Comprehensive Check-Up Guide: How Should Health Screening Be Planned by Age and Sex?
The most common misconception about health screening is: "the more tests, the better." Yet appropriate screening means finding the list that is right for you, rather than giving everyone the same list. One person may need a colonoscopy at 40, while someone of the same age can wait until 45. Breast MRI may be essential for one person but an unnecessary source of anxiety for another. What makes the difference is age, sex, and family history.
The following step-by-step planner does exactly this: when you select your age, sex, and the relevant factors from 40 different risk factors , it applies international guideline rules (USPSTF, ACS, NCCN, ADA, AHA) to your situation to create a personal screening schedule . Perhaps more importantly, it also tells you which tests you do not need.
This tool follows the logic of the Check the Life holistic health model. It assesses health across five dimensions (Physical, Psychological, Social, Environmental, and Advanced Health Layers), rather than through a single list. Its purpose extends beyond screening for disease to making risk patterns visible early and matching the right test to the right person at the right time in their care.
- This is not a diagnostic tool. It does not detect, rule out, or calculate the probability of any disease. It only applies guideline screening rules to your selections.
- No information is saved. Your selections are not sent anywhere or stored. They disappear when you close the page.
- The resulting plan is a starting point — an agenda to discuss with your physician, not a decision that replaces your physician. The physician who knows you may change the plan, and that is normal.
- If you have symptoms, do not wait for screening. Screening means looking for hidden disease in people without symptoms . If you have a symptom, this is a matter of diagnosis rather than screening, and it cannot wait for a scheduled date.
Personal Health Screening Planner
Check the Life holistic model · age · sex · 50 risk factors · 5 dimensions of health
Your age range
The first and most influential factor in determining your screening schedule.
Your biological sex
This is asked because screening recommendations are organ-based. The organs you have matter, regardless of your gender identity; if you have a history of hormone therapy or surgery, you need to adapt the plan with your physician.
Your risk factors
Check those that apply to you — you may choose as many as you like. If none apply, leave them blank; a plan will still be generated. Each selection adds a separate card below your plan with its own explanation.
Select your age range and sex above.
The following plan follows the Check the Life approach, which considers five dimensions of health. The aim goes beyond "looking" for disease to making risk patterns visible early.
- Cervical cancer — HPV DNA test Starts at age 25 · Every 5 yearsIn Turkey, it is free through KETEM between ages 30–65. Screening is still necessary after HPV vaccination.
- HPV vaccine — 9-valent vaccine Routinely recommended up to age 26This is a cancer vaccine: it protects against cervical, vulvar, vaginal, anal, and head and neck cancers.
- Blood pressure Every 1–3 yearsHypertension causes no symptoms; measuring it takes minutes.
- Lipid profile (cholesterol) From age 20, every 4–6 yearsFasting is not required. Detecting elevated levels early provides lifelong benefit.
- Hepatitis B and C At least once in a lifetimeThey can remain symptom-free for years, cause liver cancer, and both are treatable.
- Mental health — screening for depression and anxiety At the annual check-upThe most frequently overlooked and one of the most useful screenings in this age group.
- Dental and oral health Every 6–12 monthsAn examination that also includes oral cancer screening.
- Eye examination Once in your 20s
- Tetanus–diphtheria (Td) Every 10 yearsThe most commonly forgotten adult vaccine.
- Skin — mole self-examination MonthlyABCDE: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, Evolution over time.
- If you are planning a pregnancy — folic acid, immune status, and thyroid assessment Before pregnancy
- Testicular self-examination Monthly, after a showerTesticular cancer is the most common cancer in men aged 15–35 , and a painless palpable lump is the first sign. Cure rates are very high at an early stage. This awareness is rarely discussed.
- HPV vaccine Routinely recommended up to age 26Also recommended for men: HPV-related head and neck cancers are more common in men and are increasing.
- Blood pressure Every 1–3 years
- Lipid profile (cholesterol) From age 20, every 4–6 years
- Hepatitis B and C At least once in a lifetimeBoth are treatable; hepatitis C can usually be completely cured.
- Mental health At the annual check-upIn young men, depression often presents as anger, sleep disturbances, or substance use and is overlooked.
- Dental and oral health Every 6–12 months
- Eye examination Once in your 20s
- Tetanus–diphtheria (Td) Every 10 years
- Skin — mole self-examination MonthlyThe ABCDE rule: Asymmetry, Border irregularity, Color variation, Diameter over 6 mm, Evolution over time.
- Cervical cancer — HPV DNA test Every 5 yearsThis age range is covered by the free KETEM program (ages 30–65).
- Map your family history Once, then keep it updatedThis is the most valuable thing you can do this decade, and it is free. Three details for each relative: which organ was affected, age at diagnosis, and mother's or father's side. This information will determine your screening plan at 40.
- Blood pressure 1 time a year
- Lipid profile Every 4–6 years
- Blood glucose / HbA1c From age 35, every 3 yearsEarlier and more often if overweight or if there is a family history of diabetes.
- Eye examination Twice in your 30s
- Mental health At the annual check-up
- Dental and oral health Every 6–12 months
- Thyroid examination Palpation at the annual check-upNot ultrasound, but physical examination — screening ultrasound is not recommended in an asymptomatic person.
- Hepatitis B and C Now, if you have never been tested
- HPV vaccine Shared decision-making with your physician up to age 45
- Map your family history Once, then keep it updatedThis will determine your screening plan in your 40s. For each relative: which organ was affected, age at diagnosis, and which side of the family.
- Blood pressure 1 time a yearHypertension in men begins at this age and can remain unnoticed for a decade.
- Lipid profile Every 4–6 years
- Blood glucose / HbA1c From age 35, every 3 yearsEarlier if waist circumference exceeds 94 cm or there is a family history of diabetes.
- Waist circumference Annual measurementMore informative than weight: over 94 cm indicates increased metabolic risk, and over 102 cm indicates substantially increased risk.
- Eye examination Twice in your 30s
- Mental health At the annual check-up
- Dental and oral health Every 6–12 months
- Testicular self-examination MonthlyTesticular cancer risk continues until age 35.
- Hepatitis B and C Now, if you have never been tested
- Breast cancer — digital mammography (tomosynthesis) Starts at 40 · Shared decision-making at 40–44; 1 time a year after 45Mammography is one of the few screenings shown in randomized studies to reduce breast cancer deaths. In Turkey, it is free every two years through KETEM for ages 40–69. If you have been told you have "dense breast tissue," discuss additional ultrasound with your physician.
- Colorectal (bowel) cancer — colonoscopy or FIT Starts at 45 · Colonoscopy every 10 years, FIT annuallyThe most valuable screening on the list: it detects cancer early and also prevents cancer from developing by removing polyps. International guidelines start at 45; Turkey's national program covers ages 50–70.
- Cervical cancer — HPV DNA test Every 5 yearsFree through KETEM.
- Blood pressure 1 time a year
- Lipid profile Every 1–2 years
- Blood glucose / HbA1c Every 3 years (annually if risk factors are present)
- Eye examination Once at age 40, then every 2–4 yearsAge 40 is specifically mentioned in guidelines for glaucoma screening.
- Dental and oral health Every 6–12 months
- Mental health At the annual check-up
- Menopause counseling When symptoms beginBone health, cardiovascular risk, and treatment options are considered together.
- Endometrial warning Applies at all timesThere is no screening test for uterine cancer. The single rule: persistent changes in menstrual patterns or bleeding between periods must be reported to a physician.
