The top 3 men’s health issues, ranked by what shortens men’s lives, are heart disease, cancer, and metabolic disease, with heart and cerebrovascular disease standing as the leading cause of death for men in the United States. Medical consensus places heart disease and cancer at the top of the male mortality hierarchy, yet heart and cerebrovascular disease kills far more men than second-place cancer. In the United States, those three conditions account for the decisive share of preventable male deaths:
- Heart and cerebrovascular disease
- Cancer
- Metabolic disease (non-alcoholic fatty liver disease and type 2 diabetes)
Longevity physician Dr. Peter Attia, speaking on Virgin Radio UK’s Journey to a Better You series, ranks the four biggest killers overall as heart and cerebrovascular disease, cancer, neurodegenerative disease, and chronic obstructive pulmonary disease (COPD). Because COPD is almost exclusively a smoker’s disease, it drops off the list for non-smokers, and metabolic diseases take that slot. Cancer gets the pink ribbon and most of the headlines, while heart disease wears the red ribbon and quietly kills more of us. Men also go to the doctor less often than women, missing the fact that the right maintenance schedule shifts with every decade.
Key Takeaways
Heart and cerebrovascular disease is the number one killer of men ahead of second-place cancer, making a relatively inexpensive ApoB blood test and blood pressure checks (every 3 to 5 years from ages 18 to 39, then yearly from 40 to 69) the top preventive priority.
Cancer screening windows depend on the organ and your risk profile: colorectal screening starts at age 45, prostate conversations begin at 45 for Black men and between 50 and 55 for average-risk men, and lung screening covers current or recently quit smokers with 20 to 30 pack-years.
Under the Affordable Care Act, insurers must cover USPSTF “A” or “B” graded screenings with zero cost-sharing, while Medicare Part B covers yearly PSA tests for free after age 50 and Illinois law mandates no-cost prostate screening for eligible men.
Table of Contents
Heart disease: the under-screened number one
Heart disease is the leading cause of death for men, killing more men than second-place cancer, and catching both early requires pairing routine heart health checks like blood pressure, cholesterol, and ApoB testing with age-gated cancer screenings.
The ApoB blood test and the artery wall
Men should ask for an apolipoprotein B (ApoB) blood test alongside a standard cholesterol panel, an inexpensive addition that a men’s preventive-care podcast speaker argues belongs on everyone’s screening list. Standard lipid panels give a broad picture, whereas the ApoB test counts the exact concentration of cholesterol-carrying lipoprotein particles in your blood. The ApoB lipoprotein is the actual particle that crosses into the artery wall and deposits cholesterol, which is the physical mechanism that starts heart disease.
Blood pressure and cholesterol screening intervals
According to the Illinois Department of Public Health (IDPH), men ages 18 to 39 need blood pressure and cholesterol checks at least every 3 to 5 years. You need them sooner if your numbers come back abnormal, if heart or kidney problems run in your family, if you have diabetes, if you’re overweight or obese, or if you’re African American. Once you hit age 40, IDPH guidelines step blood pressure screening up to once a year through age 69.
Abdominal aortic aneurysm screening
IDPH also recommends a one-time ultrasound for an abdominal aortic aneurysm for men ages 65 to 75 who currently smoke or ever smoked.
Cancer: prostate, colorectal, and lung screening
Second-place cancer doesn’t operate on a single schedule. Screening start ages shift depending on your baseline risk and which medical organization’s rules your doctor follows.
Prostate cancer screening: when to start
Men should discuss prostate cancer screening starting at age 45 if they’re Black, or between ages 50 and 55 if they’re at average risk, using a yearly or provider-guided schedule. Regular screenings starting in your 40s or 50s are designed to catch tumors before they spread, when the disease is most treatable. According to IDPH, prostate cancer is the second leading cause of cancer death in men, yet it carries a 99% five-year survival rate when caught at the earliest stage.
Different organizations set the starting line a few years apart. The Prevent Cancer Foundation advises Black individuals with a prostate to start discussing the pros and cons of screening with a provider at age 45, while average-risk individuals should start in their 50s. Dr. Jeremy Brown of Baylor Scott and White, speaking on CBS Texas’s Eye on Health segment for Men’s Health Month, puts the average-risk start at age 50, moving into the 40s when risk factors dictate. IDPH suggests considering screening around age 55 using a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE).
PSA density, PSA velocity, and multi-parametric MRI
The PSA blood test alone isn’t enough to fully assess prostate risk, so men tracking their prostate health, especially those with a family history of the disease, should look at PSA velocity, PSA density, and multi-parametric MRI. As Dr. Attia points out, a single raw PSA number doesn’t tell you much on its own. Looking at PSA density (how the number compares to the size of the prostate) and PSA velocity (how fast that number changes over time) gives a much clearer signal. If you need a definitive look, multi-parametric MRI is the gold standard for examining the prostate, and Attia advises over-indexing on it if your father, uncles, or grandfathers had prostate cancer.
