Gerontology, Palliative Care & Prevention · Topic 9 of 13

Adult Preventive Screening

Prevention · USPSTF screening by age

Adult Preventive Screening

USPSTF screening by age: colorectal 45–75, mammography every 2 years 40–74, cervical 21–65, lung CT 50–80 with 20 pack-years, one AAA ultrasound for men 65–75 who smoked.

Key numbers

Colorectal cancer screening: ages 45–7545–75 y

Mammography every 2 years, ages 40–7440–74 y · every 2 y

Cervical screening ages 21–6521–65 y

Annual LDCT: age 50–80, ≥ 20 pack-years50–80 y · ≥ 20 pack-yr

One AAA ultrasound: men 65–75 who smokedmen 65–75, ever smoked

01 · The ruleColorectal cancer screening: ages 45–75

USPSTF: screen all adults 45–75 for colorectal cancer (grade A for 50–75, B for 45–49); at 76–85, screen selectively by overall health, prior screening and preference (grade C).

02 · The ruleMammography every 2 years, ages 40–74

USPSTF 2024: biennial screening mammography for women 40–74 (grade B); evidence is insufficient (I statement) to recommend for or against screening at 75 or older.

03 · The ruleAnnual LDCT: age 50–80, ≥ 20 pack-years

USPSTF: annual low-dose CT for adults 50–80 with ≥ 20 pack-years who smoke now or quit within 15 years; stop after 15 smoke-free years or when health limits curative surgery.

The rules

Know these

Cervical screening ages 21–65 must knowUSPSTF: cytology every 3 years at 21–29; at 30–65, cytology every 3 years, high-risk HPV testing alone every 5 years, or cotesting every 5 years.

One AAA ultrasound: men 65–75 who smoked must knowUSPSTF: one-time abdominal ultrasound screening for abdominal aortic aneurysm in men aged 65–75 who have ever smoked (≥ 100 cigarettes in a lifetime).

Colonoscopy every 10 years, FIT every yearAccepted colorectal strategies: FIT or high-sensitivity guaiac test yearly, stool DNA-FIT every 1–3 years, CT colonography or flexible sigmoidoscopy every 5 years, sigmoidoscopy every 10 years plus yearly FIT, or colonoscopy every 10 years.

No cervical screening: under 21, after hysterectomyDo not screen for cervical cancer before 21, after 65 with adequate prior negative screening and no high risk, or after hysterectomy with cervix removal and no history of CIN 2–3 or cervical cancer.

Bone density for women 65 and olderUSPSTF 2025: screen for osteoporosis (DXA, with or without fracture-risk assessment) in women 65 and older and postmenopausal women under 65 at increased risk; evidence in men is insufficient.

AAA: selective in never-smoking men, not womenUSPSTF: selectively offer AAA screening to men 65–75 who never smoked (grade C); do not screen women who never smoked and have no family history (grade D).

Hepatitis C once for ages 18–79USPSTF: screen adults 18–79 for hepatitis C. CDC screens every adult 18 or older at least once for hepatitis C (unless local prevalence is under 0.1%) and once for hepatitis B with a triple panel.

HIV screening ages 15–65USPSTF: screen everyone aged 15–65 for HIV (grade A), plus younger or older people at increased risk and every pregnant person.

Diabetes screening: 35–70 with overweightUSPSTF: screen for prediabetes and type 2 diabetes in adults 35–70 with overweight or obesity, and refer prediabetes to effective preventive interventions.

Blood pressure screening from age 18USPSTF: screen all adults 18 and older for hypertension with office blood pressure, and confirm with measurements outside the clinic before starting treatment.

Statin for 40–75 with 10-year risk ≥ 10%USPSTF: prescribe a statin for primary prevention in adults 40–75 with at least one risk factor (dyslipidemia, diabetes, hypertension or smoking) and a 10-year cardiovascular risk of 10% or more.

PSA: shared decision at 55–69, none at 70+USPSTF: PSA screening for men 55–69 is an individual decision after discussing benefits and harms (grade C); do not screen men 70 and older (grade D).

Management

Orders

Abnormal stool test or CT colonography → colonoscopyAny abnormal stool-based test, CT colonography or flexible sigmoidoscopy must be followed by colonoscopy to achieve the benefit of screening.

More detail

Reference

Show 3 reference facts

For dense breasts on an otherwise negative mammogram, the USPSTF finds insufficient evidence for supplemental ultrasound or MRI; these women still start screening at 40.

The 2023 American Cancer Society guideline screens ages 50–80 with ≥ 20 pack-years whether they smoke now or quit at any time — years since quitting is not a criterion.

USPSTF grades: A and B — offer or provide the service; C — offer selectively by individual circumstances; D — discourage it; I statement — evidence insufficient to weigh benefits and harms.

Pearl

45 for the colon, 40 for the breast, 21 for the cervix, 50 and 20 pack-years for the lung, 65 and a smoking history for the aorta.

Sources · USPSTF. Colorectal Cancer: Screening — final recommendation (May 2021) — JAMA, doi:10.1001/jama.2021.6238 · USPSTF. Breast Cancer: Screening — final recommendation (April 2024) — JAMA, doi:10.1001/jama.2024.5534 · USPSTF. Cervical Cancer: Screening — final recommendation (August 2018) — JAMA, doi:10.1001/jama.2018.10897 · USPSTF. Osteoporosis to Prevent Fractures: Screening (January 2025) — JAMA, doi:10.1001/jama.2024.27154 · USPSTF. Lung Cancer: Screening — final recommendation statement (March 2021) — JAMA, doi:10.1001/jama.2021.1117 · Wolf AMD et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin 2024 (Europe PMC record) · USPSTF. Abdominal Aortic Aneurysm: Screening (December 2019) — JAMA, doi:10.1001/jama.2019.18928 · CDC — Clinical Screening and Diagnosis for Hepatitis C · USPSTF. Prostate Cancer: Screening (May 2018) — JAMA, doi:10.1001/jama.2018.3710 · USPSTF. Grade Definitions · CDC — Clinical Testing and Diagnosis for Hepatitis B (triple-panel screening) · College of American Pathologists — USPSTF issues draft recommendations on screening for cervical cancer (Dec 17, 2024) · USPSTF. Screening for Hepatitis C Virus Infection in Adolescents and Adults. JAMA 2020 (Europe PMC record) · USPSTF. Screening for HIV Infection. JAMA 2019 (Europe PMC record) · USPSTF. Screening for Prediabetes and Type 2 Diabetes. JAMA 2021 (Europe PMC record) · USPSTF. Screening for Hypertension in Adults — reaffirmation. JAMA 2021 (Europe PMC record) · USPSTF. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. JAMA 2022 (Europe PMC record) · Starter sheet built from the verified AGACNP fact map (facts reviewed 2026-10-15).