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Women’s Health Tests: Screening Exams for Prevention and Detection


A doctor can perform many tests to assess a woman's wellness and screen for disease. All diseases or conditions respond better with early intervention, especially cancer.

One of the first screening tests for cancer was the Pap smear, named after the gynecologist who devised a way to collect cells from the cervix with a gentle scraping of the organ, then analyze them under a microscope to detect abnormalities. This is a cytologic test because it only looks at cells under a microscope, whereas a biopsy looks at the whole abnormality and the tissue surrounding the abnormal growth.

Other tests to detect tumors or abnormalities include radiologic imaging such as mammography, or blood tests to detect levels of hormones, cholesterol, or biologic tumor markers.

Annual wellness exam

Most women will have annual physical exams to assess for problems, receive education about fertility and contraception, review breast and cervical health, get lifestyle counseling, receive screening for diseases if they're at risk, and address other general health concerns. Thyroid testing may be done on women seeking pregnancy or in non-pregnant women with symptoms or a family history of the disease. Annual exams will also help pick up high blood pressure.

Cervical cancer screening

Cervical cancer screening is an essential aspect of women’s healthcare. The age to start is when you reach 21, possibly sooner if there has been early exposure to sexually transmitted diseases. Pap smears and HPV testing are done during a pelvic exam when a spatula or brush is used to collect cells of the cervix and the endocervical canal, which is the canal that connects the uterus to the vagina.

  • Women 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.
  • Women who are 30 to 65 have three options for testing: A Pap test and an HPV test (co-testing) every 5 years, a Pap test alone every 3 years, or HPV testing alone every 5 years.

A woman can stop having cervical cancer screening after age 65 in the following circumstances:

  • You do not have a history of moderate or severe abnormal cervical cells (dysplasia) or cervical cancer.
  • You have had either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years. The most recent test should have been done within the past 3 to 5 years.

Sexually Transmitted Diseases

Chlamydia and gonorrhea should be screened for in sexually active women until age 25 or in older women who have new or multiple sexual partners. HIV and other sexually transmitted infections should be tested in all women and their partners before sexual activity begins, but that is often impractical. A risk assessment will determine what to test for. Pregnant women should be screened for HIV.

Breast disease screening

Mammography is done for two reasons:

  • As a screening test to check for breast cancer in women who do not have signs or symptoms of the disease.
  • As a diagnostic test, to check lumps or other symptoms that you have found during a self-breast exam, or by an obstetrician-gynecologist (ob-gyn) or other health care professional.

Mammography uses x-rays, exposing you to radiation during the test. Ultrasound may be performed before a mammogram to look for benign, fluid-filled cysts. If the ultrasound is unclear, a mammogram will pick up solid masses that may be benign or cancerous.

Women can do their breast exam and health professionals will also perform a breast exam, but they are limited in detecting lumps under 1 centimeter in size and for those with dense breasts. Up to 50% of women have dense breasts.

How often should you have a mammogram?

Every 1-2 years beginning between ages 40 and 50. The guidelines vary, so talk to your health care provider about your risks and benefits. Continue annual or biennial screenings at least through age 74, and beyond that, guidelines vary. Age alone should not be the reason to discontinue screenings.

You may consider genetic testing if your personal or family history shows that you have an increased risk of cancer. Your health care professional may ask you these and other questions:

  • Have you or any family members been diagnosed with cancer?
  • If yes, what types of cancer, and at what ages?
  • Were you or any of your family members born with birth defects?
  • Are you of Eastern or Central European Jewish ancestry?
  • If your pregnancy history consists of miscarriages or babies with genetic defects.

Depending on your answers, your ob-gyn or another health care professional may suggest that you talk about genetic testing with a genetic counselor or a physician who is an expert in genetics.

Bone mineral density

Screening for bone mineral density is recommended at age 65 or earlier if there are risk factors, such as smoking, chronic steroid use, you have a small frame, or a family history of osteoporosis. Osteoporosis is the disease of thin and fragile bones and may require medication, especially if there has been a fracture. While osteopenia is the beginning of bone thinning that can lead to osteoporosis. There are no warning symptoms of osteoporosis, so a screening test called a DEXA can tell you how severely thinned your bones have become.

