Preventive care can seem like the boring part of medicine, but the importance of thorough, routine preventive care cannot be stressed enough. Preventive care helps detect health issues early, before symptoms appear, which can prevent serious diseases, reduce the risk of chronic illness, and improve long-term health outcomes. It also lowers healthcare costs by avoiding expensive treatments later, while promoting a longer, healthier, and more productive life.
In this newsletter, I provide a brief overview of the recommended preventive care for adults with some specific recommendations based on sex.
Core preventive care for all adults over 40 centers on cardiovascular risk reduction, cancer screening, metabolic screening, immunizations, and behavioral/lifestyle counseling. The recommendations below reflect the guidance from major medical societies; several cancer-screening entries involve shared decision-making rather than fixed age cutoffs.
Core preventive care for all adults over 40 centers on cardiovascular risk reduction, cancer screening, metabolic screening, immunizations, and behavioral/lifestyle counseling. The recommendations below reflect the guidance from major medical societies; several cancer-screening entries involve shared decision-making rather than fixed age cutoffs.
Shared across all adults ≥40 (both sexes)
- Blood pressure screening at every visit; measure height/weight and BMI.
- Lipid screening in adults 40–75 years to guide statin therapy; calculate a 10-year ASCVD risk score. I perform this at least annually.
- Diabetes screening (e.g., in adults with elevated BP or overweight/obesity). I perform this at least annually.
- Colorectal cancer screening starting at age 45 for average-risk adults, continuing to 75 (then individualized to 85 depending on life expectancy). Options include FIT annually, multitarget stool DNA every 3 years, colonoscopy every 10 years, CT colonography or flexible sigmoidoscopy every 5 years. If you have a 1st degree relative with a history of colon cancer, that leads to more frequent screening.
- Lung cancer screening with annual low-dose CT for ages 50–80 with a ≥20-pack-year history who currently smoke or quit within 15 years (USPSTF).
- Behavioral screening/counseling: tobacco, alcohol and substance use, diet and physical activity, depression/anxiety, and HIV/STI risk.
- Immunizations per ACIP (influenza, COVID-19, Td/Tdap, and age/risk-based hepatitis, HPV, herpes zoster, pneumococcal, RSV). See below under immunization schedule.
Sex-specific reminders — female patients
- Breast cancer: mammography every 1–2 years starting at age 40 (USPSTF now recommends biennial screening beginning at 40; ACS offers annual starting at 40–44, annual 45–54, then every 1–2 years).
- Cervical cancer: screening every 3 years with cytology, or every 5 years with HPV testing/co-testing, discontinuing after age 65 with adequate prior negative screening (or after total hysterectomy for benign disease).
- Osteoporosis: DXA screening for women ≥65, or earlier if elevated fracture risk; treat based on T-score ≤ −2.5 or elevated FRAX score. Medicare allows a DEXA scan every 2 years.
- Ovarian cancer: routine screening is not recommended in average-risk, asymptomatic women; refer BRCA positive/family-history patients for genetic counseling.
- Cardiovascular disease is the leading cause of death in postmenopausal women—emphasize risk-factor screening and statin use where indicated.
Sex-specific reminders — male patients
- Prostate cancer: PSA-based screening is an individualized, shared decision for men 55–69 years; do not screen after 75/with <10-year life expectancy. Earlier discussion (age 45, or 40 with multiple affected relatives) for higher-risk men including Black men and those with affected first-degree relatives.
- Abdominal aortic aneurysm: one-time screening ultrasound in men 65–75 years who have ever smoked.
- Testicular and skin cancer: insufficient evidence for routine screening in asymptomatic average-risk men.
Immunization schedule: For patients 40–49 the schedule is largely driven by annual/seasonal vaccines plus catch-up needs, while several vaccines become universally recommended at defined age thresholds (50, 60, 65, 75).
Recommended for all adults ≥40 (routine, age- or season-based)
- Influenza: annually for all adults without contraindications.
- COVID-19: per current ACIP recommendations; dosing depends on the product and prior vaccination history.
- Td/Tdap: a Td (or Tdap) booster every 10 years; a one-time Tdap dose if not previously received, and Tdap for wound prophylaxis if >5 years since the last tetanus-containing dose.
- Herpes zoster (recombinant, Shingrix): 2-dose series for all adults ≥50 years (and for immunocompromised adults ≥19).
- RSV: added in 2024—single dose recommended, with age thresholds now emphasizing older adults (shared clinical decision-making previously applied to ages 60–74, with a stronger recommendation at ≥75).
Recommended at age ≥65 (or younger with risk conditions)
- Pneumococcal: all adults ≥65 with no prior PCV should receive PCV15 or PCV20; if PCV15 is used, follow with PPSV23 (≥1 year later, or ≥8 weeks if immunocompromised, CSF leak, or cochlear implant). Adults 19–64 with chronic conditions (chronic heart/lung/liver disease, diabetes, alcohol use, cigarette smoking) or high-risk/immunocompromising conditions should also be vaccinated.
Risk-, condition-, or history-based (any age, including 40+)
- Hepatitis B: recommended for all adults 19–59, and for those ≥60 with risk factors (may also be given to any adult ≥60 who requests it).
- Hepatitis A: for adults with specific risk factors (chronic liver disease, HIV, MSM, travel, injection drug use, etc.).
- MMR: 1 dose for adults born in 1957 or later without evidence of immunity; 2 doses for those at higher risk (e.g., healthcare personnel, students, international travelers).
- HPV: routine through age 26; for adults 27–45, shared clinical decision-making based on individual likelihood of benefit (not routinely recommended in this age band).
- Meningococcal (ACWY and B), poliovirus (IPV), and Mpox: for adults with specific risk factors or exposures.
If you’d like to talk through which preventive screenings and immunizations make sense for you, please call our office at (707) 938-1255 to schedule an appointment with Dr. Guy.