for people of Black ethnicity, or if the top (systolic) reading is 120 to 129 or the bottom (diastolic) reading is 70 to 79 mmHg, and in women if blood pressure was previously raised during pregnancy. It defines stage 1 hypertension as a systolic reading of 130 to 139 or a diastolic reading of 80 to 89 mmHg, and anything above that as stage 2.

USPSTF recommends screening for hypertension in adults aged 18 and over who do not have known hypertension (Grade A, April 2021).

Cholesterol (hyperlipidaemia, and see the lipid profile) — from age 20: MedlinePlus, attributing it to the American Heart Association, states that cholesterol screening begins at age 20 for those with no known risk factors for coronary heart disease and is repeated every 4 to 6 years, and more often with a change in lifestyle (such as weight gain or a change of diet), or with diabetes, heart or kidney disease, stroke or poor blood flow to the legs or feet, or when taking a cholesterol medicine.

Prediabetes and type 2 diabetes — from age 35: according to MedlinePlus, screening starts at age 35 for those who are overweight or obese and is repeated every 3 years for as long as this applies; for those aged 65 and over, every 3 years until age 70. It starts earlier or is repeated more often with a first-degree relative with diabetes, hypertension, prediabetes or a history of heart disease, and in women with previous gestational diabetes.

USPSTF recommends screening for adults aged 35 to 70 who are overweight or obese (Grade B, August 2021), considers that repeating it every 3 years may be a reasonable approach for those with normal results, and calls for considering earlier screening for those with a family history of diabetes, a history of gestational diabetes or polycystic ovary syndrome.

Diabetes screening tests according to USPSTF: fasting plasma glucose, glycated haemoglobin (HbA1c) or the oral glucose tolerance test. For prediabetes it lists: fasting glucose 100 to 125 mg/dL (5.55–6.94 mmol/L), or HbA1c 5.7% to 6.4%, or glucose 140 to 199 mg/dL 2 hours after a glucose load; and for diabetes: fasting glucose 126 mg/dL (6.99 mmol/L) or more, or HbA1c 6.5% or more, or 200 mg/dL (11.1 mmol/L) or more at 2 hours. Interpreting the result and confirming the diagnosis are for the doctor.

Colorectal cancer (colon cancer) — before age 45: according to MedlinePlus, screening is discussed with a care provider if there is a strong family history of colon cancer or polyps, or a personal history of inflammatory bowel disease or polyps.

Ages 45 to 75: MedlinePlus lists the options as colonoscopy every 10 years, or a stool test for hidden blood (FOBT or FIT) every year, or a stool DNA test with FIT every 1 to 3 years, or flexible sigmoidoscopy every 5 years (or every 10 years with an annual FIT), or CT colonography every 5 years; a positive stool test requires a colonoscopy. USPSTF recommends screening for adults aged 45 to 49 (Grade B) and 50 to 75 (Grade A) (May 2021).

Age 65 and over: according to MedlinePlus, regular screening continues until age 75, from 76 to 85 continuing is discussed with a care provider, and from 86 and over screening is no longer needed.

Breast cancer (breast cancer) — women 18 to 39: according to MedlinePlus, mammography is not recommended for most women under 40, and a care provider may consider mammography, MRI or ultrasound when risk is high, such as a relative diagnosed at a young age or a high-risk genetic marker.

Women 40 to 64: MedlinePlus states that mammography is generally recommended from age 40 every 1 to 2 years, that it is most effective between 40 and 74, that its effectiveness from age 75 is unclear, and that MRI may be recommended with other risk factors. Women 65 and over: mammography every 1 to 2 years until 75 depending on risk factors. USPSTF recommends screening women aged 40 to 74 (Grade B, April 2024).

Cervical cancer — women: according to MedlinePlus, screening starts at age 21 unless a care provider advises otherwise; from 21 to 29 a cervical smear (Pap test) every 3 years, and from 30 to 65 a smear every 3 years, or human papillomavirus (HPV) testing every 5 years, or both together every 5 years. USPSTF recommends screening women aged 21 to 65 (Grade A, August 2018).

After age 65, MedlinePlus states that screening can stop if there has been no cervical cancer or precancerous lesion, and there have been 3 consecutive negative smears or 2 consecutive negative HPV tests within 10 years, the most recent within 5 years. After treatment of a precancerous lesion, smears continue for 20 years or until age 65, whichever is longer, and after a total hysterectomy with no history of cancer or precancerous lesion, screening is not needed.

Lung cancer (lung cancer) in those with a heavy smoking history — ages 50 to 80: according to MedlinePlus and USPSTF, a low-dose CT scan is done annually for people aged 50 to 80 with a smoking history of 20 "pack-years" who currently smoke or quit within the last 15 years (USPSTF: Grade B, March 2021).

Osteoporosis (osteoporosis) — women: according to MedlinePlus, bone density testing is not routinely recommended under age 40 (although earlier testing may help after a previous fracture or when risk is high), from age 50 to 64 with risk factors screening is discussed with a care provider, and bone density testing (DEXA) is recommended for all women aged 65 and over. USPSTF recommends screening women aged 65 and over, and postmenopausal women under 65 with one or more risk factors (Grade B, January 2025).

Osteoporosis — men: according to MedlinePlus, screening is discussed with a care provider from ages 50 to 69 (the 40–64 page) and from 65 and over where there are risk factors. Risk factors it lists include long-term steroid use, low body weight, smoking, excessive alcohol, a fracture after age 50, and a family history of hip fracture or osteoporosis.