- Colorectal (bowel) cancer — colonoscopy or FIT Starts at 45 · Colonoscopy every 10 years, FIT annuallyColorectal cancer is more common in men, and this screening can prevent the disease by removing polyps before cancer develops in the bowel.
- Prostate cancer — PSA, preceded by a shared decision-making discussion First discussion between ages 45–50This is the only "shared decision" screening on the list: after discussing its benefits and harms (overdiagnosis, unnecessary treatment), you make the decision. It is inappropriate to add PSA to a check-up package without informed consent.
- Blood pressure 1 time a year
- Lipid profile Every 1–2 yearsAt this age, 10-year cardiovascular risk is calculated and statin treatment is considered.
- Blood glucose / HbA1c Every 3 years (annually if risk factors are present)
- Waist circumference Annually
- Eye examination Once at age 40, then every 2–4 years
- Dental and oral health Every 6–12 monthsAn oral cancer examination is particularly important if you smoke and/or drink alcohol.
- Mental health At the annual check-upMiddle-aged men have a high suicide risk and are the group in whom depression is diagnosed least often.
- Skin — mole self-examination Monthly
- Breast cancer — mammography 1 time a year (after 55, every 1–2 years is an option)Free every two years through KETEM up to age 69.
- Colorectal (bowel) cancer — colonoscopy or FIT Colonoscopy every 10 years · FIT annuallyTurkey's national program covers this age range: ages 50–70, fecal occult blood testing every two years and colonoscopy every 10 years, free of charge.
- Cervical cancer — HPV DNA test Every 5 years, until age 65
- Blood pressure 1 time a year
- Lipid profile Every 1–2 years
- Blood glucose / HbA1c Every 1–3 years
- Bone health After menopause, before 65 if risk factors are presentWithout risk factors, bone density testing starts at 65. Osteoporosis is also silent: its first sign is often the fracture itself.
- Shingles (herpes zoster) vaccine At 50, 2 dosesIts most feared consequence is nerve pain that can last for months; vaccination is effective in preventing it.
- Hearing assessment Immediately if you have symptomsUntreated hearing loss is associated with dementia risk and can be corrected.
- Eye examination Every 2–4 years
- Dental and oral health Every 6–12 months
- Influenza vaccine Every autumn
- Endometrial warning Applies at all timesAny vaginal bleeding after menopause is abnormal and must be assessed without delay. This single sentence is the most lifesaving information on this list.
- Prostate cancer — PSA ± digital rectal examination, after shared decision-making From age 50 · Every 1–2 years depending on the PSA levelWith a family history, screening starts at 45 or even 40. Before making a decision, be sure to discuss overdiagnosis as well.
- Colorectal (bowel) cancer — colonoscopy or FIT Colonoscopy every 10 years · FIT annuallyIn Turkey, it is free through KETEM for ages 50–70.
- Blood pressure 1 time a year
- Lipid profile Every 1–2 years
- Blood glucose / HbA1c Every 1–3 years
- Shingles (herpes zoster) vaccine At 50, 2 doses
- Hearing assessment Immediately if you have symptoms
- Eye examination Every 2–4 years
- Dental and oral health Every 6–12 monthsWhen smoking and alcohol are combined, head and neck cancer risk increases multiplicatively ; this examination is where screening takes place.
- Influenza vaccine Every autumn
- Skin — mole self-examination Monthly
- Mental health At the annual check-up
- Bone density (DXA) At 65 · Every 2–5 years depending on the resultFor women, this is the standard age to begin bone density testing , which is the most frequently missed investigation. A hip fracture can lead to loss of independence in older age. Vitamin D, calcium, and resistance exercise are integral to treatment.
- Breast cancer — mammography Every 1–2 years, until 74The KETEM program is free up to 69.
- Colorectal (bowel) cancer Continues · Until 75
- Cervical cancer May end at 65It is stopped if there have been enough negative screening results in the last 10 years. If you have never been screened or your screening history is insufficient, screening should continue — clarify this distinction with your physician.
- Blood pressure 1 time a year
- Lipid profile · Blood glucose 1 time a year
- Pneumococcal vaccine At 65
- Influenza vaccine Every year
- Eye examination Every 1–2 yearsCataracts, glaucoma, and macular degeneration become more common at this age.
- Hearing test If you have symptoms
- Fall risk and gait assessment 1 time a yearThis is the most useful and least frequently performed assessment at this age. Home safety, footwear, vision, and reviewing the medications you take truly reduce falls.
- Dental and oral health Every 6–12 months
- Abdominal aortic aneurysm — abdominal ultrasound Between ages 65–75, for men who have smoked once in a lifetimeA single, painless investigation. An aneurysm detected before rupture can be treated electively; after rupture, it has a fatal course. This screening is almost unknown.
- Prostate cancer The decision to continue is reassessedAs 70 approaches, benefits decrease and the risk of overdiagnosis rises. The decision depends on general health, life expectancy, and your preferences.
- Colorectal (bowel) cancer Continues · Until 75
- Bone density (DXA) At 70Men also develop osteoporosis, and it is diagnosed much less often.
- Blood pressure 1 time a year
- Lipid profile · Blood glucose 1 time a year
- Pneumococcal vaccine At 65
- Influenza vaccine Every year
- Eye examination Every 1–2 years
- Hearing test If you have symptoms
- Fall risk and medication review 1 time a year
- Dental and oral health Every 6–12 months
- Discussion about stopping screening Once, in detailThis is an overlooked but essential discussion. Screening usually needs a period of 10 years before its benefits appear, whereas harms occur immediately. Decisions therefore consider life expectancy, accompanying diseases, and your preferences together. "Stopping screening" is not giving up; it is appropriate medical care.
- Bone health and fall prevention 1 time a yearAt this age, this is the first item on the screening agenda — offering more benefit than most cancer screenings. Gait assessment, home safety, vision, and foot health.
- Medication review (polypharmacy) 1 time a yearAll medications, vitamins, and herbal products are reviewed together. Stopping an unnecessary medication is as valuable a medical intervention as adding a new one.
- Nutrition and muscle mass 1 time a yearUnintentional weight loss and muscle loss (sarcopenia) determine independence at this age. Protein intake and resistance exercise should be discussed.
- RSV vaccine At 75, a single dose
- Pneumococcal and influenza vaccines According to schedule / every year
- Eye examination Every 1–2 yearsVision loss is associated with both falls and dementia risk and is largely correctable.
- Hearing If you have symptomsHearing aids are the most frequently delayed intervention and the one that most improves quality of life at this age.
- Cognitive assessment If symptoms are present or relatives notice changesRoutine screening is not recommended; symptoms require assessment.
- Dental and oral health Every 6–12 monthsChewing ability directly affects nutrition.
- Bleeding warning Applies at all timesAny vaginal bleeding at this age must be assessed.
- Discussion about stopping screening Once, in detailScreening usually needs a period of 10 years before its benefits appear, whereas harms occur immediately. Decisions therefore consider life expectancy, accompanying diseases, and your preferences together. Prostate screening is generally stopped at this age.
- Fall prevention and gait assessment 1 time a yearAt this age, this is the first item on the screening agenda and offers more benefit than most cancer screenings.
- Medication review (polypharmacy) 1 time a yearStopping an unnecessary medication is as valuable a medical intervention as adding a new one.
- Nutrition and muscle mass 1 time a yearUnintentional weight loss and muscle loss (sarcopenia) determine independence.
