Why preventive screenings matter
Most of the high-impact medicine in adult primary care is preventive. Blood pressure, cholesterol, diabetes, cancer screening, bone density, vascular disease. Almost all of these are treatable, often effectively, when caught early. Most are harder or impossible to reverse once they're advanced. Screening is the one tool that lets us see what's coming before it arrives.
What to screen for, by age
All adults
- Blood pressure at least annually, with home readings to confirm
- Lipid panel every 4 to 6 years, more frequently with risk factors or a family history
- Diabetes screening (A1C or fasting glucose) every 3 years starting at 35, earlier with risk factors
- Weight and body composition at every visit, plus waist circumference
Ages 40 to 49
- Comprehensive cardiovascular risk assessment, including ASCVD calculation and consideration of advanced lipid testing (ApoB, Lp(a), particle size) for patients with family history or ambiguous risk
- Baseline eye exam at 40
- Discussion of colorectal cancer screening options (current guidelines start at 45)
- Skin exam, especially if you have significant sun exposure or family history
Ages 50 and up
- Colonoscopy every 10 years starting at 45 to 50, or stool-based testing as an alternative for some patients
- Lung cancer screening with low-dose CT for eligible current or former heavy smokers
- Bone density (DEXA) for women at 65, men at 70, earlier with risk factors
- One-time abdominal aortic aneurysm screening for men 65 to 75 with a smoking history
- Continued age-appropriate cancer screening (mammography, cervical, prostate after a shared-decision conversation)
Family history matters
The above is a general framework. Your actual plan should be adjusted for family history, personal risk factors, and what's already known about you. A first-degree relative with early coronary disease changes your cardiovascular screening. A mother or sister with breast cancer changes your mammography timing. Good screening is specific to you, not formulaic.
How this works in my practice
In a rushed annual visit, screening usually becomes a defaulted checklist. Something gets ordered if it comes up; otherwise nothing happens. In my practice, the annual physical runs 60 to 90 minutes, and building a real screening plan is part of that visit. We actually calculate cardiovascular risk, review family history, and decide which tests make sense for your specific situation.
When results come back, I call you or text you to review them. Not a portal message. If something needs follow-up, I coordinate it directly rather than sending you a referral slip and hoping the handoff works.
If you want a serious, personalized look at your screening plan, reach out. I'll walk through your specific situation and tell you what I'd recommend and why.
