The Screening Schedule by Decade: What to Test in Your 40s, 50s, 60s and 70s

I want to open with something most screening articles leave out. The U.S. Preventive Services Task Force, the volunteer panel whose letter grades decide which preventive tests your insurance must cover at no cost, is in an unusual institutional position. As of March 2026 it had not held a meeting in over a year (CNN, 2026). In May 2026, HHS dismissed its two vice chairs and opened recruitment for new members (CNN, 2026).

So please read what follows the way I'd want my own patients to read it. Every recommendation below is current, and I've linked each one to its source. But this ground is less settled than a tidy table makes it look, and parts of it may move within the year. Confirm anything here with your physician before you act on it.

The schedule still matters enormously. Arizona ranks 42nd of 50 states for cancer screening, with 60.5% of adults up to date compared with 64.5% nationally (America's Health Rankings). Here is what to test, when, and, the part almost nobody discusses, when to stop.

Key Takeaways

• Your 40s add mammography every two years (Grade B), diabetes screening, a one-time hepatitis C test, and colorectal screening at 45.
• Your 50s add colorectal at Grade A, annual low-dose CT if you have a 20 pack-year smoking history, and the PSA conversation.
• Your 60s add bone density for women at 65 and a one-time aortic ultrasound for men 65 to 75 who ever smoked.
• Screening stops on life expectancy, not birthdays. PSA ends at 70, cervical at 65, and mammography's recommendation ends at 74.
• Only Grade A and B recommendations must be covered without cost sharing under federal law.

Why are these guidelines less settled than they look?

The Task Force that grades every test below had not met in more than a year as of March 2026, and HHS dismissed both vice chairs in May 2026 while opening member recruitment (CNN, 2026). The existing recommendations remain in force. Membership, and therefore future grades, is genuinely in flux.

What does that mean for you, practically? Very little in the short term. A Grade B recommendation issued in 2024 still binds your insurer today. It is not a reason to postpone a mammogram you're due for. It is a reason to ask, at each visit, whether the guidance you're following is still the current guidance.

What should you screen for in your 40s?

Your 40s are when routine cancer screening begins in earnest. Mammography now starts at 40, with a Grade B recommendation for screening every two years (USPSTF, 2024). Colorectal screening starts at 45 (USPSTF, 2021). Blood pressure, diabetes, depression and hepatitis C round out the decade.

Test	Who	How often	USPSTF grade
Blood pressure	All adults 18 and older	Periodically; interval set with your physician	A
Mammography	Women 40 to 74	Every 2 years	B (2024)
Cervical cancer	Women 21 to 29	Cytology every 3 years	A (2018)
Cervical cancer	Women 30 to 65	Cytology every 3 years, or high-risk HPV every 5 years, or cotesting every 5 years	A (2018)
Prediabetes and type 2 diabetes	Adults 35 to 70 with BMI 25 or higher (23 or higher if Asian American)	Every 3 years is reasonable	B
Hepatitis C	Adults 18 to 79	Once in a lifetime	B
Depression	Adults 19 and older	Interval not specified	B
Colorectal cancer	Adults 45 to 49	Depends on the test chosen	B (2021)
Statin, primary prevention	Adults 40 to 75 with a risk factor and 10-year risk of 10% or more	Risk assessment, not a fixed interval	B (C if risk is 7.5% to under 10%)

The hepatitis C line surprises people. It is a single blood test, once, for every adult between 18 and 79. I still find undiagnosed cases in patients who have no risk factors they'd volunteer and no symptoms at all. It's cheap, it's curable now, and most people have never been offered it.

What about cholesterol?

Here is a correction worth making, because I see it wrong in nearly every article of this kind. There is no current USPSTF adult lipid screening recommendation with a graded interval. The graded pathway runs through the 2022 statin recommendation, which presupposes that cardiovascular risk has been assessed.

So when I order a lipid panel every few years, that's clinical judgment feeding a risk calculation, not a Task Force schedule. Anyone who tells you the USPSTF says to check cholesterol every five years is repeating something that isn't there. If you want help reading the panel once it comes back, I wrote about that in understanding your lab results.

