Why "ask your doctor" isn't good enough advice

Every patient is told, at some point, to "stay up to date on their screenings." It is true and almost useless as advice, because nobody follows it up with which ones, starting when, and why those specific ages. The guidelines exist, they are public, and almost nobody reads them — understandably, since the source documents run to dozens of pages apiece and change every few years.

The checklist above is my attempt to close that gap honestly. It draws on the current U.S. Preventive Services Task Force (USPSTF) recommendations, the same body that most American insurers and primary care guidelines are built around, and it distinguishes clearly between a Grade A/B recommendation — strong enough evidence that it becomes a default — and a Grade C item, where the evidence is real but the right answer depends on you specifically. It also says so, plainly, when the evidence is not yet good enough to grade either way. That distinction gets lost in most "screening checklist" content online, and I think it's the part that actually matters.

What each screening actually is, and why the guideline says what it says

Heart & metabolic health

Blood pressure check. A cuff reading, repeated before anything is diagnosed, because a single high number is common and usually means nothing on its own. It is recommended for every adult starting at 18, checked yearly from 40 onward or if you run high-normal or carry other risk factors, and every three to five years before that if your readings have been consistently normal.1 High blood pressure has essentially no symptoms until it has already done damage to your heart, kidneys, or blood vessels — which is the entire reason it gets checked on a schedule rather than waited out.

Cholesterol & cardiovascular risk. A blood draw for your lipid panel, combined with a 10-year cardiovascular risk estimate that also factors in your blood pressure, smoking status, and diabetes status. Between 40 and 75, if that combined risk comes out at 7.5% or higher, a statin is specifically recommended to discuss.2 This is why the tool above doesn't just ask for a cholesterol number — the number in isolation matters less than what it means combined with everything else about you.

Prediabetes & type 2 diabetes. A fasting blood sugar or an A1c blood test. Recommended between 35 and 70 for anyone with a BMI of 25 or higher (23 or higher for Asian American adults, whose diabetes risk climbs at a lower BMI).3 Outside that BMI range, the guideline doesn't call for it by default — but a family history, a past pregnancy with gestational diabetes, or PCOS are all real reasons to ask for it anyway, regardless of your weight.

Weight-management support. Not a test at all — a referral. At a BMI of 30 or higher, structured, intensive behavioral programs (regular sessions over a year or more, not a pamphlet) are specifically what the evidence supports, because they outperform advice given once and left there.4 If this describes you, my energy needs calculator and diabetes remission calculator are reasonable next stops.

Cancer screening

Colorectal cancer. Colonoscopy every 10 years, an annual at-home stool test (FIT), or a stool DNA test every one to three years — they are considered equally acceptable options, so "I don't want a colonoscopy" is not a reason to skip this entirely. Recommended from 45 to 75, individualized from 76 to 85, and not routinely continued past 85.5 This is one of the strongest-evidenced screenings on this entire list; catching a polyp before it becomes a cancer is about as close to prevention, rather than early detection, as screening gets.

Breast cancer. A mammogram, an X-ray of breast tissue, every two years from 40 to 74.6 The starting age moved from 50 to 40 in the 2024 update — if you were told to wait until 50 by an older guideline, that advice is out of date. A strong family history or a known BRCA mutation can move screening earlier still, sometimes to 30, often paired with MRI — that's a conversation to have specifically, not something this tool can calculate for you.

Cervical cancer. A Pap test, an HPV test, or both together. From 21 to 29, cytology (Pap) alone every three years; from 30 to 65, any of three equally effective options — HPV testing alone every five years, HPV plus Pap together every five years, or Pap alone every three years.7 Not recommended before 21, and not needed after 65 if your recent screening history has been consistently normal — the emphasis is on "consistently"; irregular past screening is a reason to keep going, not to assume you're covered.

Lung cancer. A low-dose CT scan of the chest — quick, no contrast, and a small fraction of the radiation of a standard CT. Recommended yearly from 50 to 80 for anyone with roughly 20 pack-years of smoking (about a pack a day for 20 years) who currently smokes or quit within the last 15 years.8 That last part surprises people: once it's been more than 15 years since you quit, screening is no longer recommended, because by then the risk has fallen enough that the harms of continued yearly scans outweigh the benefit.

Prostate cancer. A PSA blood test, occasionally followed by a physical exam. This is the one item on this list where the guideline itself says the honest answer is "it depends on you" — from 55 to 69 it's an explicit shared decision, weighing a small chance of catching a dangerous cancer earlier against a real chance of a false alarm or treating a cancer that never needed treating. Past 70, routine screening is specifically recommended against, though continuing is still a personal choice some men make with their doctor.9 I would rather a tool tell you honestly that this is a conversation than pretend it's a checkbox.

Abdominal aortic aneurysm. A single, painless ultrasound of the abdomen, done once. Recommended for men 65 to 75 who have ever smoked, even if that was decades ago.10 It's a one-time check specifically because an aneurysm that hasn't formed by then is unlikely to become a problem later — and one that has formed is worth finding before it becomes an emergency rather than after.

Infectious disease

HIV. A blood or oral-swab test, often with results in minutes. Recommended at least once for everyone 15 to 65, and for every pregnant person regardless of age.11 "At least once" is doing real work in that sentence — it's a baseline, not a lifetime pass; ongoing risk factors are a reason to test again periodically rather than treat the first result as final.

Hepatitis C. A one-time blood test for hepatitis C antibodies, recommended for every adult 18 to 79 regardless of any risk factor.12 This one is universal on purpose: most people carrying hepatitis C don't know it, because it can sit quietly for decades before it damages the liver, and the case for testing everyone once turned out to be stronger than testing only people who report a specific risk.

