One of the most important parts of keeping yourself in optimal health over the course of your life is having regular testing at the appropriate times.
While it’s common to have regular check-ups in early childhood, this frequency drops significantly over time.
Many adults don’t even think about having a check-up unless something drastic happens and they’re forced into it.
Of course, my goal is to save you from having to face a drastic situation and the ripple effect a major health problem can cause throughout your life.
A chronic illness or lifestyle disease will often develop slowly over time, and the longer it goes unnoticed, the worse your outcome is likely to be — medically, psychologically and financially.
That’s why I’ve put this screening exam timeline together.
This timeline covers the basic tests I recommend at every stage of life, so you can use it to manage your own health, and to help inform the care of your kids, parents and other loved ones.
Please note: This is a basic testing timeline for the low-risk healthy person. Those with higher or increased risk factors need to talk to their doctor about the most appropriate testing timeline.
One more note:
I’ve written this post with notes for tests specific to males and females. In this context, ‘female’ refers to the anatomy present at birth and includes all gender identities where female anatomy is present. ‘Male’ refers to the anatomy present at birth and includes all gender identities where male anatomy is present.
Screening Exam Timeline
In the following categories, I outline the type of check-up or test that’s recommended by national health organizations. Note that some of these exams should be repeated annually from early childhood, such as dental exams and eyesight checks.
From Age 1
(Either starting at one year of age or after the first tooth appears.)
The health of your mouth directly impacts your chronic disease risk. To maintain optimal oral health, the American Dental Association (ADA) recommends a regular dental exam and cleaning twice yearly or at an interval determined by your dentist to accommodate your current oral health status and health history.
Biological dentists are holistic dentists that use natural therapies in combination with conventional. To find a biological dentist, search the biological dentist registry. Here is an interview that I did with my favorite holistic dentist on how to maintain proper dental hygiene.
EYE / VISION EXAM
The US Preventative Services Task Force recommends vision screening for all children at least once between the ages of 3 and 5 years.
FEMALE PHYSICAL EXAM
The American College of Obstetrics and Gynecologists recommend that the first visit to the obstetrician-gynecologist should take place between the ages of 13-15 and when they plan to become sexually active.
Unless indicated by the child’s health history, this visit generally does not include a pelvic examination (internal examination).
The focus should be on the discussion of anatomical development, body image, self-confidence, healthy nutrition, exercise, hygiene, immunization options, contraception, and prevention and testing of STIs (if sexually active).
MALE PHYSICAL EXAM
Teenage males should have a full physical around the ages of 13-15 and when they plan to become sexually active.
The exam should include a discussion of the following health topics: anatomical development, body image, self-confidence, healthy nutrition, exercise, hygiene, immunization options, contraception, and prevention and testing of STIs (if sexually active).
*Attention parents: make sure to request that your doctor discuss all of these topics with your child! It’s very important to start an open and honest conversation about all of these health topics early.
COMPLETE BLOOD WORKUP
Starting around the age of 18, I recommend that the average healthy person get a complete blood workup every 6 to 12 months. Read my article on How to Use Blood Tests to Improve Your Health.
YEARLY PHYSICAL EXAM
I recommend that all people get a yearly physical exam starting at the age of 18.
If possible, get this exam from the same doctor each year so that they will more easily be able to detect changes in your typical health picture.
A good physical exam should include a thorough history of your health and risk factors including family history, tobacco and alcohol use, sexual health (STI screening), diet and exercise, and vaccinations. Your vital signs will be checked which include your blood pressure, heart rate, respiration rate, and temperature.
Following that, you will be given the following exams: heart, lung, head and neck, abdominal, neurological, skin, and genitalia.
Females should be instructed on breast self-exam and males on testicular self-exam so that they are aware of what normal looks and feels like so that they will know if any changes occur throughout life.
*Doctors who are trained in Functional medicine consistently give very good and comprehensive physical examinations. Consider seeing a physician in your area who also is trained in naturopathic or functional medicine here or here.
SKIN CANCER SCREENING
A basic skin cancer screening should be completed yearly during your physical exam.
If you are high-risk or have a personal or family history of skin cancer I recommend going directly to a dermatologist for your exam so that they can monitor your skin from year to year.
Use this helpful guide from the American Academy of Dermatologists to help to spot skin cancer early.
Ages 21+ (female)
CERVICAL CANCER SCREENING
The US Preventative Services Task Force recommends women ages 21 to 65 should have a PAP test every 3 years.
Between the ages of 30 to 65, if cytology (PAP test) is done with high-risk human papillomavirus (hrHPV) testing, the testing interval can be changed to every 5 years assuming a history of normal test results.
The American College of Obstetricians and Gynecologists recommends pelvic examination when indicated by medical history or symptoms, not in asymptomatic, non-pregnant adult women.
Ages 40+ (female)
The American College of Obstetricians and Gynecologists recommends starting with screening mammograms every 1-2 years starting at age 40. However, the US Preventive Services Task Force says that the greatest benefit for yearly mammography is from age 50-74.
It is important to start to talk to your doctor about your risk factors for breast cancer starting at age 40.
