Longevity Medicine

Establish Your Health Baseline

The power of early detection isn't just in catching disease⁠—it's in establishing baselines that let you track your body over decades. This guide covers the latest evidence-based screening, from essential tests to cutting-edge imaging.

Updated January 2026 with latest clinical evidence.

Once you have results, Proactives Health helps you organize them, track trends, and prepare for appointments. Free to use.

The New Approach

From Reactive Screening to Proactive Baselines

Traditional medicine waits for symptoms, then screens. Longevity medicine takes a different approach: establish comprehensive baselines in your 40s, then track changes over time.

The difference is profound. A single cardiac CT scan tells you if you have plaque. Serial scans over years tell you if your interventions are working⁠—whether that plaque is stable, progressing, or actually regressing with aggressive treatment.

This is now possible thanks to advances in AI-powered imaging (like Cleerly for cardiac plaque), liquid biopsies for cancer, and a deeper understanding of which biomarkers actually predict outcomes.

Old Approach

  • • Wait for symptoms
  • • Get standard lipid panel
  • • CAC score once at 50
  • • React to abnormal findings

New Approach

  • • Establish baselines at 40
  • • ApoB + Lp(a) for true risk
  • • Quantitative plaque tracking
  • • Prove interventions are working

What We're Fighting

The Four Horsemen of Aging

Most people will die from one of four conditions. Each requires a distinct early detection strategy. (Framing borrowed from Peter Attia's Outlive, which we recommend.)

Heart Disease

The #1 killer. Often silent until a heart attack.

Detection Strategy

  • ApoB & Lp(a) testing
  • CAC score as gatekeeper
  • Cleerly CCTA for plaque quantification
  • Serial imaging to track regression

Cancer

Many cancers are curable if caught early.

Detection Strategy

  • Standard screenings (colonoscopy, mammogram, LDCT)
  • Galleri MCED as adjunct
  • Full-body MRI for baseline
  • Genetic testing if family history

Neurodegenerative

Alzheimer's, Parkinson's. Limited screening available.

Detection Strategy

  • Control vascular risk factors
  • Optimize sleep (treat apnea)
  • Metabolic health (insulin sensitivity)
  • Cognitive baseline testing

Metabolic Disease

Type 2 diabetes, NAFLD. Highly preventable.

Detection Strategy

  • Fasting insulin (not just glucose)
  • HbA1c and HOMA-IR
  • CGM trial for awareness
  • DEXA for body composition

When to Start

Your Baseline Timeline

Specific ages matter. Here's when to establish key baselines.

Age 35-40

Establish Core Baselines

  • ApoB (better than LDL for CV risk prediction)
  • Lp(a) (one-time, genetically determined)
  • Fasting insulin + HbA1c + HOMA-IR
  • Comprehensive metabolic panel
  • Consider: DEXA for body composition baseline
Age 40-45

Add Imaging Baselines

  • CAC score (coronary artery calcium)
  • If CAC > 0 or risk factors: Consider Cleerly CCTA
  • Consider: Full-body MRI (Prenuvo) as reference baseline
  • DEXA scan if not done earlier
  • Colonoscopy at 45 (or earlier if family history)
Age 45-50

Full Cancer Screening Cadence

  • Colonoscopy (if not done at 45)
  • Mammogram (women, annual or biannual)
  • PSA discussion (men)
  • LDCT if smoking history (50-80)
  • Consider: Galleri MCED as adjunct for gaps
Age 50+

Higher-Intensity Monitoring

  • Repeat Cleerly CCTA every 3-5 years if baseline abnormal
  • Annual cancer screenings
  • DEXA every 2 years
  • Full-body MRI every 2-3 years if using
  • Pancreatic screening if BRCA1/2 carrier

Cardiovascular Screenings

Heart & Vascular Health

Heart disease is the #1 killer⁠—but also the most preventable with early detection.

Essential

Apolipoprotein B (ApoB)

Who
All adults 35+ (should be universal)
Tests
Blood test
Frequency
Annually with lipid panel
Note
Meta-analyses consistently find ApoB outperforms LDL-C as a predictor of cardiovascular events⁠[Sniderman 2011]. ~20% of people with 'normal' LDL have elevated ApoB and hidden risk.

Key question to ask:

"Can you add ApoB to my lipid panel? It's a better predictor than LDL."