What changes in your 50s?

Colorectal screening strengthens from Grade B to Grade A at 50 (USPSTF, 2021), and lung screening opens up for people with a significant smoking history. Arizona lags here too: 66.7% of adults 50 to 75 are current on colorectal screening versus 71.9% nationally (State Cancer Profiles).

Test	Who	How often	USPSTF grade
Colorectal cancer	Adults 50 to 75	Varies by test, see below	A
Low-dose CT, lung	Adults 50 to 80 with 20 or more pack-years who currently smoke or quit within the past 15 years	Annually	B
PSA, prostate	Men 55 to 69	Individual decision, shared with your physician	C (2018)
Bone density	Postmenopausal women under 65 at increased fracture risk	Interval not specified	B (2025)

Which colorectal test should you choose?

The Task Force does not rank these. All six are acceptable options in the 2021 statement:

• High-sensitivity stool test (gFOBT or FIT) every year
• Stool DNA-FIT every 1 to 3 years
• CT colonography every 5 years
• Flexible sigmoidoscopy every 5 years
• Flexible sigmoidoscopy every 10 years plus annual FIT
• Colonoscopy every 10 years

In my experience, the best test is the one a patient will actually complete. A stool test done faithfully every year beats a colonoscopy that gets rescheduled three times and then quietly dropped. If a stool test is positive, though, colonoscopy follows. That's part of the deal, and it's worth knowing up front.

What gets added in your 60s?

Two new tests arrive at 65. Bone density screening for women 65 and older is Grade B (USPSTF, 2025), and a one-time abdominal ultrasound is Grade B for men 65 to 75 who have ever smoked (USPSTF). This decade also brings several honest admissions of uncertainty.

Test	Who	How often	USPSTF grade
Bone density	Women 65 and older	Interval not specified	B (2025)
Bone density in men	Men, any age	Not established	I, evidence insufficient
Aortic aneurysm ultrasound	Men 65 to 75 who ever smoked	One time	B
Aortic aneurysm ultrasound	Men 65 to 75 who never smoked	Selectively, case by case	C
Aortic aneurysm ultrasound	Women who never smoked and have no family history of AAA	Do not screen	D
Falls prevention, exercise	Adults 65 and older at increased fall risk	Ongoing	B
Cognitive impairment	Adults 65 and older	Not established	I
Visual acuity	Adults 65 and older	Not established	I
Hearing loss	Adults 50 and older	Not established	I
Aspirin, primary prevention	Adults 60 and older	Do not start	D

The aspirin line deserves attention, because it reverses advice many of my patients were given decades ago and never revisited. The Task Force now recommends against starting daily aspirin for primary prevention at 60 or older. If you are already taking it, or you've had a heart attack or stroke, that's a different question. Don't stop on your own. Bring the bottle to your next visit.

When does screening stop?

This is the question I'm asked least and should be asked most. Screening does end. PSA at 70 and older is a Grade D, recommending against it. Cervical screening ends at 65 with adequate prior testing, also Grade D. Mammography's recommendation simply ends at 74 (USPSTF, 2024).

Test	Who	What to do	USPSTF grade
Mammography	Women 75 and older	Evidence insufficient, decide individually	I
Colorectal cancer	Adults 76 to 85	Offer selectively based on overall health, prior screening and preferences	C
Colorectal cancer	Adults 86 and older	Evidence lacking; benefit unlikely to outweigh harms	Not recommended
Cervical cancer	Women over 65 with adequate prior screening who are not otherwise at high risk	Stop screening	D
Cervical cancer	After hysterectomy with cervix removed, with no history of CIN 2/3 or cervical cancer	Stop screening	D
PSA, prostate	Men 70 and older	Do not screen	D
Low-dose CT, lung	Adults who reach 81, or 15 years since quitting	Stop screening	Part of the B recommendation

"Adequate prior screening" is a specific term, not a judgment call. The Task Force cites the joint ACS/ASCCP/ASCP definition:

"3 consecutive negative cytology results or 2 consecutive negative cotesting results within 10 years before stopping screening, with the most recent test occurring within 5 years."

