Adult Health Maintenance & Screening
The USPSTF grade A and B recommendations boards love to test
The USPSTF grading framework
Grades A and B mean do it. The US Preventive Services Task Force grades each service by the certainty and size of its net benefit. Only grade A and B services must be covered without cost-sharing under the Affordable Care Act. Knowing when NOT to screen (grade D) is tested as often as knowing when to screen.
| Grade | Meaning | What to do |
|---|---|---|
| A | High certainty of substantial net benefit | Offer or provide |
| B | Moderate to substantial net benefit | Offer or provide |
| C | Small net benefit | Offer selectively, individualized to the patient |
| D | No net benefit, or harms outweigh benefits | Discourage |
| I | Insufficient evidence | If offered, explain the uncertainty |
Cancer screening
| Cancer | Who | Test and interval | Grade and when to stop |
|---|---|---|---|
| Breast | Women 40–74 | Mammography every 2 years | B; insufficient evidence (I) at 75+ |
| Cervical | Women 21–65 | 21–29: cytology every 3 years; 30–65: cytology every 3 years, hrHPV every 5 years, or co-testing every 5 years | A; stop at 65 after adequate negative screening; none before 21 |
| Colorectal | Adults 45–75 | Colonoscopy every 10 years, annual FIT, FIT-DNA every 1–3 years, flexible sigmoidoscopy or CT colonography every 5 years | B for 45–49, A for 50–75; selective (C) at 76–85 |
| Lung | Adults 50–80 with ≥20 pack-years who smoke now or quit within 15 years | Annual low-dose CT | B; stop after 15 smoke-free years or with limited life expectancy |
| Prostate | Men 55–69 | PSA only after shared decision-making | C; do not screen at 70+ (D) |
Breast. The 2024 update lowered the start age of biennial mammography from 50 to 40.
Cervical. Begin cytology (Pap) at 21 regardless of sexual history; sexual debut and HPV vaccination status do NOT change the start age. Women who have had a hysterectomy with removal of the cervix for benign disease need no further screening. A 2024 USPSTF draft update favors primary hrHPV testing every 5 years from 30 to 65 and allows patient self-collected samples.
Colorectal. The start age for average-risk adults is now 45. Any positive stool-based or imaging test must be followed by colonoscopy. A first-degree relative with colorectal cancer before 60 moves screening earlier (US Multi-Society Task Force, not USPSTF): colonoscopy at 40 or 10 years before the relative's age at diagnosis, whichever comes first, repeated every 5 years.
Lung. All three eligibility criteria must be met: age 50–80, at least 20 pack-years, and current smoking or quitting within the past 15 years.
Prostate. Discuss overdiagnosis, false positives, and biopsy harms before ordering a PSA; never order it reflexively.
Do not screen asymptomatic adults for ovarian, pancreatic, thyroid, or testicular cancer (grade D).
Cardiovascular and metabolic screening
Abdominal aortic aneurysm. One-time abdominal ultrasound for men 65–75 who have EVER smoked (at least 100 cigarettes in a lifetime) is grade B. It is selective (C) in never-smoking men, and women who have never smoked should not be screened (D).
Statins. Adults 40–75 with at least one CVD risk factor (dyslipidemia, diabetes, hypertension, smoking) AND an estimated 10-year ASCVD risk of 10% or more should take a statin (grade B). A risk of 7.5% to under 10% is a selective, grade C decision.
Diabetes. Screen adults 35–70 who are overweight or obese for prediabetes and type 2 diabetes (grade B).
Hypertension. Screen ALL adults 18 and older (grade A): yearly from age 40 or with increased risk, every 3–5 years for younger adults at low risk. Confirm with out-of-office (home or ambulatory) readings before making the diagnosis.
Aspirin and bone health
Aspirin for primary prevention. Low-dose aspirin in adults 40–59 with a 10-year CVD risk of 10% or more is an individualized decision (grade C). Do NOT initiate aspirin for primary prevention at age 60 or older (grade D), because GI and intracranial bleeding outweigh the reduction in CVD events. Low-dose aspirin still prevents preeclampsia in high-risk pregnancy (grade B).
The 2022 update reversed the older "aspirin for everyone" teaching: after 60, bleeding risk wins.
Osteoporosis. Screen women 65 and older with DEXA (grade B), and younger postmenopausal women whose fracture risk on a formal tool (e.g., FRAX) is increased, judged by clinical risk factors or a formal risk tool (USPSTF 2025). Evidence is insufficient (grade I) to screen men.
Infectious disease and behavioral screening
- HIV: at least once for everyone 15–65 (grade A), plus all pregnant patients and those at increased risk.
- Hepatitis C: once for adults 18–79 (grade B).
- Hepatitis B: adults at increased risk (grade B).
- Chlamydia and gonorrhea: sexually active women 24 and younger, and older women at increased risk (grade B).
- Syphilis: adults at increased risk and all pregnant patients.
- Depression: ALL adults, including pregnant and postpartum patients (grade B).
- Anxiety: adults 64 and younger (grade B).
- Unhealthy alcohol use in adults (grade B) and tobacco use in all adults, with counseling and pharmacotherapy for smokers (grade A).
Whole-body CT, routine vitamin D levels, and carotid ultrasound are not recommended screens for the general population.