Essential

Lipoprotein(a) - Lp(a)

Who
All adults (one-time test)
Tests
Blood test
Frequency
Once in lifetime
Note
Elevated in 20-25% of population, with a 2-3x increased risk of MI and aortic stenosis. European and Canadian guidelines recommend universal one-time testing⁠[EAS 2022].

Key question to ask:

"Have I ever had my Lp(a) tested? It's genetic and doesn't change."

Coronary Artery Calcium (CAC)

Who
Adults 40-45 (or earlier with risk factors)
Tests
Non-contrast CT scan (~$100-300)
Frequency
Once as gatekeeper, repeat in 5-7 years if zero
Note
Zero score = excellent prognosis. But CAC cannot see soft plaque⁠—the dangerous kind that ruptures.

Key question to ask:

"Would a CAC score help determine if I need more aggressive treatment?"

New Science

Cleerly CCTA (AI Plaque Analysis)

Who
Adults with CAC > 0, family history, or risk factors
Tests
Contrast CT with AI quantification
Frequency
Baseline, then every 3-5 years to track
Note
FDA-cleared AI⁠[FDA K202280] quantifies all plaque types. CONFIRM2 registry data (2024-2025)⁠[CONFIRM2] shows high plaque burden carries elevated MACE risk even without obstructive disease. Coverage from major US payers (Aetna, UHC, Cigna) is expanding for specific indications⁠—check your plan.

Key question to ask:

"Can we do a Cleerly scan to quantify my plaque and track it over time?"

Standard Lipid Panel

Who
Adults 20+
Tests
LDL, HDL, triglycerides, total cholesterol
Frequency
Every 4-6 years (more often if elevated)

Key question to ask:

"Given my numbers, what's my 10-year cardiovascular risk?"

Blood Pressure

Who
All adults
Tests
Blood pressure measurement
Frequency
At least every 2 years (annually if elevated)
Note
Target: Below 120/80 mmHg

Key question to ask:

"Is my blood pressure well-controlled?"

Why This Matters: Plaque Regression is Possible

With aggressive LDL lowering (target <70 mg/dL with statins, or even lower with PCSK9 inhibitors), studies show atherosclerotic plaque can actually regress. The GLAGOV trial⁠[GLAGOV (JAMA)] showed a small but measurable reduction in plaque volume (~1%) with evolocumab added to statin therapy—modest in absolute terms, but meaningful evidence that the trajectory can be bent. You can only tell whether it's bending if you have a baseline and track over time. This is the power of serial Cleerly imaging.

Cancer Screenings

Cancer Screenings

Standard evidence-based screenings plus emerging adjuncts for hard-to-detect cancers.

Standard Screenings (Strong Evidence)

Colorectal Cancer

Who
Adults 45-75 (earlier if family history)
Tests
Colonoscopy, FIT test, Cologuard
Frequency
Colonoscopy every 10 years, or FIT annually

Key question to ask:

"Given my family history, should I start earlier?"

Breast Cancer

Who
Women 40+ (earlier if high risk)
Tests
Mammogram, breast MRI for high-risk
Frequency
Annually or biannually depending on guidelines

Key question to ask:

"What's my breast density, and does that change my screening approach?"

Lung Cancer

Who
Adults 50-80 with 20+ pack-year history
Tests
Low-dose CT scan
Frequency
Annually
Note
One of the 'Big Three' most commonly misdiagnosed cancers

Key question to ask:

"Do I qualify for lung cancer screening based on my smoking history?"

Prostate Cancer

Who
Men 50+ (earlier if Black or family history)
Tests
PSA blood test, digital rectal exam
Frequency
Discuss with doctor based on risk

Key question to ask:

"What are the trade-offs of PSA screening for someone like me?"

Cervical Cancer

Who
Women 21-65
Tests
Pap smear, HPV test
Frequency
Every 3-5 years depending on age

Key question to ask:

"Should I get HPV co-testing?"

Skin Cancer

Who
Everyone, especially fair-skinned or high sun exposure
Tests
Full-body skin exam
Frequency
Annually, or more often if high risk

Key question to ask:

"Are there any spots you're monitoring or concerned about?"

Advanced Adjuncts (Emerging Evidence)

Advanced

Galleri Multi-Cancer Early Detection

Who
Adults 50+ (not a replacement for standard screening)
Tests
Blood test detecting cancer DNA signals
Frequency
Consider annually as adjunct
Note
PATHFINDER 2: 73.7% sensitivity for 12 deadliest cancers, 99.6% specificity⁠[PATHFINDER 2]. Correctly identifies cancer origin 92% of time. Not FDA-approved; FDA review is underway (GRAIL submitted a PMA in January 2026⁠[GRAIL]), and timing/outcome are uncertain.

