2 Screening and Preventive Services

Principles for using preventive care

Preventive care aims to prevent disease, detect it early, and support health throughout life. Recommendations depend on age, health history, pregnancy, risk factors, previous test results, and patient preferences. Screening is useful only when appropriate follow-up and treatment are available.

A Screening test is intended for someone without symptoms. Symptoms or abnormal findings call for Diagnostic evaluation rather than relying on routine screening. A preventive visit does not replace assessment of new or concerning symptoms.

In the United States, the USPSTF evaluates many preventive services for adults. Its A or B grade indicates a recommended service for the appropriate population; a C grade supports selective offering based on individual circumstances; and an I statement means evidence is insufficient to assess the balance of benefits and harms. Pediatric preventive visits generally follow the Bright Futures and American Academy of Pediatrics schedule, while the CDC issues immunization schedules. Recommendations are updated periodically, so current official schedules and guidance should be checked.

Prevention across the lifespan

Routine recommendations usually apply to people at Average risk. A strong family history, prior disease or abnormal screening, certain genetic conditions, immunosuppression, or significant exposures may call for earlier, more frequent, or different care. A plan tailored to such risks is not the same as routine screening guidance.

Pregnancy and newborn period

Provide prenatal care and review maternal health, medications, nutrition, and immunization. Screen for infections and other conditions according to pregnancy guidance. At birth and in early infancy, complete recommended newborn and hearing screening, assess growth and feeding, and arrange follow-up for abnormal results.

Infancy and childhood

Schedule regular well-child visits. At recommended visits, track weight, length or height, and head circumference as appropriate; assess development, nutrition, oral health, vision, hearing, behavior, and family well-being. Provide routine vaccines and age-appropriate injury-prevention guidance.

Adolescence

Continue preventive visits and assess growth, development, emotional health, school and social functioning, substance use, sexual health, and safety. Provide recommended vaccines, including HPV vaccination. Discussions should be confidential and respectful, and appropriate to the young person’s age and circumstances.

Adulthood

Review blood pressure, tobacco and alcohol use, nutrition, physical activity, mental health, sexual and reproductive health, and immunization status. Offer screening and preventive counseling based on age and risk.

Older adulthood

Reassess screening in light of health, function, previous screening, life expectancy, and preferences. Review immunizations, falls risk, medication safety, vision and hearing concerns, and goals of care. For some screenings, likely benefit decreases when serious illness or limited life expectancy makes follow-up treatment unlikely to help.

Pediatric visits and guidance

Bright Futures recommends health-supervision visits from the newborn period through age 21. Visits bring together history, examination, screening, immunization, and anticipatory guidance—not just measurement of height and weight.

Growth is interpreted over time using age- and sex-appropriate growth charts; a single measurement is less informative than the pattern. Developmental surveillance occurs at visits, with standardized developmental screening at recommended ages and autism screening at recommended visits. Screening for maternal depression, child or adolescent emotional concerns, and other risks is included at selected visits. Abnormal results call for assessment, support, and referral when appropriate.

Anticipatory guidance changes with age. Examples include safe sleep and car-seat use in infancy; injury prevention and oral hygiene in childhood; and sleep, nutrition, activity, substance-use prevention, relationships, and mental well-being in adolescence. Pediatric schedules specify timing and tools, and not every item is performed at every visit.

Common adult screening examples

These examples describe major U.S. preventive recommendations for people without symptoms; they are not a complete checklist.

• Blood pressure: Screen adults. When an office result is elevated, confirm it with measurements outside the clinical setting when feasible before diagnosing hypertension.

• Diabetes: Screen adults ages 35–70 who have overweight or obesity. Discuss preventive interventions when prediabetes is found.

• Depression: Screen adults, including pregnant and postpartum people, and adolescents ages 12–18. Connect screening with evaluation and access to care.

• HIV and hepatitis C: Offer screening according to current age- and risk-based guidance, and test during pregnancy as recommended. Repeat testing may be appropriate when risk continues.

