We experience a lot of life changes as we age, and the way we monitor our health is no exception. Whether you feel healthy or not, you should be regularly screened for certain health issues—and when you reach your 40s, guidelines for those health screenings start to change. Learning about these tests before you see your doctor will help you better engage in your testing and possible treatments.
Wondering what to expect as you hit middle age? Arif S. Hussain, MD, an internist at LifeCare Physicians in Robbinsville, New Jersey, explains what tests both men and women should expect and when to get them.
Vaccinations and Annual Checkups
Many of us received regular checkups as children. Though as adults our reason for a wellness visit changes, it is still important. While frequency may ultimately depend on your age and health status, healthy people between ages 40 and 49 should go every one to three years. After 50, it’s every year.
Dr. Hussain notes that the wellness visit is to assess general health and should include counseling for disease prevention, based on your risk factors. “This goes for probably every age range, but your doctor should be asking about depression and your mental health,” says Hussain. “They should be counseling you about diet and exercise, about alcohol and tobacco use.”
At your wellness visit you can also expect to receive any immunizations you need that year. A flu shot is recommended annually and can be administered by your doctor or at a local pharmacy. Additionally, you should receive a tetanus-diphtheria (Td) booster vaccination every 10 years if you were immunized before age 19; if you weren’t, ask your doctor about a catch-up schedule. You should also get the shingles vaccine when you turn 50.
Hussain notes to ask your provider about the pneumonia vaccine as it may be indicated if you have certain risk factors—like you’re a smoker—or a history of certain conditions such as asthma, diabetes or certain cancers.
Blood Pressure Screenings
Hypertension—or high blood pressure—puts your heart at risk. It can lead to heart disease and stroke, and nearly half of American adults face that risk due to their blood pressure numbers.
That’s why the US Preventive Services Task Force (USPSTF) recommends blood pressure screenings begin at age 18. The American Heart Association (AHA) suggests they start at age 20, and you have one every two years after that. According to AHA guidelines, a normal systolic (upper) number should come in under 120 mm Hg, and a healthy diastolic reading should be lower than 80 mm Hg.
“[It is advised to] periodically check your blood pressure at home, just to make sure that it’s not creeping up for some reason,” says Hussain. Don’t have access to the equipment? Try your local drugstore—many offer testing.
Cholesterol screenings help evaluate your risk of heart disease. High cholesterol can contribute to buildup in your arteries, which may make them narrower, reduce flexibility and increase your risk of an event, like a heart attack. Guidelines state that both men and women without cardiovascular disease should begin regular screenings at age 20 and keep getting them every four to six years.
“This blood test is to make sure that your cholesterol is not high; it also checks your triglyceride levels to make sure they are all normal,” explains Hussain. “It breaks it down between the good cholesterol (HDL) and the bad cholesterol (LDL) and our goal is to keep them within normal limits.” That is, a total cholesterol reading under 200mg/dL.
Hussain notes that if you have high cholesterol, a family history of high cholesterol or other conditions such as diabetes or kidney problems, your doctor will advise that you get screened more frequently than others.
Should you have high cholesterol—or too much LDL and not enough HDL—your doctor will advise lifestyle changes and possible restrictions. Many doctors will want to begin checking your cholesterol every six months. “We also recommend dietary changes and make sure people exercise on a regular basis before we prescribe medication,” reveals Hussain.
According to the American Diabetes Association, over 7 million adults with diabetes are undiagnosed, even though a staggering 1.5 million Americans are diagnosed every year. That’s why diabetes screening is crucial. Both men and women without risk factors for diabetes are advised to start at the age of 45, with regular testing every three years.
Hussain notes that there is an oral glucose tolerance test along with two blood tests that can evaluate your blood sugars. The first blood test is done in the morning after fasting and shares your blood glucose number. The second blood test is the hemoglobin A1C test and gives a measure of blood sugar levels over the previous three months.
“If [these test results are] abnormal—in the sense that you’re considered a diabetic—then we check it every four to six months,” explains Hussain, though some doctors may check every three months. “But if you’re in the prediabetic range, most doctors check it every six months.”
Other factors, including high blood pressure and obesity, can lead to earlier or more frequent testing. Official guidelines note that Asian Americans should be screened earlier if their BMI is greater than 23.
Screenings for Colorectal Cancer
Colorectal cancer—which is cancer in the colon, rectum or both—is the third most common cancer found in Americans. According to guidelines released by the American Cancer Society (ACS) in May 2018, colorectal cancer screening should begin at age 45 for people with average risk. However, many organizations, including the USPSTF, advise that men and women should start at age 50—unless there is a family history.
“If you have a strong family history, meaning first degree relatives such as parents, siblings or children, then you have to start screening 10 years before the age that they were diagnosed,” mentions Hussain. “If someone was diagnosed at 60, you’re going to start at 50, anyway. But if the father or mother had colon cancer when they were 55, then you have to start the child at 45.”
Common screening methods include:
- Fecal occult blood test, done every year
- Stool DNA test (called Cologuard), done every 3 years
- Flexible sigmoidoscopy, done every 5 years
- Colonoscopy, done every 10 years
Hussain notes that the main colon cancer screening is the colonoscopy, where a scope is inserted through the rectum into the colon to examine the large intestine. The ACS and USPSTF don’t give a preference for screening methods—it’s whatever the patient is most comfortable with.
Both men and women are advised to go to their dentist once or twice every year for a dental exam and regular cleanings. The National Institute on Aging notes that oral cancer is more prevalent in people over age 40; your dentist can evaluate your mouth and throat during this checkup, as well.
When choosing how often to see your dentist, you want to take your overall health into consideration, according to Hussain. “Your dentist should be aware of medications or other medical illnesses that may affect the teeth or the gums.”
The CDC has reported that about half of Americans age 30 and up have periodontal (gum) disease. Brushing, flossing, getting regular cleanings and following recommendations from your doctor, such as eating a healthy diet and limiting tobacco, can help lower your risk.
Around age 40, your chance of developing vision issues starts to rise, and you may begin to have problems seeing things up close. That’s why, from the ages of 40 to 54, both men and women are advised to have an eye exam at least every two to four years. From ages 55 to 64, it’s every one to three years.
The exception to these guidelines is if you have diabetes, existing vision problems or an increased risk for glaucoma, which means you should see your doctor at least once per year.
“Once you have a diagnosis of glaucoma then [visits change to] every six months as the pressure inside a person’s eye needs to be monitored because there are certain medications and sprays for allergies that can increase it,” explains Dr. Hussain. “For people who are diabetic, there are certain changes we wouldn’t notice that could happen on a microscopic level, that only your eye doctor can see and diagnose.”
By 2020, a staggering 43 million Americans could lose some or all of their sight from age-related eye diseases, according to the American Academy of Ophthalmology. They add that this is an increase of over 50 percent from current statistics, further highlighting the importance of receiving regular eye exams to address any issues as early as possible.
Every year, more Americans are diagnosed with skin cancer more than all other cancers combined. That’s a big reason why your primary care provider will often perform a skin exam yearly and may refer you to a dermatologist. You may be at higher risk if you or a close relative has had skin cancer, if you’ve been exposed to a lot of sun or if your immune system is weakened.
Neither the American Cancer Society and the American Academy of Dermatology have hard-and-fast rules about skin cancer screening. Instead, they highlight the importance of regular self-examination, especially if you’re at a higher risk for skin cancer. Getting familiar with your own skin can help you detect changes and spot cancer early.
Lung Cancer Screenings
If you have a history of smoking, you may be advised to undergo lung cancer screening. Dr. Hussain notes that certain people ages 55 to 80 should be screened:
- Those who have a 30 pack-year history and currently smoke
- Those who have a 30 pack-year history and quit within the past 15 years
A “pack-year” refers to the number of packs smoked per day multiplied by the number of years you’ve smoked. So, if you smoke three packs per day for 10 years, it’s 30 pack-years.
“Chest x-rays [are not used] anymore because they’re not as accurate as CAT scans are,” explains Hussain. “[Now they use] a low dose CAT scan (LDCT)—where the amount of radiation is not at high as a normal CAT scan would be—to make sure you’re not developing lung cancer.”
Usually, lung cancer won’t show symptoms until it’s advanced. The earlier it’s detected, the better your chances of survival.
Additional Tests For Women
There are a series of tests that women are specifically advised to get. Women over 50 who are at increased risk of osteoporosis should get a bone density test (DEXA scan) as an osteoporosis screening. Screening for normal-risk women should begin at age 65.
The USPSTF recommends women get mammograms every one to two years beginning at age 50 unless there is a history of breast cancer in the family. Both the American College of Obstetricians and Gynecologists (ACOG) and the ACS suggest women be given the option starting at 40. They also advise women to become familiar with the feel of their own breasts, so they’re better able to recognize changes; ACOG recommends a clinical breast exam, as well.
ACOG also suggests women between ages 30 and 65 receive a Pap smear and HPV test every five years, though a getting a Pap smear alone every three years is also acceptable. (USPSTF says women over 30 can just get HPV test, without the Pap, every 5 years.) Women should begin getting regular Pap smears when they turn 21.
Additional Tests For Men
For men, when to screen for prostate cancer is controversial, due largely to false positives or unnecessary treatment that can be more harmful than the disease itself. Recommendations vary among organizations, and ultimately, a lot depends on patient preference.
That said, it’s generally accepted that men should begin discussing the risks and benefits between ages 50 and 55, unless they’re in a high-risk group. “African Americans or those who have a close relative with a diagnosis should begin screenings at the age of 45 or earlier,” says Hussain. Many experts even suggest starting around age 40.
Testicular cancer screenings are generally not recommended without symptoms, though some organizations suggest men with a family history or certain risk factors consider performing self-examinations.
Sourcing: U.S. National Library of Medicine, American Academy of Pediatrics, CDC, American Heart Association, American Diabetes Association, American Cancer Society, U.S. Preventive Services Task Force, U.S. Department of Health and Human Services, American Optometric Association, American Academy of Periodontology, Skin Cancer Foundation