- Bone health AssessedOsteoporosis is diagnosed much less often in men, but hip fracture outcomes are more severe.
- RSV vaccine At 75, a single dose
- Pneumococcal and influenza vaccines According to schedule / every year
- Eye examination Every 1–2 years
- Hearing If you have symptomsHearing aids are the most delayed intervention and one of the most impactful.
- Cognitive assessment If symptoms are present or relatives notice changes
- Dental and oral health Every 6–12 months
- Difficulty urinating If you have symptomsProstate enlargement is very common at this age and can be treated independently of cancer.
Annual low-dose computed tomography (LDCT) — your age and smoking exposure meet the screening criteria. This method has been shown to reduce lung cancer deaths in eligible people and is the most frequently missed screening in Turkey. A chest X-ray is not sufficient for this purpose — "low-dose CT" must be specifically requested. To continue screening, the time since quitting must not exceed 15 years.
Your smoking exposure meets the criterion, but you are still under 50. Annual low-dose CT screening will become appropriate when you reach 50 — note this in your calendar. This does not mean "no risk"; it means you are outside the age range in which screening benefits outweigh its harms.
Your smoking exposure is high, but your age is outside the recommended 50–80 screening range. This does not mean there is no risk — it means you are outside the range in which screening benefits have been demonstrated . Discuss your situation with your physician.
Quitting saves more lives than all the screenings on this list. Lung cancer risk falls substantially over the years; cardiovascular risk starts falling in the first months. The risks of head and neck, bladder, esophageal, stomach, pancreatic, kidney, and cervical cancers also decrease.
The Ministry of Health's ALO 171 smoking cessation helpline is free; smoking cessation clinics and medication support are available. It does not matter how many times you have tried — most people who quit did so after several attempts, not on their first try. Each attempt is practice for the next one, rather than a failure.
Alcohol is a direct risk factor for oral, throat, esophageal, liver, colorectal, and breast cancer and no safe threshold has been defined. When combined with smoking, head and neck cancer risk increases multiplicatively rather than additively with the combined exposure.
Added to the plan: Monitoring liver enzymes and a complete blood count · Specifically emphasizing oral cancer screening during dental examinations · Not waiting when esophageal symptoms develop (difficulty swallowing or a feeling of food getting stuck). Even reducing consumption provides measurable benefit; the goal does not have to be "none."
The guideline approach is to start breast screening 10 years before the age of your youngest relative at diagnosis (not before 30) and to screen annually . If your lifetime risk exceeds 20%, mammography is supplemented with breast MRI — mammography alone may be insufficient in this group.
Learning your relative's age at diagnosis is the single most decisive piece of information for this plan. Ovarian cancer in the family is a criterion for genetic counseling regardless of age. Risk-reducing medication, such as tamoxifen, can also be discussed at high risk. In men, this family history also raises prostate cancer risk.
Screening starts at 40 rather than 45 — or 10 years before the youngest age at diagnosis, whichever is earlier. The interval is 5 years rather than 10.
In this group, stool tests (FIT) do not replace colonoscopy; colonoscopy is preferred, because the aim is to detect cancer and also remove polyps before they turn into cancer. Find out your relative's age at diagnosis and tell your physician. Genetic counseling is also required if two or more relatives are affected or the diagnosis was made under 50.
The shared decision-making discussion takes place at 45 rather than 50 ; if several relatives are affected or the diagnosis was made at a young age, it may be brought forward to 40 . The discussion remains the same: benefits and the risk of overdiagnosis are discussed together, and you make the decision.
Also note: if there is metastatic or aggressive prostate cancer in the family, or a combination of prostate + breast/ovarian/pancreatic cancer, this is a criterion for genetic counseling (it may be BRCA2-related).
Prostate cancer affects an organ you do not have, but it is still important for your screening plan. The reason: prostate cancer can belong to the same hereditary susceptibility group as breast and ovarian cancer (particularly BRCA2). If prostate cancer occurs alongside breast, ovarian, or pancreatic cancer in your family, this combination is a criterion for genetic counseling and may change your breast screening. Sharing this history with your brothers and sons also enables them to have a PSA discussion at 45.
Let's be clear: a family history of lung cancer alone does not make you eligible for lung screening. Screening criteria are based on age and smoking exposure; family history is not yet included. This does not mean there is no risk — the evidence has not reached the level needed to change screening decisions.
But you can do two things: quit if you smoke (the benefit is even greater with a family history), and review radon in your home and occupational exposures (asbestos, silica, diesel exhaust). Also, when persistent cough, bloody sputum, breathlessness, or hoarseness occurs, do not wait.
Helicobacter pylori testing and eradication treatment if positive — this is the clearest evidence-based step; eliminating the bacterium lowers stomach cancer risk. Turkey is not a country with a low incidence of stomach cancer.
Routine endoscopic screening in average-risk people is not recommended; with a family history, it can be considered by the physician. A history of stomach cancer at a young age (particularly the "diffuse" type) requires genetic assessment for a CDH1 mutation . Reducing salty foods, salt-cured foods, and processed meat is also part of this plan.
This is a criterion for genetic counseling. However, unless a mutation is found or several relatives are affected, imaging surveillance is not recommended — there is no effective screening test for the pancreas, and unnecessary imaging only generates incidental findings and anxiety.
A hereditary mutation and a family history together may warrant, at experienced centers, annual surveillance with MRI/MRCP or endoscopic ultrasound . It usually starts at 50 or 10 years before the youngest age at diagnosis. New-onset diabetes with unexplained weight loss is a combination that warrants attention in these families.
A whole-body mole (nevus) examination by a dermatologist, 1 time a year — with dermoscopy and digital mole mapping if needed. A family history of melanoma is an accepted reason for regular dermatological follow-up.
Examine yourself monthly using the ABCDE rule: Asymmetry · irregular borders (Border) · variation in Color · diameter over 6 mm (Diameter) · changes over time (Evolution). A changing mole is a concerning mole. The back, scalp, soles, and beneath the nails are the most frequently overlooked areas — ask someone close to you for help. Sun protection and completely avoiding tanning beds are also part of the plan.
For endometrial cancer, there is no screening test at average risk — but a family history changes two things.
First: Endometrial cancer is Lynch syndrome's second most common cancer. If colorectal, stomach, urinary tract, or ovarian cancer also occurs in your family — or diagnosis was made under 50 — genetic counseling is needed. If Lynch syndrome is found, colonoscopy starts at 20–25 and is repeated every 1–2 years; endometrial surveillance and risk-reducing surgery after completing childbearing are also discussed.
Second: Your threshold for acting on symptoms is lower. Any vaginal bleeding after menopause or bleeding between periods / persistent changes in menstrual patterns before menopause must be assessed without delay by a clinician.
This is the single strongest sign of hereditary susceptibility and an accepted criterion for genetic counseling. Cancer is largely a disease of aging; when it appears at a young age, an explanation beyond "time" needs to be considered.
Genetic counseling is a discussion in which you decide together whether testing should be done — it does not require you to undergo a test. Its outcome can change the screening plans of your siblings and children as well as your own. Bring the following information: which relative, which organ, age at diagnosis, and mother's or father's side. This is the step most often missed in practice — ask for the referral yourself.
Hereditary syndromes follow a single family line. Related cancers clustered on one side are much more significant than those spread across both sides — this pattern is an accepted criterion for genetic counseling.
