What to actually get tested at 40, 50 and 60

There are two bodies of advice on this question and a gap between them. Public health guidance covers blood pressure, cholesterol, glucose and the cancer screening programmes, then stops. Private programmes begin at several thousand euros with imaging and genomics. The most valuable tests sit in the gap, cost very little, and almost nobody markets them because there is no margin in a €30 blood test.

The free layer, which most people have not used

Statutory entitlements differ by country. In Germany, insurees get a health check every three years from 35, covering a physical examination, blood pressure, fasting glucose, a full lipid panel, urinalysis, a one-off hepatitis B and C screen and a consultation.5 Cancer screening sits separately: mammography, cervical, colorectal, skin and prostate examination, each with its own age rules.

Nothing on this page is more cost-effective than using that. A meaningful share of people enquiring about premium programmes have never had it.

At 40

Lipoprotein(a), once. This is the highest-value single blood test available to an adult, and hardly anybody has had it. Lp(a) is almost entirely genetically determined and stable across adult life, which is why the 2026 ACC/AHA guideline recommends universal measurement at least once in all adults as a Class I recommendation.1 Roughly one person in five has a level at or above 125 nmol/L, which raises ASCVD risk about 1.4-fold; at or above 250 nmol/L the risk is at least doubled.2

One test, once, answers the question for life. If it is high, your cardiovascular risk has been higher than any calculator told you, and the whole approach to your lipids and blood pressure should change. If it is normal, you never think about it again.

ApoB, alongside your lipid panel. LDL cholesterol measures the cholesterol carried inside particles. ApoB counts the particles. Where the two disagree, which happens most often in people with raised triglycerides or metabolic syndrome, the particle count is the better predictor. ApoB entered the US guideline as a recommended measurement for the first time in 2026, particularly where triglycerides are 150 mg/dL or above, in diabetes, or where achieved LDL-C is under 70 mg/dL.2

HbA1c with fasting insulin, not glucose alone. Fasting glucose is the last thing to move in the progression toward type 2 diabetes. Insulin resistance is detectable years earlier, and the years are the point.

Blood pressure, measured properly. At home, over a week, sitting still for five minutes first. A single reading in a clinic where you arrived rushed is a worse measurement than the free one you can take yourself.

A cardiopulmonary exercise test, if you can get one. In 122,007 adults followed for a median 8.4 years, the least-fit group had roughly five times the all-cause mortality of the elite-fit group, and the association continued with no observed upper limit of benefit.4 Fitness is also the rare measurement that is both strongly prognostic and reliably modifiable, so a repeat test in a year tells you something real.

This is where private programmes start to earn their price, because statutory checks do not fund it. Among the providers we catalogue, YEARS in Berlin places spiroergometry in its €1,900 entry tier, the one that contains no imaging, liquid biopsy or genetics.7 Preventicum, Biograph, Everlab and Fountain Life include a form of it. Neko Health, Prenuvo and Function Health do not.

At 50

Everything above, plus the following.

Colorectal cancer screening. Recommended from 45 and the highest-value cancer screen available at this age by a wide margin. Colonoscopy is the reference standard; stool-based tests are a reasonable alternative if the alternative is doing nothing.

Mammography for women, from 40 in most guidelines, on the interval your national programme uses.

A coronary calcium score, if you are in the intermediate-risk band. Between 40 and 75 with a calculated ten-year risk of 7.5% to under 20%, this is the best-evidenced cardiac test available, and a score of zero can take a statin off the table for five to ten years. Note that in Germany this requires an individual medical indication under §83 StrlSchG and cannot be bought as routine screening.

Repeat the fitness test. The trend matters more than the number.

At 60

Everything above. Two additions and one subtraction.

Bone density. DEXA, for women after menopause and for men with risk factors. Cheap, well-evidenced, and absent from a surprising number of premium panels.

Cognitive and hearing baseline. Hearing loss is among the more treatable contributors to cognitive decline, and a baseline makes later change interpretable.

Stop chasing things that will not change management. By 60 the question shifts from finding disease to deciding what is worth treating, and an additional 140 biomarkers rarely helps with that.

What the private programmes add, and where

If you decide to buy something, the useful frame is which layer you are paying for.

Blood-panel subscriptions such as Function Health add breadth to the layer you can mostly get through a GP, with better presentation and longitudinal tracking. Neko Health at £299 adds a full-body optical skin scan and cardiovascular sensors to a standard panel, in an hour, and notably declines imaging; nothing in it requires a leap of faith about screening efficacy.

Imaging adds anatomy, which no blood test can see, and it is the layer with the weakest outcome evidence: no randomised trial has shown a mortality benefit in asymptomatic adults, and about a third of scanned people acquire a critical or unresolved finding.6

Multi-modal day programmes add interpretation, which is the thing hardest to buy piecemeal. Reading a biomarker next to a fitness result next to an image, in one sitting, by one physician, is a different service from three appointments.

Read the tier rather than the price range when you buy. Programmes gate modalities, not just depth: YEARS publishes 87 biomarkers with functional testing and no imaging at €1,900, whole-body MRI and a multi-cancer blood test at €7,600, and genome sequencing with epigenetic clocks at €16,900.7 Biograph holds its multi-cancer blood test back for the $15,000 tier rather than the $7,500 one. A programme advertised from a low number may not contain the thing you want.

The sequence, compressed

Use the free check. Add Lp(a) once, ApoB, HbA1c with insulin, and a home blood pressure series. Get your fitness measured and measure it again. Attend the cancer screening you are eligible for. Then, if you have a real inherited risk or a decade of avoidance behind you, buy one comprehensive baseline from somebody who publishes prices and owns the follow-up.

That list costs a few hundred euros plus whatever the baseline costs, and it covers more evidenced ground than most five-figure annual memberships.