9 Medical Checkups You May Regret Putting Off Any Longer

If you've delayed these doctor’s appointments and health screenings, it’s time to book them

masked medical provider and patient in office setting

Morsa Images/Getty Images

By:

Barbara Stepko,

AARP

En español

Published May 27, 2021

/ Updated August 10, 2022

The worst of the COVID-19 pandemic is likely behind us, but now there’s a new health care hurdle: getting people to return for recommended routine screenings, checkups and exams. With the country focused on the pandemic over the past two years, many people have re-prioritized preventive health care. Others, concerned about contracting COVID-19, have been delaying necessary doctor visits. “There has also been a general exhaustion with most things medical,” notes Cory Fisher, a family medicine specialist affiliated with the Cleveland Clinic.

In fact, 2021 research appearing in JAMA Oncology found that a whopping 9.4 million breast, colorectal and prostate cancer screening tests that normally would have taken place in the United States in 2020 — the height of the pandemic — didn’t happen. What’s more, recent findings, led by researchers at the American Cancer Society, show that the number of women in the United States who reported having a breast cancer or cervical cancer screening dropped by 6 percent and 11 percent, respectively, in 2020 compared to 2018. Colonoscopies, crucial for the early detection of colorectal cancer, fared even worse, dropping by 16 percent for both men and women — though, note researchers, that number was offset by an increase in stool testing (7 percent). Another study, led by researchers at Johns Hopkins Bloomberg School of Public Health, found that the number of primary care consultations — where cholesterol and blood pressure assessments usually take place — plummeted by more than 21 percent during the second quarter of 2020, compared with the same time period in 2018 and 2019.

And although research shows that health screenings appear to be rebounding, they have yet to return to their pre-pandemic levels. Case in point: According to a June 2022 study, an analysis of the National Mammography Database, which evaluated data from over 5 million mammogram screenings at 377 facilities, the use of breast imaging services — including mammography screenings — returned to just 85.3 percent of pre-pandemic levels. Doctors worry that delays in screening could result in patients being diagnosed with more advanced, harder-to-treat health problems down the road.

The National Cancer Institute predicted in June 2020 that the pandemic would result in 10,000 excess deaths from breast and colorectal cancers alone over the next decade in the United States. Indeed, the consequences of delaying care are fast becoming clear. For example, new findings from researchers at Moores Cancer Center at UC San Diego Health found that about 64 percent of breast cancer patients were diagnosed at stage 1 in 2019, but that slipped down to 51 percent in 2020, the first full year of the pandemic. If you have put off cancer screenings and other preventive care during the COVID-19 pandemic, now is the time to get back on track.

1. Colonoscopy

When you need it: The U.S. Preventive Services Task Force issued recommendations in May 2021 that average-risk colorectal cancer screening should begin at age 45, not 50. Part of the reason for the change is that while death rates have been decreasing year by year, numbers have been increasing among people younger than 50. Health care experts don’t know the exact reason, though some suspect poor eating habits — including diets high in red meat and processed foods — may be a cause. “Now the universal message is, start [having the conversation about] screenings at age 45 and continue every 10 years thereafter if the results are normal,” says Aasma Shaukat, M.D., professor of medicine and gastroenterology at NYU Grossman School of Medicine. Those at higher-than-normal risk — say, smokers or those with first-degree relatives who have had colon cancer — should have the procedure every three to five years. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through age 75. For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health and prior screening history. Screening is not recommended for people over 85.

Why you need it: Though colon cancer is the most preventable cancer (caught early, the five-year survival rate is about 90 percent), it is the third most commonly diagnosed cancer and the third leading cause of cancer death in the U.S. Why? Only about 66 percent of adults over age 50 are up to date on colorectal screening, according to the American Cancer Society. The group estimates that, in 2022, 106,180 new cases of colon cancer and 44,850 cases of rectal cancer will be diagnosed in the United States, a majority of those in adults age 50 and older.

At-home stool sample tests, such as the fecal immunochemical test (FIT) or the DNA test (Cologuard), are very effective if done regularly (either once a year or, in the case of Cologuard, every three years). But the gold standard is still a colonoscopy. As experts point out, it’s a one-stop test: It not only discovers precancerous polyps, it removes them before they can cause trouble down the road. (It takes about 10 years for polyps to turn into cancer.) Also, if anything suspicious is found with a stool test, a follow-up colonoscopy will be needed.