COLON CANCER SCREENING *Recently updated recommendation*
In 2018 the American Cancer Society updated its colorectal cancer screening guideline to start screening exams at age 45 for people with average risk.
Previously the recommendation was age 50. This change was based on an analysis of data finding a rise in colon and rectal cancer in younger people, even though the overall rates are declining.
Of the top 5 deadliest cancers in the US — lung, colorectal, pancreas, breast, and liver — colorectal is one of the easiest to catch early and it is also very treatable when in this stage.
While nothing compares to the colonoscopy and it is still the preferred testing method, this is the list of the testing options and how often they should be performed:
- Highly sensitive fecal immunochemical test (FIT): yearly
- Highly sensitive guaiac-based fecal occult blood test (gFOBT): yearly
- Multi-targeted stool DNA test (MT-sDNA): every 3 years
- Colonoscopy*: every 10 years
- CT colonography: every 5 years
- Flexible sigmoidoscopy (FSIG): every 5 years
Talk to your doctor about the best option for you.
*Note – As with any medical procedure, there are risks.
Although the overall benefits of getting a colonoscopy outweigh the risks there is a small risk of perforation of the colon and major bleeds in asymptomatic people.
Perforation occurs in 4 in 10,000 procedures and bleeding occurs in 8 in 10,000 procedures. So, before you get your first colonoscopy there are few things to know. Know your colonoscopists adenoma detection rate, called the ADR. It should be about 30% in men and >20% in women. Also, how many perforations they have caused or other serious complications.
It is also important to know their withdrawal time (time spent viewing the colon). A longer withdrawal time is a more throughout inspection and 6-minutes is the standard of care. The tumor miss rate during a 3-minute versus 6-minute procedural withdrawal was more than double in a small study of four endoscopists!
Lastly, you want an endoscopist with a cecal intubation rate above 95%. This means that they have the skill required to get the colonoscope all the way to the beginning of the large intestine. Make sure to follow the recommendations to prep for your colonoscopy closely! Poor preparation leads to missed problems.
My thanks to Peter Attia, MD for his recent newsletter reviewing this important information.
Ages 55+ (male)
PROSTATE EXAM (DIGITAL RECTAL EXAM) & PSA
The US Preventive Services Task Force did a systematic review of the data current research and concluded that men ages 55-69 should make the decision for prostate testing with their doctor, taking into account their individual risk.
The net benefit of testing is small and the risk of complication is high (1.3 in 1000 men avoided dying from cancer due to testing). African American men and those with a positive family history are at increased risk of mortality from prostate cancer.
Men aged 70+ should not be screened for prostate cancer as the benefits do not outweigh the risks.
Screening tests need to be continually reviewed to make sure that they are done at the correct intervals, and are preventing medical complications and saving lives.
Occasionally the testing and treatment is found to cause more harm than good. And in the case of these prostate screenings, repeated testing of low risk individuals led to more treatment and complications and did not alter life quality or expectancy at a statistically significant level.
LUNG CANCER SCREENING *This recommendation is currently under review*
The US Preventive Services Task Force previously recommended annual screening for lung cancer with low-dose computed tomography (CT scan) in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.
Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that limits life expectancy.
ABDOMINAL AORTIC ANEURYSM TEST
The US Preventive Services Task Force recommends a one-time screening for abdominal aortic aneurysm by ultrasonography in men ages 65 to 75 who have ever smoked. Men who have never smoked need to discuss their risk factors with their doctor. The current evidence is insufficient for women who have a smoking history and it is not recommended for women who have never smoked.
OSTEOPOROSIS SCREENING TO PREVENT FRACTURES
The US Preventive Services Task Force recommends screening for osteoporosis using a DXA (DEXA) in women aged 65+ and in postmenopausal women younger than 65 who are at increased risk of osteoporosis. The current evidence is insufficient to assess the balance of benefits and harms for screening in men.
Choosing Wisely adds that men age 70+ should talk to their doctors about their risk factors and that men ages 50 to 69 and younger women should consider the test if they have risk factors for serious bone loss.
Helpful websites for the most recent screening exam recommendations:
The Choosing Wisely® campaign was created as an initiative of the American Board of Internal Medicine (ABIM) Foundation to improve healthcare quality.
More than 70 specialty societies have identified commonly used tests or procedures within their specialties that are possibly overused.
The U.S. Preventive Services Task Force is an independent panel of experts in primary care and prevention who systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.
These reviews are published as U.S. Preventive Services Task Force recommendations on the Task Force Web site and/or in a peer-reviewed journal.
I’ll be the first to admit that regular testing can feel inconvenient. When we’re healthy, it seems like an annoying waste of time to be carting ourselves off to the doctor all the time for tests that probably won’t find any problems.
But testing is our best option for accurately monitoring the state of our health over time.
We can do everything right, we might feel fine, but without the data from these tests, we can never really know if we need to be taking preventative measures or implementing a course of treatment that could protect our quality of life and even save our lives.
The inconvenience and discomfort are a small price to pay for peace of mind and a proactive approach to managing your health.
And if you’d like to explore what it’s like to work with me, to optimize your health and meet your performance goals, you can click here to find out more.
This medical information is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition.