三十几岁、四十几岁和五十几岁时需要做这些早期健康筛查

You’ve heard the adage “screening saves lives” and you’ve probably undergone—or had your doctor recommend—a range of routine screenings from diabetes and depression to cervical and colorectal cancer. These screenings are in addition to regular blood pressure and cholesterol screenings that are part of annual wellness care.

“Screening is a big part of preventive care,” says Dr. Soenda P. Norman, a family physician with Duke Primary Care Arringdon Family Medicine. “We want to catch something before it becomes problematic and there are irreversible consequences.”

Here are the screenings you may need in your 30s, 40s and 50s.

In Your 30s

Depression

Rates of depression are at an all-time high with 29% of adults reporting a diagnosis of depression in 2023—10% higher than 2015.

In 2022, the United States Preventive Services Task Force (USPSTF), an independent medical panel that makes evidence-based recommendations for preventive care, recommended screening all adults for depression.

Your doctor might ask questions about changes in appetite and sleep patterns, feelings of sadness or struggles with motivation at your next appointment to determine if you are experiencing depression. Screenings will continue annually throughout adulthood, according to Dr. Tina-Ann Thompson, director of the Division of Family Medicine and the Emory program lead, primary care, at the Emory University School of Medicine.

Cervical cancer

Starting at age 30, those with a cervix should be screened for the human papillomavirus (HPV), which is responsible for almost half of all high grade cervical pre-cancers.

“Younger women can get the virus and sometimes clear it on their own,” says Dr. Matthew Bonzelet, internist at Washington University in Saint Louis. “If [the virus] is still present at [age] 30, we need to start paying closer attention.”

Screening is recommended every five years in addition to a regular pap test, regardless of your sexual history or HPV vaccination status. Healthcare providers may recommend earlier or more frequent screening for those who are at high risk of cervical cancer.

Diabetes

Blood glucose testing to screen for pre-diabetes and diabetes starts at age 35. While USPSTF only recommends screening those who are overweight or obese but the American Diabetes Association advises screening for all adults 35 and older, regardless of their risk factors.

Your doctor may also recommend screenings for sexually transmitted infections and human immunodeficiency virus (HIV) in your 30s, depending on your health and risk factors, Thompson adds.

In Your 40s

Vision

Aging is associated with changes to your vision, so a baseline eye disease screening with an ophthalmologist is recommended at age 40. The screening can detect eye diseases like glaucoma and cataracts that become more common when you reach your 40s.

“Over time, the lens in your eyes get stiff and that changes their ability to adjust to [see] near and far,” says Bonzelet. “The 40s is the general timeframe when that starts to happen.”

Colorectal cancer

The rates of colorectal cancer in adults under age 50 has increased and accounts for more than 10% of new colorectal cancer cases. As a result, screening is recommended starting at age 45.

“Colorectal cancer screening is incredibly important but colonoscopy is not the only way to do it; stool testing can be just as good,” says Dr. Ronald Adler, associate professor of family medicine and community health at UMass Chan Medical School. “The best test for that is the one that gets done.”

Breast cancer

Earlier this year, the USPSTF issued new draft guidance for breast cancer screening. The task force lowered the recommended age for biennial screening from 50 to 40 for women for women at average risk of breast cancer. (The American Cancer Society has recommended annal mammograms starting at age 40 since 2003).

The USPSTF pointed to higher rates of breast cancer death in Black women as one of the reasons for adjusting the screening guidelines.

But the effectiveness of mammography screening is controversial with one study, published in the New England Journal of Medicine, found strong links between increases in breast cancer screening and over-diagnosis of breast cancer.

“There are debates about the proportion of mammographically-detected breast cancers that are over-diagnosed; it’s at least 15% but could be as high as 30%,” Adler says. “So, 2,400 women in their 40s need to be screened to prevent one breast cancer death and in that group, there are going to be hundreds of false positives and about a dozen over diagnosed cases.”

If your healthcare provider suggests mammography starting at age 40, Adler suggests asking about the potential downsides to screening and making a decision based on your risk factors.

In Your 50s

Prostate cancer

Conversations about prostate cancer screening start around age 50 (though your healthcare provider might recommend screening earlier if you are 45 or older and African American or have at least one first-degree relative who was diagnosed with prostate cancer, putting you at high risk of developing the disease).

Bonzelet notes that a prostate cancer screening may include a blood test for levels of prostate-specific antigen (PSA) or a digital rectal exam.

“The screening for prostate cancer is set up that no man should have be screened until after he has participated in a shared decision making process [with his healthcare provider] in which he considers his risk, the benefits and his own preferences and values,” Adler adds.

Lung cancer

Smokers may be advised to undergo lung cancer screenings.

The low-dose CAT scans are recommended for those who have accumulated 20 “pack years” as smokers, which is a calculation of the number of cigarettes smoked per day multiplied by the number of years they have smoked. One pack of cigarettes per day for 20 years or two packs of cigarettes per day for 10 years is the equivalent of 20 pack years.

“We’re essentially looking for any sort of nodule or mass that could be cancerous so we can refer them to appropriate care or at least recommend more frequent surveillance,” says Norman.

Additionally, Norman notes that lung cancer screening is an opportunity to counsel those who are still actively smoking on smoking cessation and providing support they need to successfully quit.

It’s important to be aware of age and risk related screening recommendations, but you should always have honest conversations with your healthcare provider to decide which screenings are right for you.