Need a nudge? For many patients, the bowel prep before the procedure — which once required downing jugs of an awful liquid laxative — is the hardest part of a colonoscopy. But, Shaukat notes, there are now preparations that are half the volume of the regular prep (about a gallon of liquid, or about two liters). “You can also do things to make the prep more palatable,” she says. “Since a lot of these preps have a salty aftertaste, add flavored Crystal Light to the mixture and sip it on ice, with a straw.” If you just can’t stand downing that loathsome liquid, good news: Prepping for a colonoscopy now can be as easy as swallowing a pill — well, 24 of them. In 2020, the FDA approved a prescription prep tablet, Sutab, a laxative that clears the colon. How it works: A course of Sutab has 24 tablets, which are split up into two doses of 12 tablets each. You take the first dose of 12 tablets the night before your procedure, along with water, followed by more water, and the second dose (with more water) the morning of the colonoscopy, at least two hours before your appointment, to make sure your colon is completely clean. The downside: Some drug plans don’t cover Sutab. Discount coupons are sometimes available from the drug manufacturer.

2. Mammogram

When you need it: Breast cancer screening guidelines vary among medical boards. To keep it simple, many doctors recommend that women who are not at higher-than-average risk have annual screening mammograms beginning at age 40. The American Cancer Society recommends annual mammograms for women ages 45 to 54, with women age 55 and older continuing annual mammograms or switching to a mammogram every two years. (Breast cancer diagnosed in women over 55, especially those who have transitioned through menopause, is more likely to be slower-growing and less aggressive.) Women at high risk because of a family history of the disease or other factors, such as dense breasts or the presence of a BRCA gene mutation, likely need more frequent screenings. Mark Pearlman, M.D., one of the authors of the American College of Obstetricians and Gynecologists Practice Bulletin on Breast Cancer Risk Assessment and Screening in Average-Risk Women, says “women who have very dense breasts have about a four-fold risk of developing breast cancer in their lifetime, compared to women who have very fatty breasts.”

The American Cancer Society also suggests that women continue to undergo screening mammograms as long as they are in good health and are expected to live at least 10 more years.

Be sure to let your mammography technologist know if you’ve gotten the COVID-19 vaccine — along with how many doses you’ve gotten and in which arm it was administered. Why: In some women, breast cancer appears as swollen lymph nodes under one arm. Some patients have reported developing swollen lymph nodes after a COVID-19 vaccination. This finding could be mistaken for a potential breast cancer diagnosis.

Why you need it: Eighty percent of all breast cancers occur in women 45 and older. (Women ages 40 to 50 have a 1 in 68 risk of developing breast cancer. From age 50 to 60, that risk increases to 1 in 42. In the age group 60 to 70, the risk is 1 in 28.) Since 1990, breast cancer death rates have fallen between 1.8 percent and 3.4 percent per year — in large part because mammograms are good at finding breast cancer, especially in women age 50 and older, correctly identifying cancer 87 percent of the time.

Most medical organizations don’t recommend routine breast self-exams as a part of breast cancer screening. According to the Mayo Clinic, “that’s because breast self-exams haven’t been shown to be effective in detecting cancer or improving survival for women who have breast cancer.” Getting an annual mammogram is the best way to catch the disease at an early stage, when it’s less likely to have spread.

Need a nudge? It’s estimated that up to 50 percent of women skip mammograms because the procedure can be painful. Popping an acetaminophen or ibuprofen about an hour before your mammogram can help, Pearlman says. You can also try this breathing trick: Before the technician compresses your breast between the imaging plates, take a deep breath, then slowly exhale as the compression begins. (Breathing out helps your muscles relax.) Just be sure to hold your breath while the X-ray is being taken to avoid (yikes) retakes.

3. Dental exam

When you need it: The American Dental Association recommends getting a professional cleaning every six months to do away with cavity-causing plaque and tartar buildup that you won’t be able to get rid of with brushing alone. The association also suggests getting a set of X-rays taken every six to 12 months for adults with an increased risk of cavities; those with no decay or increased risk may be able to extend it to every two to three years.