The breast–ovary–pancreas–prostate combination suggests BRCA1/2 and related genes; the bowel–uterus–stomach–urinary tract combination suggests Lynch syndrome as a possible cause. A crucial and frequently overlooked point: breast–ovarian susceptibility can also be inherited from the father's side — your father's sisters and your paternal grandmother must be included. If possible, draw a three-generation family tree on paper and take it with you.
Male breast cancer is rare, and even a single case in the family is sufficient for genetic counseling — particularly for BRCA2. This is one of the clearest referral criteria in guidelines, yet it is almost always overlooked in practice.
The result may change breast and ovarian screening for female relatives, prostate screening for male relatives, and pancreatic surveillance decisions for both.
BRCA1 and BRCA2 mutations are substantially more common in this population. This ancestry is an accepted criterion for referral to genetic counseling even without a strong family history of cancer. Testing a limited number of founder mutations can be informative. The decision is again made together during counseling.
The general plan above is not sufficient for you in this situation. Depending on the mutation, screening starts much earlier, takes place much more frequently , and includes additional organs.
Examples: Colonoscopy for Lynch syndrome starts at 20–25 and repeats every 1–2 years; breast MRI for BRCA starts at 25, mammography at 30, and for BRCA1, a discussion at 35–40 about risk-reducing salpingo-oophorectomy ; surveillance for FAP starts in adolescence. Options also include preventive medication (such as aspirin for Lynch syndrome or tamoxifen for breast cancer risk) and risk-reducing surgery where appropriate.
This plan must be implemented under medical genetics and oncology follow-up . An important responsibility must also be remembered: testing your first-degree relatives should be discussed, because they also have a 50% chance of being carriers.
Lipoprotein(a) — Lp(a): a single blood test, once in a lifetime is enough. Lp(a) levels are largely inherited and remain unchanged throughout life. Elevated levels increase cardiovascular risk even with normal LDL and do not appear in a standard lipid panel — the test must be requested separately. If high, other risk factors are targeted more aggressively, and testing your first-degree relatives is also considered.
Added to the plan: Lipid profile every 1–2 years · a lower treatment threshold · if the decision remains uncertain at 40–75, a coronary artery calcium score (CAC) — a score of zero is reassuring, while a high score accelerates treatment. A family history of sudden cardiac death or unexplained death at a young age also requires ECG and cardiology assessment for inherited rhythm disorders and cardiomyopathies.
Fasting blood glucose or HbA1c, before 35 and every 1–3 years. A family history of type 2 diabetes is an accepted risk factor for earlier screening. Type 2 diabetes remains silent for years; in some people, organ damage has already begun by diagnosis.
The good news: If detected at the prediabetes stage, lifestyle programs can substantially reduce progression to diabetes — one of medicine's best-proven examples of prevention. A family history of diabetes does not determine your destiny; weight, exercise, and sleep truly change the equation.
First, to be clear: For a person without symptoms, there is no recommended dementia screening test — neither brain imaging, blood biomarkers (such as p-tau217), nor APOE genetic testing. In healthy people, these only create anxiety that cannot be addressed, because they do not offer an action that changes the outcome.
In contrast, much can be done — that is the real news. The Lancet Commission on Dementia identified 14 modifiable risk factors for prevention: correcting hearing loss with hearing aids · blood pressure control · LDL cholesterol control · diabetes management · smoking cessation · preventing obesity · regular physical activity · avoiding excessive alcohol · treating depression · addressing social isolation · protecting against head injuries · correcting untreated vision loss · protection from air pollution · education and mental activity.
Hearing aids are the most frequently overlooked item on this list. For someone with dementia in the family, the right approach is to review these fourteen items one by one at the annual check-up, rather than look for a screening test. If cognitive symptoms appear — forgetfulness, difficulty finding words, or getting lost — then what is needed is assessment rather than screening, and it should not be delayed.
Glaucoma has a hereditary component , and a history in a first-degree relative raises risk substantially. Your eye examinations should therefore be more frequent than the standard schedule for your age.
Why this matters so much: glaucoma causes no symptoms until vision loss begins and lost vision does not return. However, when detected early, its progression can largely be halted. The examination should assess intraocular pressure, the visual field, and the optic nerve head — simply measuring your glasses prescription is not enough.
A family history of hip fracture is an independent risk factor included in the FRAX fracture risk calculation. Therefore, bone densitometry (DXA) may be considered after menopause or over age 50, without waiting for the standard age (65 for women, 70 for men).
Osteoporosis is silent: its first sign is often the fracture itself. And treatment is not just medication — vitamin D, adequate calcium, resistance exercise, and fall prevention are integral parts. Loss of height and a hunched back can indicate silent vertebral fractures; these should also be assessed.
A history of abdominal aortic aneurysm in a first-degree relative broadens the screening criteria — assessment may be considered even in people who have never smoked and in women. The method: a single abdominal ultrasound.
Why it is valuable: an aneurysm causes no symptoms until it ruptures and can be fatal when it does; by contrast, an aneurysm detected before rupture can be monitored and treated in a planned manner . It is a painless, radiation-free, one-time examination — and almost no one knows about it.
Obesity is associated with the risk of uterine (endometrial), postmenopausal breast, colorectal, kidney, pancreatic, liver, esophageal, gallbladder, stomach, ovarian, and thyroid cancer and multiple myeloma — and also increases the risk of type 2 diabetes, heart disease, sleep apnea, and dementia .
Even 5–10% weight loss provides measurable benefits and the goal need not be your "ideal weight." Added to the plan: earlier diabetes screening · assessment for fatty liver · annual waist circumference measurement (over 94 in men and 80 cm in women indicates increased risk) · if snoring and daytime sleepiness are present, sleep apnea assessment. In women, this risk becomes even more pronounced after menopause.
If you have prediabetes: this is not simply a state of "not yet having a disease," but a window for intervention. Annual HbA1c monitoring and a structured lifestyle program are recommended. Intervention at this stage significantly reduces progression to diabetes.
If you have been diagnosed with diabetes, the focus changes entirely. The two most commonly missed tests are: an annual retinal examination and the urine albumin-to-creatinine ratio. Both detect damage before symptoms appear, and early intervention can prevent blindness and the need for dialysis. In addition: an annual foot examination and sensory assessment · HbA1c every 3–6 months · lipid monitoring and usually a statin · a blood pressure target · influenza and pneumococcal vaccines.
Diabetes is also one of the factors on the Lancet dementia risk list — good control supports brain health too.
Because you already have a diagnosis, the focus is not screening; the real issue is whether the target value has been reached — and in practice, a substantial proportion of patients have not reached it.
Added to the plan: home blood pressure monitoring (office measurements alone can be misleading) · annual assessment of kidney function and urine albumin · ECG · retinal assessment · review of salt intake. Hypertension is the most powerful modifiable cause of stroke, heart failure, kidney failure, and dementia — controlling blood pressure also protects the brain.
The "normal value" for cholesterol is not the same for everyone; your LDL target is determined by your overall cardiovascular risk. The same LDL value may require treatment in a person with diabetes but not in someone else.
Added to the plan: a lipid profile every 1–2 years (sooner after a treatment change) · a 10-year risk calculation · thyroid function and liver assessment (for secondary causes) · if there is a family history of early heart disease, Lp(a) measurement. If very high values occur together with a family history of early heart disease, familial hypercholesterolemia should be considered and family members should also be screened.