Colorectal screening starts at 45
Men should begin colorectal cancer screening at age 45 and continue through age 75, choosing the specific test and interval with their doctor. Starting colonoscopies or stool tests at 45 catches precancerous polyps and early tumors while they can still be removed cleanly. Dr. Brown calls 45 the magic age, noting that the threshold dropped because of a mix of diet and lifestyle shifts across the population.
IDPH breaks colorectal screening into at-home and in-office options, splitting between non-invasive tests (stool testing and imaging) and invasive internal scopes like a colonoscopy. If you have inflammatory bowel disease (IBD) or a family history of colon cancer, Attia puts colonoscopy right at the top of the priority list.
Lung cancer screening: the pack-year threshold
Lung cancer screening depends on your smoking math. A pack-year equals smoking an average of one pack per day for one year, meaning a pack a day for 20 years puts you at 20 pack-years. The Prevent Cancer Foundation recommends lung screening through age 80 for current smokers or those who quit within the past 15 years with at least a 20 pack-year history, noting that American Cancer Society (ACS) and United States Preventive Services Task Force (USPSTF) rules differ slightly. IDPH suggests considering lung screening starting at age 50 for current or former smokers, while also citing stricter American Academy of Family Physicians (AAFP) criteria covering ages 55 to 80 with a 30 pack-year history.
| Cancer screening | Prevent Cancer Foundation | IDPH | Dr. Jeremy Brown | AAFP (cited by IDPH) |
|---|---|---|---|---|
| Prostate (average risk) | Yes (discuss in 50s) | Yes (consider around 55) | Yes (start at 50) | No (not specified in AAFP lung criteria) |
| Prostate (Black men / higher risk) | Yes (discuss at 45 for Black men) | Partial (varies by risk factors) | Yes (start in 40s for higher risk) | No (not specified in AAFP lung criteria) |
| Colorectal | Yes (ages 45 to 75) | Yes (at-home or in-office scope) | Yes (start at 45) | No (not specified in AAFP lung criteria) |
| Lung (current or quit within 15 yrs) | Yes (20+ pack-years, to age 80) | Yes (consider at 50 for smokers) | No (not covered in segment) | Yes (ages 55 to 80, 30 pack-years) |
Metabolic disease: the silent third issue
Men over 40 should watch for non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes because both accumulate silently for years without symptoms and take the fourth killer slot for non-smokers.
Fatty liver disease: fat without the alcohol
NAFLD is fat buildup in the liver that has nothing to do with drinking. On a scan or in an operating room, it looks identical to alcoholic fatty liver disease, and in the United States it’s on pace to become the leading cause of liver transplantation. During his surgical training 20 to 23 years ago, the preventive-care podcast speaker prepped a colon cancer patient who swore he didn’t drink.
When they opened the patient up, his liver looked like a ball of fat from NAFLD, a condition that was almost unheard of back then. Later, the speaker got his own wake-up call when lab work showed he was very insulin resistant despite assuming his liver was fine.
Diabetes screening by age 35, and the liver tests to get once
IDPH guidelines state that blood sugar screening for diabetes starts by age 35, or earlier if you carry extra risk. For your liver, the Prevent Cancer Foundation recommends that everyone get tested at least once in their lifetime for hepatitis B and hepatitis C. Hepatitis B is a leading cause of liver cancer, and the vaccine is recommended for unvaccinated adults age 60 and older at high risk, though any adult 60 and up can choose to get vaccinated after talking with a provider.
Family history: the free escalation trigger
Family history of breast, colorectal, or prostate cancer can move every recommended screening threshold earlier or require more frequent testing than standard schedules. Published screening calendars from groups like the Prevent Cancer Foundation are built for the general population at average risk, just as targeted measures like pre-exposure prophylaxis (PrEP) for HIV only apply when specific risk factors are present. If your father, uncles, or grandfathers had prostate cancer, you can’t rely on the standard age-50 or age-55 baseline and need to over-index on early prostate workups.
Dr. Attia calls the window between ages 40 and 60 “sniper’s Alley,” the two decades where the major killers start picking men off. If a man in that window could only get three tests, Attia says the very first one should be a thorough family history assessment. Dr. Brown backs this up from the clinic side: walking in with your family tree mapped out lets a doctor fine-tune your care and pull screenings forward before symptoms ever show up.
