By Emily McCluhan
While it’s not enjoyable, being poked and prodded is sometimes part of our annual wellness exams. The screenings we undergo at these visits are crucial for detecting and preventing conditions like cancer, heart disease, stroke and diabetes.
To sort all of these screenings out, we asked Dr. Elizabeth Neuman, an OB-GYN with Physicians for Women, about what screenings are necessary to do and when, when to depart from typical guidelines and any updated guidelines we should know about.
PAP TESTS AND HPV TESTING
Why It’s Important: Cervical cancer used to be the leading cause of cancer deaths in women, but thanks largely to screenings like Pap tests, the number of cervical cancer deaths in the U.S. has dropped by 50% since the mid-1970s.
Current Guidelines: Pap and pelvic exam recommendations are the most dynamic and complex of screenings for women. That’s because experts continue to develop new and better ways to screen for cervical cancer with the goal of reducing unnecessary follow-up procedures like colposcopies (when a doctor removes a small piece of suspicious tissue from the cervix or vagina for testing).
For healthy females, Neuman follows the American College of Obstetricians and Gynecologists (ACOG) recommendation of starting Pap tests at age 21, and then every three years until age 30.
“From age 30 to 65, the recommendation is to start co-testing,” says Neuman. “That means you have a Pap smear, but the sample is tested for both abnormal cervical cells, as well as HPV.”
If the results are normal, women can go up to five years between screenings, but Neuman says annual wellness exams are still important for staying on top of pelvic, breast and heart health.
New Information: HPV is the leading cause of cervical cancer, but your body often clears the virus on its own.
“The good news is the HPV vaccine is now recommended for women up to age 45, independent of whether or not the woman has had a prior abnormal pap smear. And the HPV vaccine can not only prevent cervical cancer or pre-cervical cancer, but it also protects against genital warts and certain types of vaginal cancer,” Neuman says.
Why It’s Important: “The long-term effects of an untreated STD can be serious, and for some women, could
affect their ability to get pregnant or lead to long-term health problems,” says Neuman. These can include pelvic inflammatory disease, infertility, cervical cancer and congenital infections in infants born to infected mothers.
Current Guidelines: For sexually-active women under age 25, the recommendation is to get tested for STDs, including gonorrhea and chlamydia, every year. Women over 25 should still be tested based on factors like new or multiple sexual partners.
New Information: Previously, the CDC recommended that anyone born between 1945 and 1965 be tested at least once in their lifetime for Hepatitis C, which can also be spread by sexual contact. In 2020, that guideline was updated to a recommendation for all adults over the age of 18 being tested at least once in their lifetime, regardless of risk factors or other lifestyle behaviors.
“There is also a recommendation that all women between ages 15 and 65 get tested at least once in their life for HIV,” Neuman says and adds that all women who get pregnant will be tested for both of these viruses.
Why It’s Important: About one in eight women will develop invasive breast cancer in their lifetime according to breastcancer.org, but finding breast cancer early reduces your risk of dying from the disease by 25-30% or more.
Current Guidelines: As an OB-GYN, Neuman says she follows the ACOG guidelines, which recommend mammogram screenings every one to two years starting at age 40 for average-risk women, and continuing until age 75.
There are differences in what other organizations recommend concerning mammograms, though. The American Cancer Society (ACS) recommends mammograms every year starting at age 45. (The ACS says women can also start screening as early as age 40 if they’d like.) The U.S. Preventive Services Task Force (USPSTF) recommends screenings every other year from ages 50 to 74 to reduce the chance of overdiagnosis and unnecessary biopsies or treatments. Talk with your doctor about your own family history and risk level to determine when and how often to have a mammogram.
Other Considerations: “Patients who have any sort of genetic cancer syndrome, like BRCA gene mutations, need to connect with their doctor in their 20s to start screenings,” Neuman says. Genetic testing is not readily available to the general public, but your provider can conduct a risk assessment to determine if you qualify for the testing.
Why It’s Important: Colorectal cancer is the third-most common cancer in the U.S., and early stages of colorectal cancer typically don’t have symptoms. Luckily, many colorectal cancers can be detected and prevented through regular screening.