Physical inactivity is associated with the risk of cardiovascular disease, type 2 diabetes, colorectal and breast cancer, osteoporosis, depression, and dementia . It is also on the Lancet dementia risk list.
The goal: each week, 150 minutes of moderate activity (brisk walking is enough) or 75 minutes of vigorous activity, plus resistance (strength) training two days a week. Resistance training is the most often overlooked half of the plan and is essential for bone and muscle mass.
And most importantly: the biggest jump in benefit comes from going from "none" to "some" — moving from zero to 60 minutes a week provides more benefit than going from 150 to 300. Not being able to reach the goal is no reason not to start.
Abdominal ultrasound ± AFP, every 6 months. This is the group for whom liver cancer surveillance is firmly recommended and the interval is 6 months — not annually. This monitoring is often overlooked.
In addition: for hepatitis B carriers, the need for antiviral treatment should be assessed · for hepatitis C, the possibility of a complete cure with treatment should be discussed (now possible in most cases) · family members should be screened and vaccinated · if cirrhosis is present, endoscopy for esophageal varices · complete avoidance of alcohol · completion of hepatitis A and B vaccination. For fatty liver, weight loss is the only effective treatment.
If a polyp has been found: the follow-up interval is not 10 years; it is usually set according to the polyp's number, size, and pathology report, generally between 3–7 years. Keep your pathology report and request the date of your next colonoscopy in writing — this date is among the most frequently lost pieces of information in all of medicine. Also, if more than 10 polyps have been found, genetic assessment is needed.
If you have inflammatory bowel disease (ulcerative colitis / Crohn's): colorectal cancer risk increases. Surveillance begins 8–10 years after disease onset and continues every 1–3 years with colonoscopy including biopsy/chromoendoscopy. Clarify the date your disease began with your doctor. If you use long-term steroids, bone density should also be monitored.
Bone densitometry (DXA) — without waiting for the standard age and FRAX to calculate your 10-year fracture risk. Systemic cortisone use for more than three months and a low-trauma fracture (a fracture caused by a simple fall or strain) are among the strongest indicators of osteoporosis.
A critical point: a low-trauma fracture after age 50, even if bone density testing is normal, may justify treatment — because the fracture itself is the strongest predictor of a second fracture. This is called the "post-fracture care gap" and is one of the most often missed treatment opportunities worldwide. The plan also includes vitamin D, calcium, resistance exercise, and fall prevention .
In this situation, a general screening plan is not enough for you and two separate areas must be addressed together.
1 · Recurrence monitoring: Your doctor determines the follow-up schedule for your specific cancer — it is outside this plan, which does not replace it. Ask for your personal follow-up schedule in writing.
2 · Screening for second cancers and late effects: This area is much more often overlooked. It varies according to the treatment you received: if you had radiation therapy to the chest, breast screening starts earlier and MRI is added; if you had radiation therapy to the neck, thyroid monitoring is needed; some chemotherapy drugs require heart function monitoring, while others require hearing or bone density monitoring; pelvic radiation therapy may bring colorectal screening forward. Also, having had a cancer diagnosis is itself a reason to assess hereditary predisposition — especially if diagnosed before age 50. Ask your oncology team for a "treatment summary and follow-up plan" document ; it is the most valuable document for the doctors who will care for you throughout your life.
Having had radiation therapy to the chest between ages 10–30 (for example, to treat lymphoma) places you in a high-risk group for breast cancer — this is a specifically defined situation in the guidelines.
Recommendation: annual breast MRI + annual mammography, beginning 8 years after radiation therapy or at age 25 (whichever is later). Also, a clinical breast examination every 6–12 months. Mammography alone is insufficient in this group. The same history of radiation therapy also calls for monitoring for heart valve and coronary disease and lung problems — consider a cardiology assessment too.
For asymptomatic people, thyroid screening is not recommended — but this history is one of the few exceptions requiring monitoring.
Recommendation: an annual neck examination and thyroid ultrasound if the doctor considers it necessary; also, monitoring thyroid function with TSH (hypothyroidism after radiation therapy is common and develops insidiously). A new lump in the neck, hoarseness, or difficulty swallowing should not be left unassessed. Radiation therapy to the same area also requires regular dental follow-up for the salivary glands and dental and jaw health .
Audiometry (a hearing test) — now. Hearing loss is not just a sensory problem: untreated hearing loss is associated with the risk of dementia, depression, social isolation, and falls and is a correctable factor. Among the Lancet Commission on Dementia's 14 modifiable risk factors, this is the most often overlooked.
In Türkiye, hearing aids are partly covered by SGK — ask your doctor. Sudden hearing loss on one side is an emergency and should be assessed within hours to days. "It is normal, just old age" is the wrong thing to say about this.
Because you have a diagnosis or a history of treatment, the focus is not screening, but the adequacy and continuity of treatment. A partial response — "not as bad as before, but not well either" — is the most commonly overlooked situation and requires treatment adjustment.
Added to the plan: review of sleep, alcohol, and substance use · thyroid function, B12, and vitamin D testing (these can mimic or worsen these conditions) · monitoring the effects of medications on weight, blood glucose, and lipids · planning physical activity as part of treatment . Depression is also on the dementia risk list and is treatable — another reason to continue treatment.
A history of high blood glucose in pregnancy (gestational diabetes): significantly increases the risk of developing type 2 diabetes later, and this risk does not disappear after pregnancy. Recommendation: every 1–3 years, for life, check HbA1c or fasting blood glucose. After the first year following childbirth, this monitoring is almost always overlooked.
A history of preeclampsia (pregnancy toxemia), hypertension in pregnancy, or preterm birth: these are considered female-specific cardiovascular risk enhancers and increase the risk of hypertension, heart disease, stroke, and kidney disease years later. This connection is little known among both women and doctors.
The most practical thing to do: always mention your pregnancy and birth history during cardiology and internal medicine assessments — the question "was my pregnancy uncomplicated?" is usually not asked. Annual blood pressure, lipid, and glucose monitoring is recommended.
1 · Bone health. Bone loss accelerates with menopause. If you have an additional risk factor (cortisone, a history of fracture, family history of hip fracture, low weight, smoking, heavy alcohol use), bone density testing before age 65 may be appropriate. Vitamin D, adequate calcium, and resistance exercise are integral parts of the plan.
2 · Cardiovascular health. Cardiovascular risk increases after menopause, and in women this risk is both less often screened for and less often treated. Blood pressure, lipid profiles, and glucose should be monitored more closely during this period.
3 · The single most important sentence: Any vaginal bleeding after menopause is abnormal and must be assessed without delay. "It happened once, it was only a little, and it stopped" does not change this rule. This single sentence is the most lifesaving information on this page.
Also, if menopausal symptoms impair quality of life, treatment options exist and should be discussed; the decision about hormone therapy is individualized according to age, time since menopause, and personal risks.
1 · Cervical screening is usually unnecessary. If the cervix was also removed and no high-grade cell changes (CIN2+) or cancer were found before surgery, screening is stopped. However, there are two exceptions: if the reason for surgery was high-grade cell changes or cancer, follow-up continues; if the cervix was retained (subtotal hysterectomy), screening continues on the normal schedule. Clarify why you had surgery and whether your cervix was removed — a distinction most patients do not know and that records often omit.
2 · If the ovaries were also removed and this happened at an early age, bone and cardiovascular health should be assessed as in early menopause; bone density testing and hormone support should be discussed. Hysterectomy does not affect breast screening, which continues on the normal schedule.
