You may have noticed that your routine physicals include a lot more discussion of tests than they did a decade or two ago. Because age is a risk factor for many diseases, including type 2 diabetes, heart disease, and most forms of cancer, the amount of screening your doctor will recommend rises as you get older.
Still, you don’t need to jump on every option. “Just because there’s a test doesn’t mean you ought to get it,” says William Hall, M.D., who practices internal medicine and geriatric medicine at the University of Rochester Medical Center.
Be particularly cautious about tests that aren’t recommended by the U.S. Preventive Services Task Force (USPSTF), American Cancer Society, American Heart Association, or other public health group. The seven below are all rated “A” or “B” by the USPSTF, the agency’s two grades for tests that are shown to be beneficial.
But, for example, the USPSTF rates the PSA test for prostate cancer a “C,” meaning it should be given only after consulting with a doctor since the harms may outweigh the benefits for some.
With any test, of course, you should ask your doctor about the risks as well as the benefits, says Hall. Plus, screening guidelines are generally written for people at average risk of a certain disease. Family history, your own medical history, or other factors might prompt your doctor to recommend a different test or timing.
The good news: Under the Affordable Care Act, any preventive services recommended by the USPSTF with a grade of “A” or “B” are covered by both Medicare and private insurers with no cost sharing.
1. What to screen for: Hypertension
The test: A blood pressure reading in the doctor’s office, followed up by portable device readings over a 12- to 24-hour time frame (because the stress and anxiety of a doctor’s visit can cause your blood pressure to spike). This condition is symptomless, so screening for it is key for gauging your risk of heart disease.
Who should get it: All adults
Timing: This is a basic test. Everyone over 40, or those who have risk factors such as obesity or being African-American, should be screened annually. Younger adults can be screened less frequently — every few years is fine.
2. What to screen for: Type 2 diabetes
The test: Either the A1C test, which does not require fasting and measures your average blood glucose level over the past three months, or fasting blood glucose, which does require fasting and is a snapshot in time.
Who should get it: The USPSTF advises testing for adults between 40 and 70 who are overweight or obese, though certain risk factors — including a family history of diabetes — can prompt screening earlier or at a lower BMI.
The American Diabetes Association recommends routine testing for everyone starting at age 45, or younger depending on risk factors.
Timing: Both groups say three years is a reasonable interval after you have a normal test result.
3. What to screen for: Colorectal cancer
The test: This is often a colonoscopy, but it doesn’t have to be. The USPSTF says that other options, including at-home fecal tests, are also effective. You can also get a virtual, noninvasive CT scan, but as with the fecal tests, any positive result must be followed up with a colonoscopy.
A flexible sigmoidoscopy, which like the colonoscopy is another “scope” test but looks only at the lower part of the colon, is also on the USPSTF’s list of options, but it’s on the decline.
Who should get it: All adults aged 50 to 75, according to the USPSTF; after that, it’s up to you and your doctor. The American Cancer Society recommends starting at age 45, making individual decisions starting at 76, and cutting out screening by 85.
Because the risks of colonoscopy increase with age, people at the upper end of the recommended age range may be better off with a non-invasive test, says Sterling Ransone, M.D., a family medicine physician in Deltaville, Ga. and a member of the board of directors of the American Academy of Family Physicians.
Timing: Colonoscopies are generally scheduled every 10 years. The CT scan and sigmoidoscopy are every five years. The fecal tests — which you get through your physician — are usually annual (a newer, less-studied DNA-based test can be taken every three years).
These intervals are dependent on your test results: If you have polyps removed, you’ll likely need to have a colonoscopy sooner than another 10 years.
4. What to screen for: Breast cancer
The test: Mammogram
Who should get it: The recommended age to start mammograms has shifted over time and depends on who you ask. According to the USPSTF, women should start getting mammograms at 50. The American Cancer Society advises starting five years earlier.
There is less evidence to gauge the risks and benefits of screening women 75 and up, but generally, if an older woman is in good health, screening is still a good idea, says Ransone.
Timing: The USPSTF recommends every other year; the ACS says you should go annually until age 55, when you can shift to every other year.
5. What to screen for: Osteoporosis
The test: DEXA scan, a non-invasive test that measures bone density and signs of osteoporosis, which can lead to broken bones.
Who should get it: Women who are 65 and up, or younger postmenopausal women at increased risk because of a family history of fractures, low weight, or smoking, among other factors, says the USPSTF.
Evidence in men is scant, but it makes sense for men with risk factors — including older age and a low BMI — to discuss the pros and cons of screening with their physician.
Timing: Determined by your initial results
6. What to screen for: Abdominal aortic aneurysm
The test: Ultrasound of your abdominal aorta, in your stomach area; when a weak arterial wall ruptures, it can lead to often-deadly bleeding.
Who should get it: Men aged 65 to 75 who have ever smoked, per the USPSTF. If you’re a man in that age range but haven’t smoked, talk to your doctor about whether the test might be appropriate for other reasons, such as your family history.
There’s not enough evidence to recommend whether women in that same age range who have ever smoked should get the test.
Timing: One time only
7. What to screen for: Lung cancer
The test: Low-dose CT scan
Who should get it: Adults aged 55 to 80 who are current or former long-time or heavy smokers.
The American Cancer Society, which has similar recommendations, points out that screening can produce false positives and lead to invasive follow-up tests. So carefully discuss the benefits and harms with your doctor first.
Timing: Annually. You can stop once you’ve been tobacco-free for 15 years.