When should you start getting a physical, and how often do you need one?

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.

Time for your annual physical exam — or is it?

Modern healthcare is more personalized than ever, and that includes the classic checkup. Find out if you're going to the doctor as often as you should.

What is a physical?

A physical is a routine medical exam to check your general health and look for any signs of disease. A regular doctor or a qualified staff member in the practice will perform the exam.

Many practices assign nurses or physician assistants to perform routine physicals, reserving the doctor's time for consultations and treatments.

What does a physical entail?

A physical usually involves an interview and a hands-on examination. If your appointment is with a doctor you haven't seen before, they'll ask you about your medical history, including your conditions and treatments. They'll probably also ask about your family history.

Once they have up-to-date information, they'll ask you how you've felt since your last visit. They'll ask about:

• Recent and current symptoms

• Medications and supplements

• Lifestyle and daily habits, including exercise, diet and substance use

• Mood and any mental health concerns

The next part is a physical examination. The person performing the exam will:

• Look into your ears, nose and throat

• Feel your lymph nodes, checking for abnormal size and shape

• Feel your abdomen for any masses or other abnormalities

• Check your reflexes

Depending on your age, your physical will also involve routine screening for certain conditions such as cancer and high blood pressure.

When should women start getting a physical?

Reproductive health is one of the most important reasons for women to get regular physicals.

But, women start having these physicals at different ages. Your doctor might have you start having regular visits in your 20s or 30s, so you don’t miss important screening tests — like Pap smears.

Missing these screenings can lead to poorer outcomes, as Canadian physicians have noticed during the COVID-19 pandemic. It is advised to talk to a doctor about when you should start having regular visits.

Breast cancer screenings

According to the Ontario Medical Association (OMA), women missed approximately 422,000 routine mammograms during the height of the pandemic.

One physician from The Ottawa Hospital reported that before the pandemic, half of breast cancer diagnoses came from routine screenings. That number then dropped to 29 per cent. The remaining 71 per cent had symptoms, which means the cancer was more advanced.

More advanced cancers have a lower five-year survival rate, about 22 to 39 per cent at stage 4 compared to 98 per cent at stage 0 or 1, the OMA said.

The Canadian Cancer Society (CCS) recommends breast cancer screenings for women aged 50 to 74. Women under 50 with a family history of breast cancer or other risk factors should talk to their doctors for personalized recommendations.

In 2022, the CCS estimated that 1,450 Canadian women would receive a cervical cancer diagnosis and 380 would die. Regular Pap tests can identify cervical cancer in its early stages. In some cases, they can even pick up on cellular changes that could become cervical cancer if left untreated.

The Canadian Task Force on Preventive Health Care (CTFPHC) recommends Pap smears every three years from ages 25 to 69 for women who are or have been sexually active. The Canadian Cancer Society suggests screening should begin at age 21 if the woman has been sexually active.

Pap tests aren't perfect, but they can increase your likelihood of an early diagnosis.

Other screenings

Non-reproductive screenings are also important. Physicians recommend that women receive screenings for:

• Type 2 diabetes, every three years, starting at age 40

• Colorectal cancer, every two years with a fecal occult blood test or every 10 years with sigmoidoscopy (similar to colonoscopy but focusing exclusively on the lower part of the large intestine)

• Osteoporosis, routinely starting at age 65 or age 50 with specific risk factors

For what it's worth, research has shown that the Canadian osteoporosis screening identifies more candidates for bone density screening compared to the U.S. approach.

A routine physical gives your doctor a chance to perform these screenings and can help you avoid missing them. Talk to your doctor about what physical exam schedule is right for you.

When should men get a physical?

Just like women, men have different medical needs. They have general screening needs like diabetes and cancer, plus sex-specific concerns like prostate cancer.

For example, the Canadian Urological Association (CUA) believes in offering prostate cancer screenings to men with a life expectancy above 10 years. Part of that process should include counselling patients on the risks and benefits of screening, which the CTFPHC has identified and shared with the public. They include:

• a one in 1,000 chance of receiving lifesaving treatment thanks to screening

• increased possibility of treating a condition that would not have caused suffering or death

• potential for fatal complications from treatment

The CTFPHC believes the risks of screening outweigh the benefits, but leaves testing available for those who want it.

Also, the CTFPHC recommends screening men aged 65 to 75 for abdominal aortic aneurysm, but only if the patient has smoked in the past.

You can talk to your doctor about when you should start getting physicals and how often you should go.

How often should you get a physical?

Diabetes screening every two years; colon cancer every three years. But, how often should you get the whole physical?

As is often the case with human biology, the answer is: it depends.

If that surprises you, you're not alone. People have been getting routine physicals since the 1920s when employers and insurers began ordering them in the name of "prevention." But, as we've learned more about how the body works, doctors have started questioning whether this practice is necessary or helpful.

The CTFPHC has spent a lot of time researching the routine physical. They've reviewed study after study and found that annual checkups don't reduce deaths from cancer, heart disease or general causes. Results showed doctors can learn just as much from talking to patients about their habits and risk factors.

In 2017, the CTFPHC recommended eliminating complete annual physical exams in favour of periodic preventive visits. Preventive visits are scheduled meetings where a doctor can offer health counselling, routine screening tests and immunizations. According to the Task Force, these visits have proven particularly beneficial for people older than 65.

For people younger than 65, the Task Force recommends customizing the frequency of your physicals based on age, sex and health history.

Figuring out preventive care

Because everyone's screening and prevention needs are different, there's never going to be a correct schedule for everyone. The best strategy is to talk to your doctor about the recommended screenings for your age group, then create a personalized schedule for preventive care.

It's a win-win for everyone — you get personalized care, your doctor can make time for what's important and no one has to stick out their tongue to say "aaah," unless it really matters.

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