06 Screening and Prevention Across the Lifespan

Choosing preventive services

Preventive care aims to detect disease early, reduce exposure to health risks, and support healthy development. The appropriate service depends on age, health history, anatomy, pregnancy status, prior screening, and individual risk. Recommendations can change, so clinicians should check current guidance and local requirements when making decisions.

Choosing and interpreting services

Screening looks for disease or risk factors in people without symptoms. A positive result usually requires confirmatory testing or evaluation, so screening should not be treated as a diagnosis. People with symptoms need clinical evaluation rather than screening alone.

Risk assessment considers family and personal history, medications, behaviors, exposures, social conditions, and prior results. These factors can affect when screening begins, how often it occurs, or which test is used.

Prevention includes vaccination, counseling, preventive medication when appropriate, and efforts to reduce barriers to care. Shared decision-making matters when a person's values or health status affect the balance of benefits and harms. Explain limitations, false positives, possible harms, and follow-up needs.

Evidence grades and follow-up

USPSTF grades summarize evidence for specific preventive services. Grades A and B indicate recommended services; grade C suggests selective use; grade D recommends against the service; and an I statement means there is insufficient evidence to assess the balance of benefits and harms. An I statement is not proof that a service is ineffective.

Close the loop by documenting and communicating results, arranging follow-up for abnormal findings, and tracking when the next service is due.

Infants, children, and adolescents

Repeated well-child care visits provide opportunities to review growth, development, behavior, family circumstances, safety, and preventive needs. The Bright Futures/American Academy of Pediatrics Periodicity Schedule organizes recommended assessments and anticipatory guidance from birth through adolescence. Concerns may call for additional visits.

• Newborn period: Complete applicable newborn blood-spot, hearing, and critical congenital heart disease screening, then review results and follow-up. Screening programs and timing can vary by state.

• Infancy and early childhood: Monitor growth and developmental milestones. Use validated developmental screening at recommended ages and whenever concerns arise. Address nutrition, oral health, injury prevention, lead exposure risk, vision and hearing concerns, and caregiver well-being.

• School age: Continue growth and developmental surveillance, preventive dental care, vision and hearing assessment as indicated, and age-appropriate behavioral, social, and emotional screening.

• Adolescence: Provide confidential, developmentally appropriate care. Assess mental health, substance use, sexual health, safety, and social context. Offer counseling and screening for sexually transmitted infections based on age and risk, and discuss healthy relationships and violence prevention.

For children and adolescents age 6 years or older with a high body mass index, at or above the 95th percentile for age and sex, the USPSTF recommends referral to or provision of comprehensive, intensive behavioral interventions.

Use the current CDC child and adolescent immunization schedule to determine routine and catch-up vaccines. Review records at every opportunity; recommendations depend on age, prior doses, health conditions, exposures, and other indications.

Pregnancy and preconception

Preconception and prenatal visits are opportunities to review chronic conditions and medications, reproductive goals, nutrition, substance use, mental health, safety, and immunization history. People who plan to or could become pregnant should take 400 to 800 micrograms of folic acid daily to reduce the risk of neural tube defects, unless a clinician recommends a different dose.

Prenatal preventive care includes blood-pressure monitoring throughout pregnancy. The USPSTF recommends early screening for syphilis during pregnancy; if it was not done early, screening should occur at the first available opportunity. Other prenatal tests and repeat screening depend on pregnancy stage, individual risks, and current obstetric guidance. For example, gestational-diabetes screening is generally performed after 24 weeks.

Vaccination recommendations are specific to pregnancy. Consult the current CDC schedule and clinical guidance before administering vaccines.

Preventive care in adulthood

Review preventive needs regularly, including blood pressure, tobacco and alcohol use, nutrition, physical activity, mental health, sexual health, and immunization status. Prioritize services according to risk and previous results.

Recommended screening examples

These recommendations concern defined groups of asymptomatic adults; they do not automatically apply to people with symptoms or substantially elevated risk.

• High blood pressure: Screen adults. Confirm a new diagnosis with measurements outside the clinical setting before starting treatment.

• Prediabetes and type 2 diabetes: Screen adults ages 35 to 70 who have overweight or obesity. Offer or refer people with prediabetes to effective preventive interventions.

• Colorectal cancer: Screen average-risk adults ages 45 to 75. For ages 76 to 85, decide selectively based on health, prior screening, and preferences; stop routine screening after age 85. Test options differ in frequency, preparation, and follow-up. An abnormal stool-based test requires colonoscopy.

• Breast cancer: The USPSTF recommends biennial mammography for women ages 40 to 74. Personal or strong family history, genetic risk, or prior chest radiation may require a different approach.

• Cervical cancer: Recommendations depend on age, prior results, and risk. Applicable guidance may vary by issuing organization and may be updated; follow current guidance for people with a cervix rather than applying one schedule to everyone.

• Lung cancer: Offer annual low-dose CT to adults ages 50 to 80 with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years. Pair screening with smoking-cessation support when relevant.

• Mental health: The USPSTF recommends depression screening in adults, including pregnant and postpartum people. When indicated, screening should connect to evaluation, treatment, and follow-up.

Symptoms need clinical evaluation, not screening alone. Family history, prior abnormal findings, and conditions such as inflammatory bowel disease can alter cancer-screening plans.

Preventive care in older adults

Continue preventive care while considering function, life expectancy, comorbidities, prior screening, treatment preferences, and whether the person could benefit from follow-up treatment. Age alone should not determine whether a service is useful.

Assess fall history, gait, balance, medications, vision, and home safety. For community-dwelling adults age 65 or older who are at increased risk for falls, the USPSTF recommends exercise interventions.

The USPSTF recommends osteoporosis screening for women age 65 or older and for postmenopausal women younger than 65 who are at increased risk after clinical risk assessment. Individualized care also includes reviewing immunization needs, sensory changes, cognition, mood, nutrition, oral health, medication safety, and support needs.

Immunization across life stages

Vaccines prevent infection and severe disease, but schedules vary by age, prior doses, pregnancy, medical conditions, and exposure risk. At each visit, check the current CDC schedule, reconcile the immunization record, identify missing or due doses, and explain expected benefits and common reactions.

Use catch-up guidance rather than restarting a series without reason. Consider contraindications and precautions, and document vaccines given or declined. Because recommendations can change, use the latest CDC schedules rather than relying on a memorized list.

Continuity and individualization

Effective prevention is age-aware, risk-based, and continuous. Use routine visits to assess development and health risks, provide recommended screening and immunization, offer practical health education, and arrange follow-up. Apply recommendations to the populations for which they were designed, and individualize decisions when history, risk, or preferences call for it.