Grade I does not mean "don't"

This distinction matters more than any other on the page. A mammogram at 78 carries a Grade I, meaning the evidence is insufficient to say whether it helps or harms on balance. That is not the same as a Grade D. It means the trials didn't enroll enough women that age to answer the question, and the decision returns to you and your physician.

Lung CT screening also stops for reasons other than age: 15 years since quitting, or when a health problem substantially limits life expectancy or your willingness to have curative lung surgery. That last clause is the most honest sentence in any screening document. If you would not accept the operation, the scan cannot help you.

The real threshold is life expectancy, not a birthday

The American Cancer Society says it plainly. Breast screening should continue "as long as a woman is in good health and is expected to live at least 10 more years" (ACS). For colorectal, ACS advises continuing through 75 in good health with a life expectancy over 10 years, individualizing from 76 to 85, and says those over 85 "should no longer get colorectal cancer screening" (ACS).

The USPSTF puts the same logic more starkly for adults 86 and older, noting that "competing causes of mortality likely preclude any survival benefit that would outweigh the harms of screening." A cancer found at 88 that would have taken 12 years to cause trouble was never going to be the thing that mattered. The colonoscopy prep and the perforation risk, however, are immediate.

I try to raise this gently and early, before someone is 84 and feels they're being written off. They aren't. Stopping a screening test is not stopping care. It usually means care shifts toward what's actually limiting someone's life, which is more often blood pressure, kidney function, balance or diabetes management. I covered that shift in detail in managing type 2 diabetes in retirement.

Where do the major guideline bodies disagree?

More than most patients realize, and the gaps have real consequences. The American Cancer Society's 2020 guideline starts at 25 with primary HPV testing every 5 years preferred; a December 2025 update added guidance on self-collected specimens and screening exit. The USPSTF's current 2018 recommendation starts at 21 with cytology every 3 years. That's a four-year gap and a different preferred test.

Screening	USPSTF	American Cancer Society	Why it matters to you
Breast	Start 40, every 2 years, recommendation ends at 74	40 optional, 45 routine, annual 45 to 54, then annual or biennial by choice, no age cutoff while healthy with 10+ year life expectancy	Interval and stopping age, not start age
Cervical	Start 21, cytology every 3 years (2018)	Start 25, primary HPV testing every 5 years preferred (2020, updated Dec 2025)	Four-year gap in start age, different test
Lung	50 to 80, 20+ pack-years, quit within 15 years	Years-since-quitting removed entirely in 2023, expanding eligibility by roughly 5 million adults	Long-ago quitters may face cost sharing

On breast cancer, I'd note honestly that the loud public fight over the start age largely resolved in 2024, when ACS publicly supported the USPSTF's move to 40. The live disagreements now are about how often, and when to stop. Those are quieter arguments, and they affect far more women.

The lung example is the most concrete. Picture a 68-year-old with 30 pack-years who quit 18 years ago. Under ACS criteria she qualifies for annual low-dose CT. Under USPSTF criteria she does not, because she quit more than 15 years ago. Her physician may still recommend the scan. Her insurer is not federally required to cover it without cost sharing.

What do the letter grades mean for what you pay?

This is where the alphabet stops being academic. Under 42 U.S.C. 300gg-13, non-grandfathered health plans must cover Grade A and B recommendations with no cost sharing. Grades C, D and I carry no federal cost-sharing protection at all. The grade is, in effect, a price tag.

• A: High certainty of substantial net benefit. Do it.
• B: Moderate to substantial net benefit. Do it.
• C: Small net benefit. Offer selectively, based on individual circumstances.
• D: No net benefit, or harms outweigh benefits. Don't do it.
• I: Evidence is insufficient to weigh benefits against harms.

Concretely, that means PSA testing at 55 to 69 (Grade C), bone density scanning in men (Grade I), mammography at 75 and older (Grade I) and supplemental MRI for dense breasts (Grade I) are not guaranteed to be free. Reasonable, sometimes excellent choices. Just not protected ones. Ask about cost before the appointment, not after.