Screenings men skip at every age
Cancer screenings for men begin with testicular and skin checks in the 20s, colorectal screening at 45, and prostate discussions from the 50s, alongside lifetime viral checks. Standard guidelines set these intervals by the decade when average-risk men start actually showing disease. While colorectal screening runs from 45 to 75, human papillomavirus (HPV), which causes at least six types of cancer, requires catch-up vaccination before the window closes at age 26, paired with an oral cancer exam at your dentist every six months.
Building a long-term plan for aging well means treating each decade like a service interval on a car. Friends of the CBS Texas interviewer joked that turning 40 is when the wheels start coming off, which makes the earlier decades your baseline maintenance window. Across a full lifespan, physical exams generally run every 3 years in your 20s, at least every 2 years starting at 40, and yearly from 50 on.
The foundation decade: your 20s and 30s
Men in their 20s and 30s need to establish a primary care doctor after leaving pediatric care, get blood pressure and cholesterol checked every 3 to 5 years, screen for diabetes by age 35, and complete yearly depression screenings and STI checks if sexually active. Dr. Brown calls your 20s the “foundation decade” for dialing in exercise, mental health, family history, and baseline labs.
IDPH also recommends eye exams every 2 to 4 years (and every 5 to 10 years before age 40), dental cleanings 1 to 2 times a year, staying on the regular vaccine schedule, and talking openly about mental health with your doctor and trusted friends. Sexually active men with HIV risk factors should also consider PrEP, with state help available through the Illinois PrEP Assistance Program and HIV Care Connect.
Warning signs of testicular cancer include persistent pain in the testicles, groin, pelvis, or lower back, and men check for it through physical exams and symptom awareness during ages 18 to 39 when the disease is most common. The Prevent Cancer Foundation advises having a doctor examine your testicles during routine physicals and learning to do self-exams so you can report changes right away. IDPH notes that the effectiveness of testicular self-screening is debated and not formally recommended, though paying close attention to physical signs and symptoms is strongly encouraged.
Skin cancer hits all ethnicities. The Prevent Cancer Foundation calls for an annual professional skin check, and IDPH adds monthly self-checks using the ABCDEs of melanoma: Asymmetry, Border irregularity, Color variation, Diameter larger than 6 mm (about the size of a pencil eraser), and Evolving spots.
Your 40s and 50s
Dr. Brown frames the 40s as making up for whatever you ignored in your 20s and 30s, bringing colon screening online at 45 and risk-based prostate checks. The 50s are about daily habits that preserve independence and vitality, adding average-risk prostate screening at 50 alongside shingles and pneumonia vaccines. Blood pressure checks tighten to once a year from ages 40 to 69, and smokers should weigh lung screening starting at 50 or 55.
and up
Once you pass 70, IDPH recommends annual preventive visits to track blood pressure, blood sugar, and cholesterol. That yearly appointment is the time to decide with your doctor whether continuing prostate and lung cancer screenings still makes sense, check your mental health, stay current on flu, COVID-19, RSV, and pneumonia vaccines, and screen earlier for dementia or Alzheimer’s if there’s any sign you need it.
| Screening or checkup | Ages 18 to 39 | Ages 40 to 69 | Ages 70+ |
|---|---|---|---|
| Blood pressure | Every 3 to 5 years | Yearly | Yearly |
| Cholesterol | Every 3 to 5 years | Yes (tracked at routine physicals) | Yearly |
| Diabetes (blood sugar) | Yes (by age 35, or earlier with risk) | Yes (ongoing if indicated) | Yearly |
| Skin check & oral exam | Yearly skin check (monthly ABCDE); 6-month dental exam | Yearly skin check; 6-month dental exam through 50s | Partial (discuss ongoing exams with doctor) |
| Testicular awareness | Yes (peak risk ages 18 to 39) | Partial (report any changes) | Partial (report any changes) |
| Colorectal screening | No (unless family history or IBD) | Yes (ages 45 to 75) | Partial (continues through age 75) |
| Prostate discussion | No (unless high risk) | Yes (at 45 for Black men; 50 to 55 average risk) | Partial (decide with doctor whether to continue) |
Why men skip screening, and what actually fixes it
Men go to the doctor less often than women because adult life has no automatic trigger forcing an appointment, and the simplest fix is finding a primary care physician you trust by asking friends who they see. As a preventive-care writer noted, kids and teens get annual checkups because schools provide guidelines and require signed physical forms, whereas grown men often fall off preventive care the second pediatric care ends, right when current habits start shaping later-life health conditions. Establishing that ongoing primary care relationship early is what Illinois public health guidance recommends to bridge the gap: Dr. Brown says a 20-year-old showing up for an annual exam genuinely puts a smile on his face, and having a doctor who knows your family history makes it easier to fine-tune care, move screenings up when needed, and actually follow through on screenings that buy you time and treatment options.