Current Guidelines: Historically, the USPSTF recommended that average-risk patients begin colonoscopies at age 50 and repeat every 10 years if there are normal results. Based on new research and an increase in the diagnosis of colon cancer in people younger than 50, Neuman expects that at some point the new recommendation by all organizations will be for everyone to get a colonoscopy at age 45.
“For now [though], most providers — including OB-GYNs — would stick with age 50 for average-risk patients [that are not Black]. For African American patients, the recommended age to begin (even for low-risk patients) is age 45,” she says.
Other Considerations: “Direct-to-consumer tests, like Cologuard, are an OK way to start screening for average-risk patients who are opposed to colonoscopies,” Neuman says. “But keep in mind, that is just a screening. If your results are abnormal, your doctor will recommend a colonoscopy.”
She reinforces that a colonoscopy is both a screening and a therapeutic tool. If polyps or abnormalities are found, they can be removed during the procedure, preventing them from progressing into cancer.
Why It’s Important: High blood pressure, or hypertension, is often called the “silent killer,” because it comes with no symptoms.
“About half of the U.S. adult population has hypertension, and it’s a major contributor to heart disease, stroke and other serious health consequences, and the longer it goes untreated, the worse those consequences can be,” says Neuman.
Regular blood pressure checks allow early intervention like diet and exercise modifications.
Current Guidelines: Hypertension can occur at any age, so blood pressure checks are a part of routine exams.
New Information: In 2017, the American College of Cardiology and the American Heart Association changed the threshold for diagnosis of stage one hypertension from 140/90 to 130/80.
“That means there’s going to be a greater incidence of patients who are being diagnosed with stage one hypertension, and the goal of that is to identify more patients early on to start interventions early,” says Neuman.
Other Considerations: For women planning a pregnancy, Neuman says it’s important to know prior to conceiving if you have hypertension since this can increase the risk of complications during pregnancy, like preterm birth, placental abruption and preeclampsia.
“Also, if you are diagnosed with high blood pressure or preeclampsia during pregnancy, even if it normalizes postpartum, you’re at about a 50% increased risk of high blood pressure later in life,” Neuman says. “Be sure to discuss any risk factors you have with your OB-GYN or primary care provider.”
Why It’s Important: Women are five times more likely to have osteoporosis compared to men, and a bone density test, called a DEXA scan, can identify your risk for osteoporosis and bone fractures.
Current Guidelines: The recommenda- tion from the ACOG for an average-risk patient is to start DEXA scans at age 65 and space them 15 years apart, so most women will only need one or two scans in their lifetime.
Other Considerations: “There are a lot of exceptions and certain groups of women who need to start having these scans sooner than age 65,” Neuman says.
She lists the following factors as reasons to be tested earlier than age 65:
- Long-term immune modulating therapies, like medications for rheumatoid or psoriatic arthritis
- Chronic steroids
- History of an eating disorder, even if you’ve recovered
- Family history of osteoporosis.
BACK TO BASICS
No matter your age, keep these screenings in mind.
This is administered as a validated screening questionnaire during routine office visits.
“These screenings are a good opportunity for patients who maybe didn’t know how to bring up concerns about depression or anxiety, and to get their foot in the door and start having those conversations if they are struggling,” Neuman says.
Your primary care doctor should do a visual check of areas of concern during annual exams.
“Even just one severe sunburn as a child can put you at increased risk of developing skin cancer,” Neuman warns. “It’s important to be aware of any changes to skin or moles, especially for fair-skinned [people].”
It’s recommended by the USPSTF to have your cholesterol tested annually starting at age 45 for women at a healthy weight, but screening may start earlier (at age 35) to stay in front of risk factors like weight, diabetes, family history or even as part of an employer- sponsored health plan incentive.
This annual blood test is typically included with a cholesterol screening starting around age 45 for low-risk women. Many risk factors exist for women to begin screening earlier, such as being overweight or obese.
“Additionally, patients that have polycystic ovarian syndrome, which is a complex endocrine disorder, are at almost double the risk of getting diabetes in their lifetime,” Neuman says.