Why you need it: A March 2022 consumer survey from the American Dental Association Health Policy Institute found that dental care was the most commonly neglected health care service during the pandemic, with more than 1 in 5 adults copping to neglecting their dental care needs. Not smart. Tooth decay can be stopped in its tracks (or even reversed) if detected early enough. Some cavities stay small for years, while others get large within months, requiring treatment. If not caught in time, a cavity will eventually work its way through the dentin layer of your tooth, just below the enamel. If your tooth remains untreated, decay may reach the nerve, and a cavity that could have been treated with a filling will require a more involved (and painful) procedure, such as root canal and crown — or possibly an extraction and dental implant.

Older adults are particularly vulnerable. “Our saliva helps neutralize the acid in our mouths,” says John Cross, a dentist at Aesthetic Dental Group in Martinsville, New Jersey. “But as we age, our salivary glands become less active, which can lead to dry mouth, and make patients more susceptible to decay. Certain medications that older adults may be taking can also cause lead to dry mouth.” And those fillings a lot of us have accumulated over the years may weaken and fracture along the edges, allowing bacteria to seep into the tiny crevices, further leading to decay.

Making matters worse, dentists have seen a rise in stress-related oral health conditions in patients since the COVID-19 pandemic began, according to data from the ADA Health Policy Institute. Fifty-nine percent of dentists polled reported increases in bruxism (more commonly known as tooth grinding) and 53 percent in chipped and cracked teeth.

Need a nudge? Not only will your teeth suffer: So will your bank account. “The longer you wait to take care of an oral problem, the more extensive — and expensive — it gets,” says Leonardo Marchini, an associate professor in the Department of Preventive and Community Dentistry at the University of Iowa College of Dentistry. Check it out: A single filling, on average, will set you back between $50 and $500 (depending on the material used), compared to a root canal and crown (about $2,500 to $3,000) or a dental implant (average price: $3,000 to $5,000).

4. Pap smear

When you need it: The American Cancer Society recommends women ages 20 to 65 get a Pap test every three years — or a human papillomavirus (HPV) test (or combination Pap-HPV test) every five years, if both tests come back negative the first time you take them. Those with a higher risk of cancer may need to be tested more often. Ultimately, your doctor can recommend what’s best for you. Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or two negative HPV tests within the previous 10 years. Women who’ve had a hysterectomy and no history of cervical cancer do not need to be screened.

Why you need it: Although your risk of cervical cancer decreases with age, your need for routine Pap tests doesn’t necessarily stop with menopause. One in 125 women will get cervical cancer — and more than 20 percent of cases are found in women over 65. However, these cancers rarely occur in women who are vigilant about getting tested. That’s because the procedure, which involves collecting a sampling of cells from the cervix, can discover precancerous changes to prevent cancer from developing. The HPV test, another screening tool, detects the presence of HPV, the virus that causes cervical cancer.

Need a nudge? Beyond the Pap test, a pelvic exam can assess other parts of your gynecological health. Your ob-gyn will look for signs of ovarian cysts or early-stage endometrial cancer — and can also address menopause-related issues such as hot flashes or vaginal dryness, as well as issues like low libido and UTIs.

5. Skin cancer screen

When you need it: The Skin Cancer Foundation recommends yearly professional skin exams, along with monthly skin self-examinations. The greater your risk of skin cancer, the more important regular skin checks are. Older adults are particularly vulnerable, since a lifetime of sun exposure can significantly up your odds. Armed with a dermatoscope, a combination magnifying glass and flashlight, a dermatologist will do a head-to-toe exam, taking an extra-close look at any suspicious spots that are hard to see with the naked eye, and, if necessary, removing a piece of tissue to be biopsied.

Why you need it: Skin cancer is the most common cancer in the U.S., affecting 1 in 5 Americans by age 70. Experts estimate that 450,000 new cases are diagnosed each year — 10,000 of which are melanomas, the most aggressive form of skin cancer. (Basal and squamous cell cancers, more common forms of skin cancer, are less deadly.) Melanoma can appear suddenly and spread quickly, so early detection is critical. In fact, it can become life-threatening in as little as six weeks. The estimated five-year survival rate for patients whose melanoma is detected early is about 99 percent; the survival rate drops to 66 percent when the disease reaches the lymph nodes. For that reason, it is crucial that you stay vigilant and contact your doctor if you see any unusual changes in your skin. (Look for lesions that are asymmetrical, have irregular or ragged borders, are multicolored, are larger than a pencil eraser in diameter, or that change over time.)