Dense breast tissue means two separate things: mammography becomes less sensitive (a tumor can be hidden in dense tissue) and dense tissue itself is an independent risk factor.
What can be done: first, tomosynthesis (3-dimensional mammography) should be preferred — it gives better images than conventional mammography in dense tissue. Adding breast ultrasound is also common; it finds more cancers but also increases false positives and unnecessary biopsies — discuss this balance with your doctor. If you also have a family history or other risk factors, breast MRI may be considered. Self-examination and prompt assessment of a newly noticed lump are particularly important in this group.
PCOS is not only a reproductive health issue; it is a long-term metabolic condition.
Added to the plan: diabetes screening starts earlier and is performed more often (HbA1c or a glucose tolerance test) · lipid profile · blood pressure · fatty liver assessment · weight management support · sleep apnea assessment if snoring is present.
And a little-known but important issue: prolonged absence of periods leaves the uterine lining exposed to unopposed estrogen, which increases endometrial cancer risk. Therefore, regulating periods is not just for comfort; it is preventive treatment and bleeding between periods and prolonged menstrual irregularities should be reported to your doctor.
Contrary to popular belief, alcohol has no lower threshold considered safe in terms of cancer — risk increases linearly from the first drink. Even moderate consumption raises the risk of breast, colorectal, liver, esophageal, and mouth and throat cancer. This relationship is particularly clear for breast cancer: each daily standard drink measurably increases risk.
This does not mean "everyone who has a drink gets cancer" — the absolute increase in risk is small for most people. But if you have a family history of breast cancer or a liver health problem, this factor carries more weight for you. The goal does not have to be "zero"; even cutting down provides measurable benefits.
Chronic stress is not a "disease," so there is no screening test — but it is a measurable aspect of health and directly affects sleep, blood pressure, immunity, blood glucose, and behaviors (eating, smoking, alcohol use, inactivity). That is why Check the Life addresses it in a separate module.
What you can do: brief depression and anxiety screening scales (PHQ-2 / GAD-2) should be part of the annual check-up · regular physical activity (one of the stress management methods with the strongest evidence) · a regular sleep schedule · when needed, seeking professional support is a sign of strength, not weakness. Burnout is a real condition that can develop into physical illness if ignored.
Sleep is not a "luxury" but a metabolic necessity. Chronic sleep deprivation is associated with the risk of weight gain, type 2 diabetes, hypertension, heart disease, mood disorders, and dementia . The goal for adults is generally 7–9 hours.
What you can do: keep regular bedtimes and waking times · reduce screens and light in the bedroom · avoid evening caffeine and alcohol (alcohol may help you fall asleep but impairs sleep quality) · get morning daylight. Consult your doctor if daytime fatigue and feeling unrefreshed persist despite making changes.
Loud snoring accompanied by excessive daytime sleepiness, morning headaches, or observed pauses in breathing are typical signs of obstructive sleep apnea . This condition is very common, largely undiagnosed and, if untreated, increases the risk of hypertension, heart rhythm disorders, stroke and metabolic problems.
Recommendation: talk to your doctor about a sleep assessment (a sleep test / polysomnography). Excess weight significantly worsens this condition; weight management is part of treatment. Effective treatment (such as CPAP) can dramatically improve quality of life and energy levels.
The health effects of social isolation are not abstract: it has been shown to be associated with mortality risk, cardiovascular disease, and dementia — indeed, social isolation appears on the Lancet Commission on Dementia's list of modifiable risk factors. Check the Life considers this a separate aspect of health.
What you can do: this requires deliberate investment, rather than a screening test — regular contact with close friends and family, joining a community or activity, volunteering, or professional support during periods of intense loneliness. Especially in older age, maintaining social connections is one of the strongest protections for cognitive and physical health.
Long-term work stress and burnout are associated with cardiovascular risk, sleep disorders, mental health problems, and unhealthy coping behaviors (smoking, alcohol, inactivity, irregular eating). This is not a matter of "resilience," but an aspect of health that needs to be managed.
What you can do: set clear boundaries between work and rest · take recovery breaks during the day · get regular physical activity · prioritize sleep · seek medical or mental health support if symptoms persist (constant exhaustion, apathy, physical complaints). Chronic stress often takes its toll on the heart and sleep.
Fine particulate pollution (PM2.5) is associated with cardiovascular disease, stroke, lung disease, and lung cancer and, with growing evidence, also appears on the dementia risk list. You cannot solve this alone, but you can reduce your exposure.
What you can do: reduce outdoor exercise on highly polluted days · ventilate indoor spaces and use a HEPA-filter air purifier if needed · avoid busy traffic times and routes · prevent exposure to wood/coal smoke and tobacco smoke at home. These measures are even more important if you have respiratory or heart disease.
Some occupational exposures are directly associated with specific cancers and diseases, and their effects can emerge decades later: asbestos → mesothelioma and lung cancer; silica and wood dust → lung/nasal cancers; welding fumes, diesel exhaust, formaldehyde, some chemicals, and ionizing radiation → various cancers and respiratory diseases.
What you can do: fully implement workplace protective measures (masks, ventilation, monitoring) · where available, occupational physician / occupational disease follow-up · and the most practical step: share your work history with your doctor — because knowing "I worked with asbestos" can completely change how a lung finding is interpreted years later. Asbestos exposure + smoking increases lung cancer risk multiplicatively.
Cumulative and intense UV exposure is a major modifiable risk factor for melanoma and non-melanoma skin cancers (basal and squamous cell), and lip cancer . Sunburn, especially in childhood and adolescence, significantly increases melanoma risk.
What you can do: avoid direct sunlight at midday (10–16) · use broad-spectrum sunscreen (including on lips) · wear protective clothing, a hat, and sunglasses · avoid tanning beds completely. Monthly skin self-examination (the ABCDE rule) and prompt assessment of changing moles are part of this plan.
Secondhand tobacco smoke increases the risk of lung cancer and cardiovascular disease even in passive smokers — particularly concerning children and exposure at home. Radon is a leading cause of lung cancer in nonsmokers; it is a colorless, odorless gas that seeps from the ground into homes, and testing is the only way to detect it.
What you can do: do not smoke at home or in vehicles · for ground floors and basements, test your home for radon (simple test kits are available) and take ventilation/sealing measures if levels are high. Because these exposures are invisible, they are easily overlooked — yet both can be reduced.
Their absence from your plan is not an omission; it follows the guidelines. If you see these tests in a check-up package, ask why they are included.
In healthy people, they are not used for screening. They rise in many noncancerous conditions (inflammation, smoking, benign cysts, liver disease) and often remain normal in early cancer — producing both unnecessary fear and false reassurance. Their role is monitoring patients already diagnosed with cancer.
Evidence that these reduce mortality is absent. Instead, they produce many incidental findings, each triggering more tests, biopsies, and anxiety. CT and PET also involve radiation exposure.
In people without symptoms or examination findings, guidelines advise that thyroid ultrasound screening is not recommended. The reason is clear: many small nodules that would never cause problems are found, leading to a chain of biopsies and operations. This is a textbook example of overdiagnosis. (Exception: a history of radiation therapy to the head and neck.)
Not recommended. Large randomized trials showed that this screening did not reduce ovarian cancer deaths but did lead to unnecessary surgery. The approach differs only for carriers of high-risk mutations such as BRCA — even then, the approach is not screening but a discussion of risk-reducing surgery.
