Annual preventive check-up: what to include by age and sex, and what not to repeat every year

You search for “annual medical check-up” or a medical “check up” and find packages of thirty tests, with the feeling that if one is missing the check-up is useless. The underlying idea is different. A general medical exam serves two purposes: finding in time what gives no symptoms (blood pressure, glucose, lipids, some cancers) and leaving a baseline to compare the following years against. Which lab tests to include depends not on the package but on your age, your sex and your risk factors, and the right frequency is almost never “everything every year”. This text brings together what the US screening guidelines (USPSTF) and Mexico’s free programs recommend in a table by age and sex, and separately what is requested a lot without backing.^[1][8]

First, what does not wait for a check-up. Chest pain or pressure lasting two minutes or more, difficulty breathing, bleeding that will not stop or sudden dizziness, weakness or vision changes are reasons for emergency care, not for an appointment.^[10] And there are signs that are not an emergency but do not wait until next year either: unexplained weight loss, a new lump, a changing mole, fever with no cause, unusual bleeding.^[9] We detail them below.

What “annual” means in a preventive check-up

Annual is the appointment, not the list. Screening guidelines do not recommend “a check-up” as a package: they recommend specific tests, for specific people, each with its own frequency. The USPSTF list of grade A and B recommendations (the US preventive services task force, which reviews the evidence for each screening test) holds side by side a mammogram every two years, a yearly lung CT only for heavy smokers and an aortic ultrasound once in a lifetime.^[1] What does make sense every year is sitting down with your doctor to review what is due for you and what is not.

The letters matter for reading the tables. The USPSTF gives grade A or B when it recommends the test because the benefit outweighs the harm, C when it leaves it as an individual decision, D when it recommends against, and I when the evidence is insufficient to say.^[1][4][6] Here, “you do not need to repeat it every year” almost always means the guideline sets a longer interval or does not recommend it without symptoms.

In Mexico the practical equivalent is the Cartilla Nacional de Salud, the national health card: a free document, by age group and sex, handed out and used in all health units (Secretaría de Salud, IMSS, ISSSTE and others), which marks which screenings, vaccines and checks you are due and how often.^[8] At IMSS, the PrevenIMSS check-up is given at the PrevenIMSS modules of your family medicine unit at least once a year.^[11] The card for women aged 20 to 59, for example, asks for weight and height at least once a year, blood pressure every year from 20, capillary glucose every three years from 20 and cholesterol from 20 only with obesity or a first-degree relative with ischemic heart disease.^[8] If you have access to any of those institutions, much of the table is already covered at no cost; what is usually missing is the record.

Table: what to include in the check-up by age and sex

The table crosses the USPSTF A and B recommendations with the Cartilla Nacional de Salud and, for lipids, the Mexican standard NOM-037. “W” is for women and “M” for men; no letter means both. Ages and frequencies are given exactly as each source states them.^{[1][2][3][7][8]}

Blood pressure, weight and waist: what really is annual

Blood pressure is the piece of the check-up most worth repeating: the USPSTF recommends it with grade A for all adults, suggests measuring it every year from 40 and in anyone at increased risk (high-normal pressure, overweight or obesity), and accepts every 3 to 5 years between 18 and 39 if the last reading was normal and there are no risk factors.^[2] The same guideline asks to confirm any high figure with measurements outside the office before speaking of hypertension,^[2] and that is done at home: here is the seven-day protocol. Weight, height and body mass index at least once a year according to the Cartilla, and the waist with its cut-off: in women, more than 80 cm already counts as a health risk.^[8] Three numbers that cost nothing and that, year against year, say more than almost any isolated test.

Glucose and lipids: every three and every five years

Screening for prediabetes and type 2 diabetes has grade B in the USPSTF for adults aged 35 to 70 with overweight or obesity.^[1] The Mexican card asks for it in all women from 20, with capillary glucose every three years.^[8] If a result comes out at 100 or more fasting, the next step is not to panic but to repeat under good conditions: this text explains what it means and what to record.

With lipids the frequency is longer. The Mexican standard NOM-037 allows a rapid screening test from age 20 and, when the panel comes out within limits and there are no cardiovascular risk factors, repeats the measurement every five years; with risk factors or family history, every one or two years at the doctor’s discretion.^[7] The USPSTF sets no interval: it uses cholesterol within the 10-year risk calculation to decide, from 40 to 75 and with at least one risk factor (dyslipidemia, diabetes, hypertension or smoking), whether a statin is worthwhile.^[1] What each line of the panel means is in high cholesterol.

Cancer screenings: one per age, not all every year

For women, cervical cancer screening has grade A: cytology every three years from 21 to 29, and from 30 to 65 cytology every three years, high-risk HPV testing every five, or both together every five.^[1] The Cartilla resolves it with a Pap every three years from 25, after two negative results.^[8] Mammography has grade B every two years from 40 to 74,^[1] and the Cartilla asks for it every two years from 40, with a clinical breast exam every year from 25.^[8] Neither is annual.

Colorectal cancer is the most forgotten screening, perhaps because it has no appointment “of its own”. The USPSTF recommends it from 50 to 75 with grade A and from 45 to 49 with grade B; from 76 to 85 it leaves it as an individual decision.^[3] There are several valid methods with very different intervals: fecal immunochemical test (FIT) every year, stool DNA every one to three years, CT colonography or sigmoidoscopy every five, colonoscopy every ten.^[3] Choosing with your doctor the one you will actually do is worth more than choosing the “best” one.