What screenings actually cost
Under the Affordable Care Act, federal law requires insurers to cover screenings rated “A” or “B” by the USPSTF without cost-sharing, including lung cancer screening for eligible smokers. That preventive-care mandate exists so out-of-pocket costs don’t block routine checks, and some insurance plans choose to cover additional groups beyond the federal minimum. When a test earns an A or B grade from the task force, your insurer has to pick up the bill.
For men over 50 on Medicare, Part B covers a yearly PSA blood test and a yearly digital rectal exam starting the day after your 50th birthday. IDPH notes that the PSA blood draw costs nothing if your doctor accepts Medicare, while the DRE costs 20% of the Medicare-negotiated fee. State rules can go even further. In Illinois, a law that took effect on January 1, 2024 required all health insurance policies in the state to cover prostate cancer screening and medically necessary follow-up testing with zero cost-sharing for asymptomatic men 50 and older, African American men 40 and older, and men 40 and older with a family history or genetic predisposition.
Where to start
Write down your family’s history of heart disease and breast, colorectal, or prostate cancer, then book a baseline physical with a primary care doctor. Before you go, grab the Prevent Cancer Foundation’s downloadable screenings overview chart, a 58 KB guide with tabs from All Ages through your 80s and an “Earl E. Bird” reminder tool built around their core rule that early detection equals better outcomes. The chart compiles average-risk guidelines from the ACS, AAFP, USPSTF, Centers for Disease Control and Prevention (CDC), and National Cancer Institute (NCI) into one checklist you can bring to the exam room.
Frequently Asked Questions
What is the leading cause of death for men in the United States?
Heart and cerebrovascular disease is the number one killer of American men, claiming far more lives than second-place cancer. Despite cancer getting more public attention, cardiovascular trouble is the bigger statistical threat and the top priority for routine preventive checks.
Heart disease vs cancer: which kills more men and what screenings catch them early?
Heart disease kills significantly more men than cancer, though both sit at the top of the mortality chart. Catching heart disease early comes down to an ApoB blood test, a standard cholesterol panel, and blood pressure checks every 3 to 5 years starting at 18 (then yearly from 40 to 69). Early cancer detection relies on age- and risk-based schedules, including colorectal screening from age 45, prostate screening conversations starting at 45 to 55, and lung scans for heavy current or former smokers.
Should men ask for an ApoB blood test instead of a standard cholesterol check?
You should ask for an apolipoprotein B (ApoB) test alongside your standard lipid panel rather than replacing it. A regular cholesterol panel only gives a broad overview, whereas an inexpensive ApoB test counts the exact lipoproteins that penetrate the artery wall and deposit cholesterol. Because those particles are the actual physical trigger for heart disease, tracking them gives a much sharper read on cardiovascular risk.
What cancer screenings should men get by age?
In your 20s and 30s, focus on yearly professional skin checks, monthly ABCDE mole self-checks, 6-month dental oral cancer exams, HPV catch-up vaccines through age 26, and testicular awareness between 18 and 39. At 45, average-risk men start colorectal cancer screening (continuing to 75), while Black men and men with a family history should begin prostate cancer talks in their 40s. By 50 to 55, average-risk men start prostate screening, and current or recently quit smokers with a 20 to 30 pack-year history qualify for lung cancer screening through age 80.
When should men start prostate cancer screening and how often?
Black men and men with a family history should start talking to their doctor about prostate screening at age 45 (or earlier in their 40s depending on risk), while average-risk men should start between ages 50 and 55. Once you begin, testing typically follows a yearly or provider-guided schedule, and Medicare Part B covers an annual PSA blood test and digital rectal exam after you turn 50. After age 70, you and your doctor should decide at your annual visit whether continuing makes sense.
Is the PSA blood test alone enough to check for prostate problems?
No, a single raw prostate-specific antigen (PSA) number does not tell you enough on its own. For an accurate picture, doctors look at PSA density (comparing the score to your prostate’s size) and PSA velocity (how fast the number changes over time), sometimes paired with a digital rectal exam. If you need a definitive check—especially if your father, uncles, or grandfathers had prostate cancer—a multi-parametric MRI is the gold standard.
At what age should men get a colonoscopy or colorectal cancer screening?
Average-risk men should start colorectal cancer screening at age 45 and keep going through age 75. You can choose between non-invasive at-home stool or imaging tests and an in-office scope like a colonoscopy, which catches precancerous polyps when they can still be removed cleanly. If you have inflammatory bowel disease (IBD) or a family history of colon cancer, you may need to start earlier and prioritize a full colonoscopy.