Without symptoms such as chest pain or shortness of breath, or high risk, the screening benefit of these tests has not been demonstrated and false positives can trigger a chain of procedures extending to unnecessary angiography. (A doctor ordering them for a specific reason is a different matter.)
Direct-to-consumer tests are not validated for clinical decisions; they may miss important mutations and produce uninterpretable results. For Alzheimer's disease, APOE testing is not recommended in healthy people — there is no action you can take to change the result, and it creates unmanageable anxiety. Hereditary risk is assessed with genetic counseling .
Every year, not every test needs to be repeated. A normal vitamin D, thyroid, or B12 test need not be repeated annually for most people. Clarifying with your doctor which tests to repeat and how often reduces both unnecessary costs and unnecessary anxiety.
The planner provides personalized output; the table below shows the general framework for an average-risk person. With a family history or personal risk factors, all of these starting ages move earlier.
| Age | For everyone | Additionally for women | Additionally for men |
|---|---|---|---|
| 18–29 | Blood pressure · height-weight-waist circumference · lipid profile (from age 20) · mental health screening · hepatitis B and C once in a lifetime · dental visits (every 6–12 months) · eye examination (once in your 20s) · skin self-examination | Cervical screening from age 25 · preconception counseling · HPV vaccination (considered up to age 45) | Testicular self-examination · HPV vaccination |
| 30–39 | Annual blood pressure · lipids every 4–6 years · glucose/HbA1c from age 35 · eye examination (twice in your 30s) · updating the family tree | Cervical screening at ages 30–65: HPV DNA every 5 years · planning breast screening for those at high risk | — |
| 40–49 | Eye examination at 40 · annual blood pressure · lipids and glucose · skin examination · colorectal screening from 45 · if smoking, checking eligibility for lung screening | The period when breast cancer screening begins (mammography) · thyroid, bone, and menopause counseling | Preparing for a shared decision-making discussion about prostate screening (45–50) |
| 50–64 | Colorectal screening continues · shingles vaccination from age 50 · annual low-dose CT if there is a smoking history · blood pressure, lipids, HbA1c · hearing assessment | Mammography continues · bone health after menopause and bone density testing according to risk factors | Prostate: PSA through shared decision-making · abdominal aortic aneurysm screening (65–75, if there is a smoking history) |
| 65+ | Eye examination every 1–2 years · pneumococcal and influenza vaccines · fall risk and gait assessment · assessment if cognitive symptoms are present · RSV vaccination from age 75 | Bone densitometry at age 65 · cervical screening ends at 65 if previous screening has been adequate | Bone density testing from age 70 · reassessing whether to continue prostate screening |
| 75+ | The focus shifts: the question is no longer "which test?" but "what will this test do for me?" At this age, screening decisions depend on life expectancy, coexisting conditions, and personal preferences. Most cancer screening stops after age 85 — because the 10 years needed for benefits to emerge are often no longer available. | ||
- False positives. An abnormal result in a healthy person, followed by biopsies, repeat imaging, and weeks of anxiety. The broader and more sensitive the screening, the greater this burden.
- Overdiagnosis. The least understood harm. Finding a cancer that truly exists but would never cause problems during that person's lifetime . The person receives treatment, has surgery, and says "I survived" — yet something that did not need treatment has been treated. This is a prominent problem in thyroid and prostate cancer.
- A cascade of incidental findings. Spots, nodules, and cysts found on extensive imaging — most harmless, but none can be dismissed as "nothing." Each brings another test, another check, another appointment.
That is why guidelines do not say "every test for everyone." For screening to be recommended, its benefits must outweigh these three harms — and that happens only in the right age range and the right risk group . The planner's decision not to recommendsome tests is not an omission; it follows the guidelines.
In accordance with international guidelines (NCCN, ACS, USPSTF), tumor markers such as CEA, CA 19-9, CA 125, AFP, CA 15-3 are not used in healthy people for screening. These tests are not standard components of check-up packages.
Why? Because these markers also rise in many noncancerous conditions (inflammation, smoking, benign cysts, liver disease) and often remain normal in early cancer. They therefore produce both unnecessary fear and false reassurance. Their role is monitoring a patient already diagnosed with cancer — not before diagnosis. For the same reason, whole-body MRI, whole-body CT, and PET-CT for screening are also not recommended in healthy people.
Family history is the most decisive part of the planner — and also the section people most often leave incomplete. Family history is not useful without these three pieces of information:
- 1 · Exactly which organ? "They died of cancer" is not informative. "They had cancer in their liver" and "they had bowel cancer that spread to their liver" mean two completely different things. If possible, find out which organ it started in.
- 2 · At what age were they diagnosed? This is the single most powerful piece of information that changes the screening plan. Breast cancer at 45 and breast cancer at 78 mean very different things for you.
- 3 · Your mother's side or your father's side? Hereditary syndromes run along a single family line. Cancers clustered on the same side are much more meaningful than cancers spread across both sides. And a critical mistake: predisposition to breast and ovarian cancer can also be inherited from your father's side — always ask about your father's sister and his grandmother.
Who is a first-degree or second-degree relative? First degree: mother, father, sibling, child. Second degree: grandmother, grandfather, paternal or maternal aunt or uncle, niece or nephew, half-sibling (not a stepsibling). Cousins are third-degree relatives and, alone, usually do not change the screening plan — but the same cancer in several cousins on the same side is also significant.
Being adopted, losing contact with relatives, or having a small family are common situations, and "I have no family history" and "I do not know my family history" are not the same. The latter means your screening plan must account for uncertainty: in this situation, guidelines recommend following the average-risk protocol but acting more quickly when warning symptoms arise. You can indicate this distinction in the planner.
Genetic testing is not for "the curious," but for people who have received counseling beforehand and understand what the result will mean . If any one of the following applies, you need a genetic counseling appointment before discussing your screening plan:
- A family history of breast, colorectal, or uterine (endometrial) cancer diagnosed before age 50 in a relative
- Ovarian or fallopian tube cancer — at any age
- Breast cancer in a man — even a single case is enough
- Pancreatic cancer or metastatic/aggressive prostate cancer
- In the same person, more than one separate cancer, or separate cancers in both breasts
- On the same family line (the same side), three or more related cancers (breast–ovarian–pancreatic–prostate or colorectal–endometrial–stomach–urinary)
- On colonoscopy, more than 10 polyps, or polyposis at a very young age
- In the family, a known mutation (BRCA1/2, Lynch, FAP, TP53, PALB2, CHEK2, etc.)
- A history of sarcoma, adrenal, or brain tumors in childhood
- Ashkenazi Jewish ancestry (BRCA mutations are substantially more common in this community)
An important warning: "Genetic predisposition panel" tests bought online are not suitable for this purpose. They are not validated for clinical decisions, may miss important mutations, and create uninterpretable results and unnecessary anxiety. Hereditary cancer risk is assessed through testing guided by medical genetics or oncology specialists.
The Ministry of Health's national screening program, delivered through its Cancer Early Diagnosis, Screening and Education Centers (KETEM), covers three cancers and is free:
· Breast cancer: for women aged 40–69, mammography every two years.
· Cervical cancer: for women aged 30–65, HPV DNA testing every five years.
· Colorectal cancer: for women and men aged 50–70, fecal occult blood testing every two years and colonoscopy every 10 years.