Chlamydia & gonorrhea. Urine or swab testing. Recommended yearly for sexually active women 24 and younger, and for older women with a new or multiple partners.13 The evidence in men isn't developed enough yet for a formal recommendation either way — that's a gap in the research, not a statement that it doesn't matter; the CDC still suggests testing for men with the same risk factors, particularly men who have sex with men.

Bone health, mood & habits

Osteoporosis. A DEXA scan — a low-radiation X-ray that measures bone density, painless and a few minutes long. Recommended for all women 65 and older, and earlier for postmenopausal women whose fracture risk, estimated with a tool like FRAX, comes out high enough.14 The evidence in men is still insufficient for a formal recommendation, which again is different from "don't bother" — long-term steroid use, a low body weight, or a fracture from a minor fall are reasons to raise it regardless of the formal grade.

Depression. A short questionnaire, usually two to nine questions, not a blood test or a diagnosis on its own. Recommended for every adult, explicitly including pregnancy, the postpartum period, and well past 65.15 It's the item on this list most likely to be skipped in a routine visit simply because nobody hands you the form — asking for it yourself is entirely reasonable.

Unhealthy alcohol use. A short, structured set of questions about drinking patterns — not a blood or breath test. Recommended for every adult, including during pregnancy, with brief counseling offered if the answers suggest risky drinking.16 It's framed around patterns rather than a number of drinks, because the same weekly total can mean very different things spread out versus concentrated into one or two nights.

What this tool deliberately doesn't do

It doesn't calculate a precise starting age for you when a family history moves things earlier — that number depends on exactly how your relative was affected and at what age, and it belongs in a conversation with a clinician who can see your actual family tree, not a formula. It doesn't cover the separate, more frequent schedule that applies during pregnancy. And it doesn't cover every screening that exists — it covers the ones with a clear evidence grade, and says so honestly when the evidence for something isn't there yet, rather than filling the gap with confident-sounding advice that isn't backed by anything.

If you take one thing from this page, let it be this: a screening you were never told about is not a screening you declined. Most of the gaps I see in practice aren't disagreement — they're a conversation that never happened. Bring the list.

Dr. Gily Ionescu, MS MD

References

Every age range, interval, and grade in the checklist and the text above comes from the current final recommendation statement on the U.S. Preventive Services Task Force website.

  1. US Preventive Services Task Force. Hypertension in Adults: Screening. USPSTF. 2021. uspreventiveservicestaskforce.org Grade A. Used for the blood pressure item and its screening intervals.
  2. US Preventive Services Task Force. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. USPSTF. 2022. uspreventiveservicestaskforce.org Grade B/C. Used for the cholesterol & cardiovascular risk item.
  3. US Preventive Services Task Force. Screening for Prediabetes and Type 2 Diabetes. USPSTF. 2021. uspreventiveservicestaskforce.org Grade B. Used for the diabetes screening item, including the BMI thresholds.
  4. US Preventive Services Task Force. Obesity in Adults: Interventions (Weight Loss to Prevent Obesity-Related Morbidity and Mortality). USPSTF. 2018. uspreventiveservicestaskforce.org Grade B. Used for the weight-management support item at BMI ≥ 30.
  5. US Preventive Services Task Force. Colorectal Cancer: Screening. USPSTF. 2021. uspreventiveservicestaskforce.org Grade A (45–49 Grade B; 76–85 Grade C). Used for the colorectal cancer item.
  6. US Preventive Services Task Force. Breast Cancer: Screening. USPSTF. 2024. uspreventiveservicestaskforce.org Grade B. Used for the breast cancer item, including the 2024 age-40 update.
  7. US Preventive Services Task Force. Cervical Cancer: Screening. USPSTF. 2018. uspreventiveservicestaskforce.org Grade A. Used for the cervical cancer item and hysterectomy exception.
  8. US Preventive Services Task Force. Lung Cancer: Screening. USPSTF. 2021. uspreventiveservicestaskforce.org Grade B. Used for the lung cancer item, including pack-year and quit-timing criteria.
  9. US Preventive Services Task Force. Prostate Cancer: Screening. USPSTF. 2018. uspreventiveservicestaskforce.org Grade C (55–69); Grade D (70+). Used for the prostate cancer item.
  10. US Preventive Services Task Force. Abdominal Aortic Aneurysm: Screening. USPSTF. 2019. uspreventiveservicestaskforce.org Grade B (men who have ever smoked). Used for the AAA item.
  11. US Preventive Services Task Force. HIV Infection: Screening. USPSTF. 2019. uspreventiveservicestaskforce.org Grade A. Used for the HIV item, including the pregnancy exception.
  12. US Preventive Services Task Force. Hepatitis C Virus Infection in Adolescents and Adults: Screening. USPSTF. 2020. uspreventiveservicestaskforce.org Grade B. Used for the hepatitis C item.
  13. US Preventive Services Task Force. Chlamydia and Gonorrhea: Screening. USPSTF. 2021. uspreventiveservicestaskforce.org Grade B (women); Grade I (men). Used for the chlamydia/gonorrhea item.
  14. US Preventive Services Task Force. Osteoporosis to Prevent Fractures: Screening. USPSTF. 2025. uspreventiveservicestaskforce.org Grade B (women); Grade I (men). Used for the osteoporosis item.
  15. US Preventive Services Task Force. Depression and Suicide Risk in Adults: Screening. USPSTF. 2023. uspreventiveservicestaskforce.org Grade B. Used for the depression item.
  16. US Preventive Services Task Force. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. USPSTF. 2018. uspreventiveservicestaskforce.org Grade B. Used for the alcohol-use item.