For men, prostate-specific antigen (PSA) does not appear among the USPSTF A or B recommendations.^[1] That does not mean “never”: it means it is not an automatic test but a conversation with your doctor about age, history and what you would do with the result. The same goes for any tumor marker ordered “to rule out”: none is on that list as screening in the general population.^[1]

Complete blood count and metabolic panel: useful, but not screening

The two tests that appear most in Mexican “check up” packages, the complete blood count and the blood chemistry panel, do not appear as such in the USPSTF A and B recommendations: what appears are specific pieces of the chemistry (glucose, lipids) for specific people.^[1] That does not make them useless: they are needed with symptoms or with a medicine to monitor, and creatinine is the figure used to look at kidney function. What changes is the expectation: a yearly blood count in a healthy person does not “find something”; it leaves a baseline to compare against if something ever drifts.

What is requested a lot and what the guidelines say

Some tests get added to the check-up “just in case” and the guidelines do not back them in people without symptoms. It is not that they are bad: without a reason, a doubtful result usually leads to more tests, more visits and more anxiety with no proven benefit. This is what the USPSTF says about five of the most frequent:^[1][4][5][6]

The thyroid panel deserves its own paragraph because in Mexico it is requested constantly. Without symptoms, the evidence is insufficient to recommend it or advise against it as screening: that is what the 2015 grade I means.^[4] With symptoms (persistent tiredness, weight changes, hair loss, feeling cold, palpitations), family history or pregnancy, it stops being screening and becomes a test with a reason, and then it is worth knowing what each value of the thyroid panel measures.

The same with vitamin D: the USPSTF concluded in 2021 that the evidence is insufficient to recommend measuring it in adults without symptoms.^[5] The “routine” electrocardiogram is the only one on the list with a recommendation against: grade D in asymptomatic adults at low cardiovascular risk, and insufficient at intermediate or high risk.^[6] If you already had one and the result worries you, this is how to read results without panicking.

What changes the result of a check-up

If you are going to compare your check-up with last year’s, the conditions have to be comparable. This is what moves the numbers most:

• Fasting: triglycerides and calculated LDL require a sample after 9 to 12 hours of fasting; total cholesterol, HDL and non-HDL can be measured without fasting.^[7] A “fasting” glucose without a real fast is a different test.
• Where blood pressure is measured: the office figure can come out high because of the context; the guideline asks to confirm it outside the clinic.^[2]
• Capillary or venous: the Cartilla glucose is capillary, a fingertip screening test.^[8] Do not compare it directly with the lab result from venous blood.
• A recent illness, a bad night or a hard workout move several lines of the blood count and chemistry; here we explain which. If it happened, note it next to the result.
• The lab and the reference range: each lab has its own methods and ranges, and a value “out of range” in one can be within range in another. That is why the reference range is not your personal norm and why it is worth repeating at the same lab.
• Medicines and supplements: oral contraceptives, corticosteroids, diuretics and several supplements alter results. The list of what you take is part of the check-up.

How to put your check-up together and when to repeat each test

With the table and the Cartilla, the check-up comes together in three steps.

1. The annual part for everyone: blood pressure, weight, height, waist and a conversation about tobacco, alcohol and mood. The USPSTF gives grade B to screening for depression and for unhealthy alcohol use, and grade A to asking about tobacco.^[1]
2. What is due by age and sex this year: check in the table which screening falls in your year (mammogram every two, Pap every three, colonoscopy every ten) and which vaccine.^[1][8]
3. What is due because of your risk factors: with overweight, relatives with diabetes or early heart disease, high-normal blood pressure or smoking, lipids move from every five years to every one or two, and blood pressure to every year even if you are 30.^[2][7]

Warning signs

A check-up is for someone without symptoms. If you have them, do not wait for the check-up date and do not try to solve it with a package of tests: book an appointment. These signs are seen within the next few days, even though they almost always have a different explanation from the one you fear:^[9]

• Weight loss or gain with no known cause.^[9]
• A new lump or swelling in the breast, armpit, neck, abdomen or groin.^[9]
• Bleeding or bruising with no cause, blood in urine or stool.^[9]
• A new or changing mole, a sore that does not heal.^[9]
• Fever or night sweats with no cause, or severe tiredness that does not improve.^[9]
• A cough or hoarseness that does not go away, trouble swallowing.^[9]

And these do not wait even until tomorrow: they are an emergency.^[10]

• Chest pain or pressure lasting two minutes or more.^[10]
• Difficulty breathing or shortness of breath.^[10]
• Sudden dizziness, weakness or vision changes, confusion or fainting.^[10]
• Bleeding that will not stop, coughing up or vomiting blood.^[10]
• Sudden, severe pain anywhere in the body,^[10] including a headache that appears out of nowhere and is the worst you remember; a frequent but familiar headache is another story, we tell it here.

What to bring to the doctor

A check-up appointment lasts minutes. What you bring decides whether they go into reconstructing your history or into making decisions.

1. Your previous results, dated and in order: this year’s and at least the two previous check-ups.
2. Your Cartilla Nacional de Salud, so vaccines and screenings are recorded in one place.^[8]
3. Home measurements: the seven-day blood pressure average, your weight and your waist with the date. The guideline asks to confirm blood pressure outside the office,^[2] so that week is part of the check-up.
4. List of medicines and supplements, including contraceptives, corticosteroids and anti-inflammatories.
5. Family history with ages: diabetes, heart attack or heart disease, breast, colon, ovarian or prostate cancer. The lipid standard, for example, shortens the interval with family history.^[7]
6. Tobacco: how much and for how many years. It defines whether you qualify for the lung CT (20 pack-years, 50 to 80) and the aortic ultrasound (men 65 to 75 who smoked).^[1]
7. Three written questions: what is due for me this year, what does not need repeating, and which result from last year we should look at together.