Screening tests you may not need without symptoms
For some tests, the USPSTF recommends against routine screening of people with no symptoms (grade D), or found the evidence too thin to say either way (an I statement). Here they are, each with its date. (USPSTF grade definitions)
With symptoms or a doctor's reason, this page does not apply to you. Every statement below is about screening people who feel well and have no particular risk. If you have symptoms, a family history, or your doctor has ordered a test for a reason, follow your doctor's advice and ask what the test is for.
What D and I mean
Grade D means the USPSTF recommends against the service: it has moderate or high certainty that it has no net benefit or that the harms outweigh the benefits. An I statement means the evidence is insufficient to weigh benefits and harms; it is not a recommendation for or against. (USPSTF grade definitions) That is why this site's screening planner leaves them out: it lists grade A and B screenings only (Method). All five grades: USPSTF grades explained.
The tests, one by one
| Test | Who the statement covers | USPSTF | Does not cover |
|---|---|---|---|
| Thyroid cancer (neck exam or ultrasound) | Adults without symptoms | D: recommends against (USPSTF, 2017) | Hoarseness, throat pain, trouble swallowing, a lump or swelling in the neck, past radiation exposure, or an inherited risk |
| Thyroid function blood test (TSH) | Adults without symptoms who are not pregnant | I: evidence insufficient (USPSTF, 2015) | Pregnancy, symptoms of a thyroid problem |
| Vitamin D blood test | Adults without symptoms living at home, not pregnant | I: evidence insufficient (USPSTF, 2021) | People in a hospital or nursing home |
| Resting or exercise ECG (heart tracing) | Adults without symptoms at low risk of heart disease | D: recommends against (USPSTF, 2018) | Symptoms such as chest pain; intermediate or high risk is an I statement |
| Ovarian cancer (ultrasound or CA-125 blood test) | Women without symptoms | D: recommends against (USPSTF, 2018) | A known high-risk inherited cancer syndrome |
| Testicular cancer (exam or self-exam) | Teen and adult males | D: recommends against (USPSTF, 2011) | A lump, swelling or pain |
| Pancreatic cancer | Adults without symptoms | D: recommends against (USPSTF, 2019) | An inherited syndrome or a family history of pancreatic cancer |
| COPD (spirometry breathing test) | Adults without symptoms | D: recommends against (USPSTF, 2022) | Chronic cough, sputum, shortness of breath or wheezing; alpha-1 antitrypsin deficiency; toxic exposure at work |
| Carotid artery narrowing (neck ultrasound) | Adults without symptoms | D: recommends against (USPSTF, 2021) | A past stroke, or signs of a mini-stroke (TIA) |
| Bladder cancer (urine test for blood) | Adults without symptoms | I: evidence insufficient (USPSTF, 2011) | Blood in the urine or other urinary symptoms |
Why a test can do harm
A screening test is only useful if finding something early changes what happens. When it does not, the test can still start a chain: a false positive, more tests, a biopsy or surgery, and worry.
- False positives. For ovarian cancer, the USPSTF notes that most women with a positive screening result do not have cancer, and that screening with ultrasound or CA-125 does not lower deaths from ovarian cancer. (USPSTF, 2018) More: ovarian cancer screening, CA-125 and ultrasound.
- Overdiagnosis. For thyroid cancer, the USPSTF cites data suggesting that screening raises the number of cancers found without changing deaths, and that the harms of screening and treatment are at least moderate. (USPSTF, 2017)
- Harms that outweigh benefits. For carotid artery narrowing in adults without symptoms, the USPSTF concludes the harms of screening outweigh the benefits; for an ECG in low-risk adults, that the harms equal or exceed the benefits. (USPSTF, 2021) (USPSTF, 2018)
Pancreatic cancer in detail, including who may be offered imaging instead: pancreatic cancer screening.
Full-body scans
The USPSTF has no recommendation on full-body CT or MRI scans for people without symptoms. Two other bodies have spoken:
- The FDA says it knows of no scientific evidence that whole-body CT screening of people without symptoms provides more benefit than harm. CT gives a relatively high radiation dose, an abnormal finding may not be serious, a normal result may be wrong, and "false" leads can prompt more testing. It advises talking to your doctor about risks and benefits first. (FDA)
- The American College of Radiology says there is not enough evidence to recommend total-body screening for people with no symptoms, risk factors or family history, and is concerned that it finds many non-specific things that lead to unnecessary follow-up tests and cost. (ACR, 2023)
Questions people ask
Do I need a thyroid test every year?
Not as a routine screening if you feel well. The USPSTF found the evidence insufficient to weigh a thyroid function test in adults without symptoms who are not pregnant (I statement, 2015), and it recommends against screening for thyroid cancer in adults without symptoms (grade D, 2017). If you have symptoms or a condition your doctor is tracking, the test may well be needed. (USPSTF, 2015) (USPSTF, 2017)
Is a full-body scan worth it?
The USPSTF has no recommendation on full-body scans. The FDA says it knows of no scientific evidence that whole-body CT scanning of people without symptoms does more good than harm, and that CT gives a relatively high radiation dose. The American College of Radiology says the evidence does not justify total-body screening for people without symptoms, risk factors or a family history, and warns of findings that lead to unnecessary follow-up. (FDA) (ACR, 2023)
Should I get an ECG at my physical?
For adults without symptoms at low risk of heart disease, the USPSTF recommends against screening with a resting or exercise ECG (grade D, 2018). For people at intermediate or high risk, it found the evidence insufficient (I). Chest pain, shortness of breath or fainting are symptoms, not screening: tell your doctor. (USPSTF, 2018)
Should I get my vitamin D level checked?
The USPSTF found the evidence insufficient to weigh screening adults without symptoms who live at home (I statement, 2021). That is not a recommendation against testing; your doctor may test for a reason that applies to you. (USPSTF, 2021)
My doctor ordered one of these tests. Should I refuse it?
No. These statements are about people with no symptoms and no particular reason for the test. If you have symptoms, a known risk, or your doctor has a reason, they do not apply. Ask your doctor what the test is for and what happens next if it comes back abnormal. (USPSTF grade definitions)
What is recommended
The screenings the USPSTF does recommend (grades A and B), by age and sex: screenings by age and gender, or build your own list with the screening planner. Grade C and I tests with their own pages: prostate cancer (PSA), skin cancer, hearing and vision.
Related
- ECG at a checkup: do you need one, and what results mean
- Spirometry and COPD screening: FEV1, FVC and the ratio
- Urinalysis results: what a routine urine test shows
- Thyroid cancer screening: neck checks, scans and nodules
- Thyroid test (TSH): who needs one
- Vitamin D test: who needs one
- Cancer screenings by age: chart of every USPSTF statement
- What tests are in an annual physical?
- Heart screenings by age, and heart tests not advised for people without symptoms
- What tests should a woman have every year?
- What tests should a man have every year?
- All adult screenings, one page each