Doctor Appointments to Schedule Before Ages 30, 40, and 50

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Preventing chronic conditions is the best way to preserve health. But as medical research continually produces new recommendations for how to prevent these ailments, it can be difficult for patients to know what to ask their physicians during appointments.

To cut down on confusion, we outlined issues that every patient should discuss with his or her primary care physician before the ages of 30, 40, and 50. Three important caveats to remember: Timing of screening and care will sometimes vary based on individual patient desires and risk factors; patients with pre-existing medical conditions require more frequent screening and monitoring; and pregnant women require completely different screening regimens under close care from their obstetricians.

Before the age of 30

High blood pressure: Elevated blood pressure (hypertension) is asymptomatic until it is severe, but it is a major risk factor for a number of other conditions, like stroke, aneurysms, heart failure, and kidney failure. Thankfully, there are a number of lifestyle and medical interventions that can control blood pressure before it becomes a serious problem, and it is important for patients to discuss potential interventions with their physicians. The U.S. Preventive Service Task Force (USPSTF) recommends screening for high blood pressure beginning at 18 years old.

Cervical cancer (women): With regular screening and follow-ups, many cases of cervical cancer and its resulting complications can be prevented. Screening should begin at the age of 21 with a pap smear and should continue through the age of 65 at regular intervals, adjusted based on age and results of prior pap smears. It is crucial for women to discuss details about screening and testing with their physicians so they know what to expect as they initiate and maintain surveillance throughout adulthood.

Sexual health: Sexually transmitted infections (STIs) are frequently asymptomatic but have far-reaching implications for personal and public health. For example, gonorrhea and chlamydia can be major causes of infertility, chronic pelvic pain, and ectopic pregnancy in women. In men, they can spread to other areas and, in rare cases, cause infertility. In addition to their direct effects, STIs like gonorrhea and chlamydia can also facilitate transmission of HIV.

Before the age of 40

Sun damage: Most people know about the association between sun exposure and skin cancer. Sunlight, however, is also a primary source of vitamin D, a important nutrient. According to the USPSTF, there is insufficient evidence to assess whether whole-body skin examinations should be used to screen for skin cancer. All adults would benefit from discussing sun exposure with their physicians to debunk myths and clarify issues around lifestyle habits and the best forms of sun protection.

High cholesterol: Many people know that having high cholesterol is not a good thing. But a range of lipid abnormalities—not just high total cholesterol, but also the levels of “good” cholesterol and “bad” cholesterol in the body—are associated with cardiovascular and metabolic disease. Unfortunately, without screening, patients often don’t notice the impact of these abnormalities until they suffer serious complications like a heart attack. Men age 35 and older and women age 45 and older who have risk factors for cardiovascular disease, such as prior cardiovascular disease, obesity, diabetes, and tobacco use, should be screened for lipid disorders.

Weight: Obese and overweight adult patients may benefit from seeing a doctor to address health concerns and then a get referral to intensive, multi-component behavioral interventions. Obesity screening and counseling is a crucial health intervention at all ages, including childhood, but it becomes particularly urgent as patients’ risks for chronic conditions increase as they age. Overweight patients and those at risk for becoming overweight should discuss the risks and benefits of intensive, individualized interventions with their physicians.

Before the age of 50

Diabetes: For many patients, there are few or no symptoms associated with initial diabetes onset. They notice problems—frequent urination, excessive thirst, blurry vision, slow healing wounds—only as their condition progresses. Individuals without symptoms should be tested for diabetes at the age of 45 in the absence of other risk factors, such as high blood pressure, abnormal cholesterol levels, history of cardiovascular disease, or a first-degree relative with diabetes. If risk factors are present, screening should be initiated earlier.

“Baby”aspirin risks: Patients frequently ask about the benefits of using “baby” aspirin (81 mg tablets) to prevent heart attacks or cardiovascular disease. Existing data suggests that taking a low-dose aspirin daily can have benefits for certain patients, particularly men with increased risk for heart attack and women with increased risk for stroke. The benefits of aspirin use, however, should be balanced against the risk of gastrointestinal bleeding that aspirin can potentially increase. The USPSTF and the American Academy of Family Physicians support baby aspirin use in men and women 45 and 55 years old or older, respectively, for whom reduction in heart attack and stroke risk outweigh potential harm from bleeding. A primary care physician can help assess individual risk and decide whether or not you would benefit from daily aspirin use.

Cancer screening: There’s been a number of recent debates about cancer screening in the fourth and fifth decades of life, leading to changes in breast and prostate cancer screening recommendations. Currently, the USPSTF recommends that breast cancer screening begin at age 50, though there is insufficient evidence to evaluate the benefits of starting screening at 40 (the age cut-off of prior recommendations). Similarly, experts have recommended against universal prostate cancer screening due to inadequate data, though it is clear that screening should be individualized. In light of these issues, it is important for patients to discuss screening with their physicians, learn about risks and benefits, and pursue individualized screening plans.