Need a nudge? Yes, at-home skin exams are important: About 44 percent of melanomas are discovered by doing self-exams. But a professional once-over can add an extra layer of protection. While skin cancer usually appears on parts of the body exposed to ultraviolet light, melanoma can appear in places that haven’t been exposed to the sun. A doctor will be able to suss out hard-to-see spots, like on your back, scalp and buttocks and behind your ears.

6. Cholesterol test

When you need it: The American Heart Association recommends that adults 20 or older have their cholesterol checked every four to six years, provided their risk remains low. People with cardiovascular disease, for instance, may need their cholesterol assessed more often. Those taking cholesterol-lowering statins also need follow-up testing of their lipid levels to monitor their response to the medication, typically a month or two after starting the drug.

Usually ordered by a primary care doctor during routine physical exams, the cholesterol test is a blood test that measures several different types of lipids, or fats, in your blood — among them, total cholesterol (the total amount of cholesterol in your blood), low-density lipoprotein (LDL) or “bad” cholesterol, and high-density lipoprotein (HDL) or “good” cholesterol, which helps remove LDL cholesterol from your blood.

Why you need it: At least 48 percent of U.S. adults have some form of cardiovascular disease, according to the heart association, and heart disease is the leading cause of death in both men and women. For men, the risk starts to climb about age 45, when 1 out of every 100 men develop signs of heart disease; by age 55, the risk has doubled, and it continues to increase. For women, the risk also goes up with age, particularly after menopause.

Advances in home-monitoring systems, such as watches that measure heart rate, and cholesterol testing at pharmacies make it easier to track the health of your ticker. But although these assessments are important tools for detecting elevated digits — and potential heart problems down the road — in-person testing is still important. For one thing, your numbers don’t tell the whole story: Your doctor will also want to take your age, gender, family history and risk factors (such as smoking and diabetes) into consideration when determining possible treatments.

Need a nudge? A Cleveland Clinic survey released in February 2021 found that 42 percent of Americans put on weight during the pandemic (25 percent gained more than 20 pounds) and three-quarters reported feeling more stressed because of COVID-19. What that means, notes doctors: While fewer of us are being checked out for heart disease or stroke, many of us may be at greater risk for those very conditions.

7. Eye exam

When you need it: The American Academy of Ophthalmology recommends that adults get a complete eye exam at age 40, when changes in vision usually start to appear. Those who have an eye disorder or risk factor should consult with their eye doctor about how often to get checked. Those who’ve undergone cataract surgery, for example, need regular checkups to monitor the health of their eyes. The American Diabetes Association recommends that adults with diabetes have a dilated eye exam every year, unless instructed otherwise. Also, if you wear eyeglasses or contact lenses, you should visit your eye doctor for a checkup every one to two years to make sure your vision hasn’t changed before purchasing a new pair. Those 65 and older should schedule an exam every year or two.

During a routine exam, your eye doctor will usually check your eyesight and peripheral vision, then whip out a lighted handheld microscope (or slit lamp) to inspect the outer eye and structures at the front of the eye (such as the cornea and lens) for signs of a cataract. For a look further inside, eye drops will be used to dilate your pupils, making it easier to examine the back of the retina and optic nerve.

Why you need it: According to the Centers for Disease Control and Prevention, the leading causes of blindness and low vision in the U.S. are age-related eye diseases, such as cataracts, diabetic retinopathy, glaucoma and macular degeneration. It is important to diagnose them early when they are treatable or, in some cases, curable.

It’s estimated that by age 65 over 90 percent of people have a cataract, and half of those between ages 75 and 85 have lost some vision due to a cataract, according to UCLA Health. As diabetes has become more prevalant, the prevalence of diabetic retinopathy has increased significantly over the past two decades. Glaucoma, which occurs when fluid pressure builds inside the eye, potentially damaging the optic nerve, is particularly concerning. There are often no early symptoms, which is why 50 percent of people with glaucoma don’t know they have the disease. By age 40, about 1 in 200 have glaucoma, increasing to 1 in 8 at age 80.

Need a nudge? Annual appointments with your ophthalmologist or optometrist are critical for maintaining your vision, sure, but their benefits go well beyond keep your eyes in working order: A close inspection of the inner workings of your orbs can reveal a host of systemic disorders — sometimes before there are symptoms anywhere else. One example: heart disease. Eye exams can detect a number of cardiovascular conditions, such as clogged arteries, says Brian Stagg, M.D., an ophthalmologist and retina specialist at the University of Utah’s John A. Moran Eye Center. “Sometimes we can see little plaque deposits inside the eye that have broken away from buildup on the carotid artery, which supplies most of the blood supply to the brain.”