Key question to ask:

"Is Galleri appropriate for me as an additional screening tool?"

Advanced

Full-Body MRI (Prenuvo)

Who
Adults 40+ seeking comprehensive baseline
Tests
Non-contrast whole-body MRI
Frequency
Baseline at 40, then every 2-3 years
Note
16% false-positive rate. Not recommended by ACR for average-risk adults. Value is in baseline comparison over time⁠—not single-point findings.

Key question to ask:

"Would a full-body MRI baseline help monitor for changes over time?"

Important Caveats on Advanced Screening

Galleri is promising but not FDA-approved, and the NHS trial was paused. It's best used as an adjunct for cancers without established screening (pancreatic, ovarian)—not a replacement for colonoscopy or mammogram.

Full-body MRI has real value in establishing a reference baseline—documenting benign findings now so future scans can detect change. But it has a 16% false-positive rate and the ACR does not recommend it for average-risk asymptomatic adults. Discuss with your physician.

High-Risk: Pancreatic Cancer Screening

For BRCA1/2 carriers and those with strong family history: Annual pancreatic screening with MRI/MRCP and endoscopic ultrasound starting at age 50 (or 10 years before the earliest family case). The CAPS5 study⁠[CAPS5] reported 73.3% 5-year survival in screening-detected pancreatic cancer vs. 1.5 years median survival when diagnosed outside surveillance. Survival endpoints in screening studies can be affected by lead-time and length-time bias; CAPS5 is encouraging, especially for high-risk surveillance in BRCA carriers and strong family-history cohorts, but it isn't definitive proof that broad screening reduces mortality.

Metabolic Health

Metabolic & Body Composition

Type 2 diabetes and metabolic dysfunction are largely preventable with early detection.

Essential

DEXA Scan

Who
Adults 40+ for baseline (not just 65+ women)
Tests
Dual-energy X-ray absorptiometry
Frequency
Baseline at 40, then every 2-3 years
Note
Measures bone density, lean mass, visceral fat. Sarcopenia (age-related muscle loss) begins in your 40s and is a leading predictor of frailty and falls. Establishing a baseline early lets you track and intervene before it's clinical.

Key question to ask:

"Can I get a DEXA scan for body composition, not just bone density?"

Essential

Fasting Insulin & HOMA-IR

Who
All adults 35+
Tests
Blood test (fasting)
Frequency
Annually with metabolic panel
Note
Fasting glucose/HbA1c catches diabetes late. Fasting insulin catches insulin resistance years earlier.

Key question to ask:

"Can you add fasting insulin to my labs? I want to know my insulin sensitivity."

HbA1c / Fasting Glucose

Who
Adults 35+ (earlier if overweight or family history)
Tests
Blood test
Frequency
Every 3 years if normal

Key question to ask:

"Should I be screened for prediabetes given my risk factors?"

Advanced

CGM Trial

Who
Anyone seeking metabolic awareness
Tests
Continuous glucose monitor (2 weeks)
Frequency
One trial for education, not ongoing
Note
Evidence for non-diabetics is limited, but real-time biofeedback changes behavior. A 2025 community-cohort CGM study found normoglycemic adults spent ~12% of the day above 140 mg/dL⁠[JCEM 2025].

Key question to ask:

"Could I try a CGM for a couple weeks to see how I respond to foods?"

Liver Health (NAFLD)

Who
Adults with metabolic risk factors
Tests
ALT, AST, GGT; FibroScan if elevated
Frequency
Annually with metabolic panel
Note
NAFLD affects roughly a third of adults globally (~32%, with men disproportionately affected) and is often silent⁠[Younossi].

Key question to ask:

"Given my weight/metabolic markers, should I be screened for fatty liver?"

Thyroid Function

Who
All adults, especially women
Tests
TSH, free T4
Frequency
Every 5 years, or more often if symptoms

Key question to ask:

"Have I had my thyroid checked recently?"

Critical Knowledge

Vascular Events: The Most Commonly Missed

Vascular events⁠—stroke, blood clots, aortic emergencies⁠—account for the largest share of serious harms from diagnostic errors. Stroke alone is missed ~17% of the time⁠[AHRQ 2022] and is the top single-disease cause of serious diagnostic harm in the US, alongside sepsis, pneumonia, venous thromboembolism, and lung cancer⁠[Newman-Toker 2024].