Why might this program differ from the planner's output? National programs are designed at the population level , taking resources, coverage, and feasibility into account. The planner applies guidelines for individuals (ACS, USPSTF, NCCN) and considers your family history. For example, the national program may specify age 50 for colorectal screening, international guidelines age 45, and a family history may mean age 40 or earlier. These do not conflict — one is the population's plan, the other is yours. KETEM for free access, your doctor for personalization.
- "Based on my family history, at what age should my screening start?" — This is the most critical question, because the answer is often "earlier than the guideline age."
- "What are the benefits and harms of this test for me?" — A good doctor explains both. A test explained only in terms of benefits has not been fully explained.
- "If the result is abnormal, what happens next?" — Knowing this beforehand cuts anxiety in half.
- "What happens if we do not do this test?" — There are tests for which the answer can be "nothing," and you have the right to ask.
- "Should I be referred for genetic counseling?" — Always ask if you have a family history; this referral is often missed.
- "When is my next check-up, and what will it include?" — Ask for the schedule in writing. A plan that is not written down is not followed.
Screening is one of the most proven yet most incorrectly practiced areas of oncology. The problem is usually not "no screening at all," but the wrong test for the wrong person: such as testing tumor markers in an average-risk 35-year-old while someone with a relative who had breast cancer at 42 waits until 40. The core of personalization is age, sex, and the family tree — and these three pieces of information are free and require no technology.
Screening methods shown by randomized data to reduce mortality are limited and well defined: breast (mammography), cervical (HPV/cytology), colorectal (colonoscopy/FIT), lung (low-dose CT in high-risk people) and primary prevention of cervical cancer with HPV vaccination. Colorectal and cervical screening also remove precancerous lesions before cancer develops, so they reduce incidence as well — the strongest screening evidence lies here. Family history is the most established factor changing these screening methods' starting age and frequency .
This tool is not a risk calculation model; it is a rule-based matching tool. It does not calculate or replace validated risk scores such as Gail, Tyrer-Cuzick, FRAX, or SCORE2. Family history relies on self-reporting and reports are often incomplete. Guidelines have real differences of opinion (for example, the starting age for colorectal screening, the role of prostate screening, mammography frequency at ages 40–49), and the tool does not eliminate these differences — it shows them. Access, reimbursement, and center capacity in Türkiye also affect the plan.
The most valuable 10 minutes of a check-up consultation are spent drawing the family tree, rather than drawing blood . The three most commonly missed things in practice are: (1) not asking relatives' ages at diagnosis ; (2) not asking about the father's side in breast–ovarian cancer predisposition; (3) when genetic counseling criteria are met, not making a referral. The most commonly performed unnecessary action, meanwhile, is ordering tumor markers. Correcting these four things provides more benefit than the most expensive screening package.
Will multigene polygenic risk scores become usable for determining the starting age for screening? Will blood-based multi-cancer early detection tests (MCED) truly enter the screening landscape — and if they do, will they reduce or increase overdiagnosis? Can AI-assisted mammography reading reduce false positives? And the most practical question: how can participation in national screening programs in Türkiye be increased? Fully implementing the three existing programs would save the most lives that can be saved today, without any new technology.
I feel very well. Should I still get screened?
Yes — that is exactly the point. Screening is done when you feel well. Testing when symptoms appear is not screening but diagnosisand generally indicates a more advanced stage.
High blood pressure, high cholesterol, early kidney damage, precancerous cell changes in the cervix, and bowel polyps — none cause symptoms. Bowel polyps are a particularly striking example: screening not only finds cancer early, but removing a polyp prevents the cancer from ever developing. Few things in medicine offer a better return.
I keep postponing because I fear "they will find something." Is that normal?
Very common, and very human. There is even a term in the literature: "scanxiety." Do not see it as a weakness.
But try this thought: if there is a problem in your body, it does not disappear because you stay away — it is simply found later, with fewer options . Screening does not create bad news; it reveals an existing situation at a stage when action can be taken . Postponing does not remove fear; it only extends the time spent afraid. And statistically, the most likely outcome is that the results will be clear.
There is cancer in my family, but my relative was very old when it developed. Does that count as a risk?
Usually not — and that is good news. Cancer is largely a disease of aging; prostate or bowel cancer in an 80-year-old relative usually points not to hereditary predisposition but to the passage of time .
The pattern suggesting hereditary predisposition is different: diagnosis at a young age (especially under 50), multiple cases on the same family line, more than one cancer in the same person, or related cancers (such as breast–ovarian–pancreatic–prostate) occurring together. That is precisely why the planner has a separate "early diagnosis" checkbox: the same cancer means very different things depending on age at diagnosis.
There is Alzheimer's disease in my family. Is there a screening test for it?
No — this needs to be stated clearly. No screening test for Alzheimer's disease is recommended in an asymptomatic person: neither brain imaging, nor blood biomarkers (such as p-tau217), nor APOE genetic testing. These are used to assess symptoms or in research; in healthy people, they only create unmanageable anxiety.
But there is much that can be done — and that is the real news. The Lancet Commission on Dementia reported that a substantial proportion of dementia cases are associated with 14 modifiable risk factors : correcting hearing loss with hearing aids, blood pressure control, LDL cholesterol control, diabetes, smoking, obesity, physical inactivity, excessive alcohol, depression, social isolation, protection from head injuries, uncorrected vision loss, air pollution, and low education. So for someone with a family history of dementia, the right approach is not to look for a screening test, but to take this list seriously. Hearing aids are the most often overlooked item on this list.
I have had this plan prepared. Can I skip seeing my doctor now?
No — for two reasons.
First: this tool applies rules; it does not examine you. A screening plan cannot replace measuring your blood pressure, palpating your thyroid, looking at your skin, or sensing while talking to you that something is wrong. Clinical assessment is a source of information no algorithm can reproduce.
Second: most screening tests require a medical order and results must be interpreted in context. The same PSA value can lead to two different decisions in two people. Take this plan to your doctor — that is its purpose: to start the consultation with a prepared agenda rather than a blank page.
Editor's note: this content and interactive planner are for general information only; they are not medical advice, a diagnosis, a screening order, or a treatment recommendation. The tool is not a diagnostic tool, risk calculation model, or validated clinical decision support system; it is a rule-based matching tool that applies only the general recommendations of common international screening guidelines (USPSTF, ACS, NCCN, ADA, AHA, and relevant specialty societies) to the information you enter. It does not calculate validated risk scores such as Gail, Tyrer-Cuzick, FRAX, or SCORE2 or replace them. The resulting plan is not a definitive, complete, or personalized medical prescription; it is a starting list for your consultation with your doctor. Family history information is based on self-reporting; incomplete, incorrect, or misremembered information directly affects the resulting plan. There are real differences of opinion among screening guidelines (for example, the starting age for colorectal screening, the role of prostate screening, and mammography frequency at ages 40–49), and they change over time; consult your doctor and official sources for current recommendations. The scope of national screening programs, reimbursement conditions, and access in Türkiye may differ from international guidelines and may change according to regulations. This tool does not record, store, or transmit any personal data; all processing takes place on the user's own device, and the data are deleted when the page is closed. No one with symptoms should wait for their screening schedule: new or worsening symptoms, a palpable lump, unexplained weight loss, bleeding, a nonhealing wound, hoarseness, a persistent change in bowel habits, or vaginal bleeding after menopause require medical attention without delay. No one should refuse a recommended test, stop a medication, or postpone a scheduled medical procedure based on this tool. Consult a doctor who knows you about every decision concerning your health.
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