8. Hearing Test

When you need it: Adults over age 50 should get their hearing checked every three years, according to the American Speech-Language-Hearing Association. Those who wear hearing aids may want to be tested more often, since adjustments to the devices may be necessary over time. Tests commonly performed by an audiologist: pure tone audiometry (a series of sounds, at various pitches and volumes, sent through headphones, to determine hearing loss) and speech testing (which gauges your ability to understand speech in noisy settings).

Why you need it: According to the National Institute on Aging, approximately 1 in 3 people ages 65 to 74 have hearing loss. But presbycusis (age-related hearing loss) sneaks up gradually, which means many may not realize there’s a problem. Indeed, in a 2017 study published in the journal JAMA, which included 2,613 people age 60 or older, researchers found that 42 percent of those who reported no hearing trouble actually had mild hearing loss when tested.

Need a nudge? Research from the Johns Hopkins School of Medicine and the National Institute on Aging found that even mild hearing loss can triple your risk of taking a tumble, with the risk increasing by 140 percent for every additional 10 decibels of hearing loss. Why? Balance requires brain power, and those with hearing loss use more of that gray matter to hear, which means there are fewer mental resources left to help you stay upright. What’s more, hearing issues can wreak havoc on spatial awareness (translation: where our bodies are positioned in relation to the people and objects around them). Another eye-opener: A study from Johns Hopkins, following 639 adults for almost 12 years, found that mild hearing loss doubled the risk for dementia — possibly by contributing to a faster rate of atrophy in the brain.

9. Bone density test

When you need it: According to the Bone Health and Osteoporosis Foundation, a bone mineral density (BMD) test is recommended for women at age 65 and men at 70; younger postmenopausal women, women in menopausal transition and men 50 to 69 with risk factors for fracture; men and women who have a fracture after 50 years of age; and adults with a condition (rheumatoid arthritis, for example) or who are taking a medication associated with low bone mass or bone loss. Different types of BMD tests are available, but the most commonly used method is a DEXA (dual-energy X-ray absorptiometry) scan, a type of X-ray capable of detecting even quite small percentages of bone loss. It screens your spine, hips and wrists — common areas for fractures — as you lie on a table. It’s a fast (figure on about 20 minutes) and painless way to measure whether you have osteoporosis or how likely you are to develop it.

Why you need it: Throughout our life our bones are constantly renewing themselves, with new bone being formed, replacing old bone, which is broken down. Until about age 25, the body makes new bone faster than it breaks down old bone, and bone density increases. Most people reach their peak bone mass in their 20s. From about age 25 to age 50, bone density tends to stay stable. After age 50, the process slows — bone mass is lost faster than it is replaced, and bone loss often speeds up, particularly around the time of menopause. It is estimated that, on average, women lose up to 10 percent of their bone mass in the first five years after menopause. Osteoporosis occurs when too much bone mass is lost. Bones gradually become brittle and are more likely to break. About 13 percent of Americans age 50 and older have osteoporosis. One in 3 women and 1 in 5 men in that age group will suffer a broken bone due to the condition, according to the International Osteoporosis Foundation. The risk is higher in women because female bones typically are smaller and less dense than male bones. The risk increases at menopause, when levels of estrogen, which bolsters bones, drop. A family history can up the odds for both sexes.

Need a nudge? Osteoporosis is sneaky — most people don’t realize they have it until they suffer a broken bone. In fact, fractures of the spine, the most common, are often brushed off as back pain as a result of getting older. What’s more, notes Meryl LeBoff, M.D., an endocrinologist affiliated with Boston’s Brigham and Women’s Hospital: “Most patients admitted to a hospital with an osteoporotic fracture are not evaluated and treated for their underlying osteoporosis.” Early diagnosis is important because one broken bone increases the risk of suffering yet more broken bones. Treatment can help prevent fractures, according to the U.S. Preventive Services Task Force, especially for postmenopausal women. After suffering a hip fracture, approximately 40 percent of people are no longer able to walk independently a year later, and 1 in 3 patients age 50 and older die within a year.