• Breast cancer: USPSTF recommends mammography every two years for women ages 40–74 at average risk. Evidence is insufficient to determine the balance of benefits and harms for routine screening after age 74 or for supplemental imaging solely because breasts are dense.

• Cervical cancer: Routine screening applies to people with a cervix within recommended ages and intervals. The USPSTF’s 2018 final recommendation is the current final statement; a later update has been published as a draft, not a finalized recommendation. Follow current guidance and individualize care for prior abnormal results, immunosuppression, or other high-risk history. Screening is generally not recommended after total hysterectomy for benign reasons when there is no history of high-grade precancer or cervical cancer, or after age 65 with adequate prior screening and no high-risk history.

• Colorectal cancer: Screen adults ages 45–75. For ages 76–85, decide selectively based on prior screening, overall health, and preferences. Options include stool-based tests and visualization procedures; a positive stool test requires follow-up colonoscopy.

• Lung cancer: Offer annual low-dose CT to adults ages 50–80 with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years. Stop when the person has been smoke-free for 15 years or cannot undergo curative treatment.

• Osteoporosis: Screen women ages 65 and older and postmenopausal women younger than 65 who are at increased risk, using clinical risk assessment to identify those who may benefit.

Screening for sexually transmitted infections, abdominal aortic aneurysm, and other conditions depends on age, anatomy, history, and specific risk factors. Select tests to match the person rather than ordering a screening panel indiscriminately.

Immunization through life

Vaccination prevents infection and its complications throughout life. At each visit, review written or reliable immunization history, age, health conditions, pregnancy, occupation, travel, prior vaccine reactions, and missing doses. If a series is delayed, most vaccine series do not need to be restarted; use the current catch-up schedule. Live vaccines may be unsuitable during pregnancy or for some people with severe immunosuppression, so check vaccine-specific precautions.

The routine childhood and adolescent schedule includes vaccines against hepatitis B, rotavirus, diphtheria, tetanus and pertussis, Haemophilus influenzae type b, pneumococcal disease, polio, influenza, measles, mumps and rubella, varicella, hepatitis A, meningococcal disease, and human papillomavirus (HPV). Timing and number of doses vary by vaccine, age, prior doses, and risk. Infants may also be eligible for RSV prevention according to current guidance.

Adults should review annual influenza vaccination, tetanus/diphtheria/pertussis boosters, and eligibility for vaccines such as COVID-19, shingles, pneumococcal disease, hepatitis, HPV, and RSV. Recommendations vary by age and risk. Pregnancy-specific vaccination includes Tdap during each pregnancy and other vaccines as advised by current guidance. Consult the current CDC child/adolescent or adult schedule for exact products, dose intervals, contraindications, and catch-up schedules.

Pregnancy screening and counseling

Pregnancy is an opportunity to identify health risks early and connect the patient with care. Prenatal testing follows current obstetric recommendations and may include screening for HIV, syphilis, hepatitis B and C, and other infections or conditions. Syphilis screening is recommended early in pregnancy; if it was not performed, screen at the first available opportunity. Additional or repeat testing depends on clinical risk and local guidance. An abnormal screening result requires timely confirmatory evaluation and treatment when indicated.

Discuss nutrition, folic acid, medications and supplements, tobacco and substance exposure, physical activity, oral health, safety, and mental health in a nonjudgmental way. Offer support for breastfeeding during pregnancy and after birth, and connect people at increased risk of perinatal depression with counseling interventions. Include the patient in decisions and account for their values, circumstances, and access to care.

Patient education and follow-up

Preventive care works as a partnership. Explain each test’s purpose and limits, possible false-positive or false-negative results, potential harms, and what happens next. Use plain language, invite questions, and confirm understanding—for example, ask the patient to describe when and how they will complete a test.

Make prevention practical: choose achievable nutrition and activity goals, support tobacco cessation, reduce injury risks, and plan vaccinations and follow-up. Track overdue services and close the loop on results. Document the screening decision, relevant risk factors, patient preference, result, and follow-up plan. Concerning symptoms need timely assessment even when screening is not due.

• USPSTF grades

• Shared decision-making