Colorectal screening

Colon cancer is a leading cancer and one of the deadliest if detected in late stages. Colonoscopy and DNA testing of the stool are the two best screening tools to detect colon/rectal cancer. Colonoscopy involves light anesthesia and a flexible tube with a camera inserted into the rectum to visualize any abnormalities in the colon, such as polyps. Any polyps or unusual findings will be biopsied.

Abnormal or cancerous DNA can be detected in the stool that you collect at home and send to a lab. Cologuard is a test that you can do at home. The advantage is that you do not have to drink any laxatives before the test as you do with the colonoscopy. Your colon must be cleared of stool for a colonoscopy, and you must have someone drive you home from the test. These tests should begin at age 50 or sooner if there is a family history. Any blood in the stool warrants testing as well.

Eye exam

An eye exam should be done at least once from age 20-29, and at least twice from age 30-39. At age 40, get a baseline eye disease screening, with follow-ups as recommended. At age 65, you should get eye exams every 1-2 years.

Cholesterol screening

Begin screening at age 20 for women at increased risk for coronary heart disease (CHD). Risk factors include diabetes, smoking, obesity, hypertension, personal history of CHD or atherosclerosis, or family history of cardiovascular disease. Screenings are recommended every 5 years for those with levels that may need treatment. Screening is less important in older people because lipid levels are less likely to increase after age 65.

Diabetes screening

Diabetes screening guidelines are recommended every 3 years starting at age 45, except for adults with increased risk for diabetes who may be tested regularly. That includes adults who are overweight or have other risk factors, including:

  • Blood pressure higher than 140/90 (or taking blood pressure medicine)
  • Family history of diabetes
  • High cholesterol
  • History of cardiovascular disease
  • Physical inactivity
  • High-risk race or ethnicity
  • Gave birth to a baby weighing 9 pounds or more or had gestational diabetes

Lung cancer screening

Lung cancer screening should be done annually with low-dose computed tomography (CT) for adults aged 55 to 80 who have a 30 pack-year smoking history or have quit within the past 15 years.

Skin exams

Women with moles and any fair-complected person with concerning lesions or a history of melanoma in the family should receive skin examinations from a dermatologist.

Vaccines

  • Influenza: Annually
  • Pneumococcal: Age 65 or in younger people at risk
  • Meningitis: College freshmen and military recruits
  • Hepatitis B: This vaccine is given to children at birth in 3 doses at 0, 1, and 6 months. It is also given to children or adults who weren't vaccinated as babies and are at risk for hepatitis B, such as health care workers.
  • Herpes Zoster (Shingles): Age 60 and older
  • Measles/Mumps/Rubella (MMR): You'll receive one dose if you haven’t had one as a child.
  • Human Papillomavirus (HPV): Age 11-12; or 13-26 if not previously vaccinated; 3 doses at 0-, 2- and 6-month intervals; no booster necessary.
  • Tetanus: Every ten years
  • Varicella (chickenpox): If not vaccinated as a child

References:

Atkinson W.L., Pickering L.K., Schwartz B., Weniger B.G., Iskander J.K., Watson J.C. (2002). Centers for Disease Control and Prevention. General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).

Daniels S.R. (2018). Universal vs targeted cholesterol screening. J Pediatr.

Gourlay M.L., Overman R.A., Ensrud K.E. (2015). Bone Density Screening and Re-screening in Postmenopausal Women and Older Men. Curr Osteoporos Rep.

Issa I.A., Noureddine M. (2017). Colorectal cancer screening: An updated review of the available options. World J Gastroenterol.

National Center for Immunization and Respiratory Diseases. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP).

Sawaya G.F., Smith-McCune K., Kuppermann M. (2019). Cervical Cancer Screening: More Choices in 2019. JAMA.

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