Men — abdominal aortic aneurysm: according to MedlinePlus, an ultrasound scan is done for men aged 65 to 75 who have ever smoked, and others discuss this test with a care provider. USPSTF recommends screening for men aged 65 to 75 who have ever smoked (Grade B, December 2019).

Men — prostate: according to MedlinePlus, men aged 55 to 69 discuss the benefits and drawbacks of a PSA test with a care provider before having it; under age 55 it is generally not recommended, and individual risk is discussed with a care provider (risk factors it lists include a father or brother diagnosed with prostate cancer before age 65), and from age 70 and over most bodies recommend against screening.

Hepatitis C and HIV: according to MedlinePlus and USPSTF, a one-time hepatitis C test for adults aged 18 to 79 (USPSTF: Grade B, March 2020), and a one-time HIV test from ages 15 to 65 (USPSTF: Grade A, June 2019), with annual testing for those at higher risk according to MedlinePlus. See viral hepatitis.

Eyes: according to MedlinePlus, an examination every 5 to 10 years before age 40, every 2 to 4 years from 40 to 54, every 1 to 3 years from 55 to 64, and every 1 to 2 years from 65 and over; more often with vision problems or glaucoma risk. For contact lens wearers an annual examination (the 18–39 pages), and for people with diabetes an examination that includes the retina at least once a year.

Teeth: according to MedlinePlus, a dental visit once or twice a year for an examination and cleaning, and the dentist decides whether you need more visits. Hearing (65 and over): a hearing test when there are symptoms of hearing loss.

How to put it into practice

Start with your age group in the points above, then discuss them with your primary care doctor; the MedlinePlus pages refer many decisions to "what is best for you" after talking with a care provider.

Tell your doctor about your family history and risk factors: MedlinePlus states that having a first-degree relative with hypertension or diabetes, a strong family history of colon cancer or polyps, a female relative diagnosed with breast cancer at a young age, or a father or brother diagnosed with prostate cancer before age 65 may change when screening starts or how often it is done.

MedlinePlus states that blood pressure, height, weight and body mass index are measured at every check-up, and your care provider may ask about depression, anxiety, diet, physical activity, alcohol, tobacco, drugs, safety and drug interactions, and for those aged 65 and over about falls and balance.

When there is more than one option, as with colon cancer screening, ask about the advantages of each option and how often it is repeated; MedlinePlus notes that a positive stool test requires a colonoscopy.

Before a PSA test for the prostate, MedlinePlus suggests asking: does screening reduce the chance of dying from prostate cancer? What are the possible harms? Is my risk higher than average?

The MedlinePlus pages also include a section on vaccines by age; see adult vaccines, and review the schedule adopted in your country with your doctor.

Special groups

Pregnancy: the MedlinePlus women's pages for 18–39 and 40–64 list screening for hepatitis B and syphilis with every pregnancy, and diabetes screening before pregnancy or when planning one for women who are overweight or obese and have other risk factors. USPSTF's recommendation on diabetes screening applies to non-pregnant adults.

People with diabetes: according to MedlinePlus, an eye examination that includes the retina at least once a year, more frequent blood pressure measurement, and more frequent cholesterol testing.

Smokers and ex-smokers: lung cancer screening with a low-dose CT scan under the conditions above, abdominal aortic aneurysm screening for men aged 65 to 75 who have ever smoked, and smoking is a risk factor for osteoporosis (MedlinePlus and USPSTF). See also quitting smoking.

Higher family or medical risk: according to MedlinePlus, colonoscopy may be needed more often with ulcerative colitis, Crohn's disease, a personal or family history of colon cancer or polyps, or hereditary syndromes (such as FAP or HNPCC); breast MRI may be recommended with other risk factors.

Those past age 70 or 75: according to MedlinePlus, diabetes screening is mentioned for those who are overweight or obese up to age 70, the effectiveness of mammography from age 75 is unclear, colon screening is discussed from 76 to 85 and is no longer needed from 86 and over, and most recommendations are against PSA screening from age 70 and over.

Risks and cautions

Not every test is useful for everyone: MedlinePlus states that USPSTF recommends against testicular examination screening because it has shown little or no benefit, and that routine prostate examinations are no longer done for men without symptoms.

The PSA test has potential harms that are discussed before it is done, and the optimal frequency for it is unknown according to MedlinePlus.

MedlinePlus says experts do not agree on the benefits of breast self-examination, or on HPV testing for ages 21 to 29, and that professional bodies neither recommend nor oppose skin self-examination; a care provider may examine the skin, especially for people who have had skin cancer, have relatives with it, or have a weakened immune system.

MedlinePlus notes that the recommendations of expert bodies may differ, as with breast cancer screening.

The figures given here are not a tool for diagnosing yourself: the diabetes criteria that USPSTF lists are applied by the doctor, and interpreting any result and any tests that follow is for the doctor.

Limits of this information

These are US recommendations from MedlinePlus and USPSTF, and ages and intervals differ between countries and according to personal risk. This page does not cover schedules specific to the UAE or the Gulf states; your reference is your doctor and the health authority in your country.

MedlinePlus states that USPSTF publishes a list of recommended tests and updates it as needed; the grades and dates here are as given on the USPSTF page when it was read, and they may change.

This page does not cover the full text of USPSTF's recommendations for each test except the prediabetes and diabetes recommendation, and its sources do not explain how "pack-years" of smoking are calculated; ask your doctor.

The source pages did not include a list of risk signs that call for urgent care, so no warning signs are listed on this page. These tests are aimed at early detection, and anyone with symptoms should discuss them with their doctor and not wait for the routine screening date.

These are US recommendations; ages and intervals differ between countries and according to personal risk, and what applies is what your doctor and the health authority in your country decide.

Common questions