What does an annual physical actually do for cancer screening?

People often describe their yearly appointment as "getting checked for cancer." It is worth untangling that, because the appointment and the screening are two different things.

The U.S. Preventive Services Task Force does not recommend a general physical examination as a way to detect cancer. What it recommends are named tests, for named groups of people, at named intervals. The appointment is the doorway. The tests are what actually do the work.

Here is the list, with the grade and the group each applies to:

• Cervical cancer — Grade A, women aged 21 to 65. Several approaches are acceptable, including cytology alone or combined with HPV testing.
• Colorectal cancer — Grade A for adults aged 50 to 75, and Grade B for adults aged 45 to 49.
• Breast cancer — Grade B, women aged 40 to 74, with biennial screening mammography.
• Lung cancer — Grade B, adults aged 50 to 80 with a significant smoking history, using annual screening with low-dose computed tomography.

The grades are not decoration. A and B mean these preventive services have a high or moderate net benefit for patients. Net benefit is the phrase to notice — it accounts for harms as well as good, which is why not every possible test earns a recommendation.

If the exam is not the screening, why bother going?

Because screening fails far more often through drift than through error. A test is due and nobody notices. A result comes back needing a repeat and the repeat never gets booked. Someone turns 45 and nothing prompts a conversation about colorectal screening. An appointment is the structure that catches those.

The check-up does not find the cancer. It is what makes sure the test that could find it actually happens.

Use the visit for four specific jobs:

• Confirm which recommendations apply to you today, given your age
• Find out which are overdue
• Choose among options where options exist, as with colorectal screening
• Agree on how you will be reminded next time

Look again at the list and you will notice how much of it is driven by birthdays. Twenty-one. Forty. Forty-five. Fifty. Sixty-five. Seventy-four. Eighty.

This is why "nothing has changed since last year" is a poor reason to skip a visit. You changed by one year, and for some people that is exactly what moves them into a group where a screening now carries a recommendation.

The Task Force notes that its A and B recommendations are relevant for implementing the Affordable Care Act. That connection is the reason the grade letter shows up in conversations about cost.

It is still worth confirming details with your own plan rather than assuming, because coverage depends on the specifics of your policy and how a service is coded.

It is not a personal schedule. The recommendations above describe populations; you are a person, with a history the Task Force list knows nothing about. A close relative diagnosed young, a previous abnormal result, or a known inherited variant can all change what is appropriate for you.

That is precisely the conversation the annual visit exists to hold. Walk in with the list, ask which lines apply to you, and leave with dates.