The challenge: symptoms can be subtle or atypical, especially in younger patients or women.

Know the warning signs:

Stroke

  • • Sudden numbness
  • • Confusion
  • • Trouble speaking
  • • Vision problems
  • • Severe headache
  • • Dizziness

Pulmonary Embolism

(blood clot in lung)

  • • Sudden shortness of breath
  • • Chest pain
  • • Rapid heart rate

Deep Vein Thrombosis

(blood clot in leg)

  • • Swelling in one leg
  • • Pain
  • • Warmth or redness

Key question if you have concerning symptoms:

"Could this be vascular? What would rule it out?"

Other Screenings

Other Important Screenings

Hepatitis C

Who
All adults 18-79 (one-time screening)
Tests
Blood test
Frequency
One-time

Key question to ask:

"Have I been screened for Hepatitis C?"

HIV

Who
All adults 13-64 (one-time, or more often based on risk)
Tests
Blood test
Frequency
One-time or based on risk

Key question to ask:

"Should I be retested based on my risk factors?"

Bone Density (DEXA)

Who
Women 65+, men 70+ (earlier if risk factors)
Tests
DEXA scan
Frequency
Every 2 years if at risk
Note
Consider baseline at 40 for body composition⁠—see Metabolic section

Key question to ask:

"Should I get a bone density scan given my risk factors?"

Eye Exam

Who
Adults 40+ (earlier if diabetic)
Tests
Comprehensive eye exam
Frequency
Every 1-2 years

Key question to ask:

"Should I be screened for glaucoma or macular degeneration?"

Health Equity

Who Gets Missed?

Diagnostic errors don't affect everyone equally.

Research shows that women and racial minorities are 20-30% more likely to be misdiagnosed than white men. This disparity persists across conditions and care settings.

Some of this is systemic⁠—differences in insurance coverage, access to specialists, and hospital quality. But some of it is cognitive⁠—symptoms in women and minorities are more likely to be dismissed, attributed to anxiety, or assumed to be benign.

What you can do:

  • Document your symptoms in writing before appointments
  • Bring a trusted person to advocate with you
  • If something feels wrong, say so explicitly: "I'm concerned this could be serious. Can we rule out [X]?"
  • If dismissed, seek a second opinion

Your instincts about your own body matter. Don't let anyone convince you otherwise.

Take the Next Step

From Baseline to Action

Establishing baselines is the 'what.' But tracking them over time⁠—and preparing for your appointments with the full picture⁠—is where the value lies.

When you get your ApoB results, Cleerly scan, or DEXA report⁠—where does it go? How do you track trends over time? How do you prepare for your next appointment with the full picture?

That's why I built Proactives Health.

Upload your documents

Lab results, imaging reports, specialist notes. Everything in one place.

Track your baselines

See trends in ApoB, HbA1c, plaque volume, and more over time.

Prepare for appointments

Generate a clinical summary in the format your doctor wants.

Ask questions

"What does my Lp(a) level mean?" "Should I consider a PCSK9 inhibitor?"

The screening tests on this page give you data. Proactives Health helps you use it⁠—tracking your baselines and proving your interventions are working.

Try Proactives Health

Sources & Further Reading

Cardiovascular
  • CONFIRM2 Registry (2025)
  • Nature Reviews Cardiology AI-QCT Consensus Statement (2025)
  • ESC/EAS Lipid Guidelines
  • National Lipid Association Lp(a) Statement (2024)
  • GLAGOV Trial
Cancer
  • GRAIL PATHFINDER 2 Study (2025)
  • NHS-Galleri Trial
  • JMRI Whole-Body MRI Meta-Analysis (2019)
  • CAPS5 Pancreatic Screening Study
Metabolic
  • Nature GluFormer CGM Study (2025)
  • JCEM CGM Reference Ranges (2025)
  • JAMA Sarcopenia Meta-Analysis
Diagnostic Errors
  • Newman-Toker et al., BMJ Quality & Safety

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Screening recommendations vary based on individual risk factors, family history, and regional guidelines. Some tests mentioned (Galleri, Cleerly, full-body MRI) are not universally covered by insurance and may not be recommended by all medical societies. Always consult with your healthcare provider to determine the appropriate screening schedule for your situation.