Two more wrinkles. The statute sets a lag: coverage attaches no sooner than one year after a recommendation issues, which is why a brand-new Grade B may not be free yet. And Medicare operates under separate authority and does not simply mirror the Task Force. Adult vaccines run through a different body, the ACIP, and a different part of the coverage rule entirely.

Did the Supreme Court settle this?

Partly. In Kennedy v. Braidwood Management, decided 6 to 3 on June 27, 2025, the Court upheld the preventive services coverage requirement, holding that Task Force members are inferior officers properly appointed by the HHS Secretary (KFF, 2025).

Notice the reasoning, though. They are inferior officers precisely because the Secretary can appoint, supervise and remove them. That holding is the legal predicate for the May 2026 dismissals. The coverage mandate survived; the panel's independence was defined downward in the same breath. Litigation on remand is not fully resolved.

What are the harms of screening?

Real, quantified, and rarely discussed in the exam room. Per 1,000 women screened every two years from 40 to 74 over a lifetime, the Task Force's own modelling projects 1,376 false-positive results and 14 overdiagnosed breast cancers, with a model range of 4 to 37 (USPSTF, 2024).

The comparison that shaped the 2024 decision is worth seeing in full. Starting at 40 rather than 50 averts an additional 1.3 deaths per 1,000 women. The cost of those 1.3 lives is 503 additional false-positive recalls, 65 additional benign biopsies and 2 additional overdiagnosed cancers. That is the trade. Both halves are true at once.

Other procedures carry their own arithmetic. Screening colonoscopy causes perforation in 3.1 per 10,000 procedures and major bleeding in 14.6 per 10,000 (USPSTF evidence summary). Low-dose CT lung screening overdiagnoses an estimated 18.5% of screen-detected lung cancers (JAMA Internal Medicine, 2014).

Here's why I put those numbers in front of you rather than hiding them. This trade-off is exactly why serious, well-intentioned expert bodies land in different places on the same evidence. When your physician says the decision is yours, that isn't a dodge or a liability maneuver. It's an accurate description of a question where the math genuinely depends on what you'd rather risk.

Which tests should you skip?

Every item in this table applies only to people without symptoms. If you have bleeding, a lump, unexplained weight loss, pain, a changing mole or any new complaint, none of this applies. You need evaluation, which is a different thing entirely from screening. With that stated clearly, here is what the evidence says not to do routinely.

Test	Who	USPSTF grade
Ovarian cancer screening	Asymptomatic women	D
Pancreatic cancer screening	Asymptomatic adults	D
Thyroid cancer screening	Asymptomatic adults	D
PSA testing	Men 70 and older	D
Cervical screening	Women over 65 with adequate prior screening	D
Aortic aneurysm ultrasound	Women who never smoked and have no family history of AAA	D
Starting aspirin	Adults 60 and older, primary prevention	D
Whole-body skin exam	Asymptomatic adults	I
Cognitive screening	Adults 65 and older, no concerns	I
Hearing screening	Adults 50 and older, no complaints	I
Vision screening	Adults 65 and older, no complaints	I

Let me be emphatic about the last few rows. The hearing and vision Grade I statements do not mean skip your eye exam or ignore your hearing. They mean the evidence for systematically testing people who have no complaint is insufficient. If you're asking people to repeat themselves, or your reading is blurring, go get checked. That's a symptom, not a screen.

How should you use this schedule?

Bring it to your next visit and work through it out loud. Ask which tests you're due for, which ones are Grade A or B and therefore covered without cost sharing, and which ones carry a bill. Ask, if you're past 70, whether each test still makes sense given everything else about your health.

And hold it loosely. The Task Force is being reconstituted as I write this, and some of these grades may read differently a year from now. That's not a reason for paralysis. It's a reason to have a physician who is tracking the changes rather than handing you a laminated card. If you'd like to work through your own schedule with me, get in touch with Prescott Professional Health Care.