For Women: Which Tests Do You Need?
You say you feel great, but what do you really know about your health? To find out, get the screening tests recommended for women.
From mammograms to cholesterol tests, screening couldn't be more crucial. "Women today have greater life potential than ever before, and they can extend it even further with preventive care and a healthful lifestyle," says Gerson Weiss, M.D., professor and chair of obstetrics, gynecology and women's health at the University of Medicine and Dentistry of New Jersey/New Jersey Medical School.
Screening tests can catch an illness before you see signs, when treatment may help most. While recommendations for testing vary, this list was drawn from interviews with women's health experts. It is based on recommendations for healthy women with no symptoms for or diagnoses of conditions or diseases. But, your lifestyle, health record and family history may change the recommendations for you; only you and your doctor know what's best for you.
Mammogram and breast exam
Excluding skin cancer, breast cancer is the most common type of cancer in women in the United States. A woman's chance of developing invasive breast cancer at some time in her life is about 1 in 7 (13.4 percent). The early detection and treatment breast cancer has caused the deaths from breast cancer to decrease. Mammograms can detect about 75 percent of cancers at least a year before they can be felt. Although mammograms can detect tumors, they still may miss some. And some mammograms results may lead to biopsies that find no cancer. If you feel a lump and your mammogram is normal, tell your provider; the lump could be cancerous.
The benefits and limitations of mammography vary based on factors like age and personal risk. Experts have different recommendations for mammography. Currently, the U.S. Preventive Services Task Force (USPSTF) recommends screening every two years for women ages 50 to 74. The American Cancer Society (ACS) recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them.
The ACS recommends clinical breast exams (CBEs) at least every three years for all women in their 20s and 30s. The ACS recommends annual CBEs for women ages 40 and older. The USPSTF, however, believes there is not enough evidence to assess the value of CBEs for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.
The USPSTF does not recommend breast self-exams (BSEs) because evidence suggests BSEs do not lower risk for death from breast cancer. The ACS says BSEs are an option for women 20 and older as a means of familiarizing themselves with their breasts so they can notice changes more easily. Talking with your doctor about the benefits and limitations can help you decide if you should start performing BSEs.
Pap test and pelvic exam
During a Pap test, doctors remove cells from the cervix to look for early warning signs of cancer that causes no symptoms. Cervical cancer screening should begin approximately three years after a woman begins having vaginal intercourse, but no later than age 21. Screening should be done every year with conventional Pap tests or every two years using liquid-based Pap tests. At or after age 30, women who have had three normal test results in a row may get screened every two to three years. Women 70 years of age and older who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years, and women who have had a total hysterectomy may choose to stop cervical cancer screening.
A woman who has had a total hysterectomy in which the uterus, cervix and ovaries are removed for non-cancer reasons does not need a Pap test, advises the USPSTF.
Although other screening methods for cervical cancer are available, the USPSTF has not endorsed any method over the Pap test for routine tests.
Sexually transmitted disease tests
If you're sexually active and have had more than one partner or have a partner who has had more than one partner, you should be screened for sexually transmitted diseases (STDs). That's even more true if you've had unprotected intercourse (no condom use) with multiple partners and any of them has had multiple partners.
"The most common STD is chlamydia, which, if left untreated, can lead to infertility," says Elizabeth Swisher, M.D., of the Seattle Cancer Care Alliance.
Other STDs are gonorrhea, syphilis, HIV, HPV (human papilloma virus), herpes, and hepatitis B. The USPSTF recommends that women 25 or younger and sexually active be tested for chlamydia. If you are older or pregnant, talk to your health care provider to see whether you should be tested. Also, talk to your provider to see whether you should be tested for other STDs.
In type 2 diabetes, blood sugar rises because you can't make enough insulin or use it normally. The disease affects 20.8 million Americans, 9.7 million of them women, according to the American Diabetes Association (ADA). A lot of women develop diabetes in middle age or older, but it's rising in the young. African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women are two to four times more likely to develop diabetes than white women. Besides being a member of these racial or ethnic groups, your risks for developing type 2 diabetes are age, obesity, lack of physical activity, and a family history of the disease. It occurs more frequently in women who have had gestational diabetes (diabetes during pregnancy) or in women who have polycystic ovary syndrome, high blood pressure, high cholesterol, impaired glucose tolerance (IGT), or impaired fasting glucose (IFG).
The ADA recommends getting tested for type 2 diabetes every three years, beginning at age 45, if you are at average risk for diabetes. If you have any of the risk factors listed above or if you are overweight or obese, you should be tested at an earlier age or more frequently. Overweight is defined as having a body mass index (BMI) of 25 to 29; obese is having a BMI of 30 or more.
Heart disease screening
Obesity, high blood pressure, high-fat diets, and diabetes fuel heart disease, the top killer of U.S. women. And women may not recognize their heart attack symptoms. Women are more likely than men to experience indigestion, breathing trouble or muscle pain instead of the classic, spreading chest pain. The USPSTF recommends that all adults ages 18 and older be screened regularly for high blood pressure. If your blood pressure is less than 120 systolic (the top number) and less than 80 diastolic (the bottom number), you should be screened every two years. If either number is higher, or if you have other risk factors for heart disease such as high cholesterol or diabetes, you should be screened more frequently.
The National Heart, Lung and Blood Institute recommends that all adults over the age of 20 have their cholesterol measured once every five years. Total cholesterol should be less than 200 mg/dL or less, LDL cholesterol should be less than 100 mg/dL; and HDL cholesterol should be higher than 50 mg/dL (the higher the better). Talk to your health care provider to find out when you should begin screening.
Bone density test
Women start with less bone mass than men. "When you become postmenopausal, you're at high risk for rapid bone loss, which may lead to osteoporosis," says E. Michael Lewiecki, M.D., past president of the International Society for Clinical Densitometry. Osteoporosis increases the risk of sustaining a broken bone.
The USPSTF recommends that women ages 65 and older be routinely screened for osteoporosis. If you have other risk factors for osteoporosis, such as being underweight or smoking, you should be screened beginning at age 60.
Colorectal cancer test
The USPSTF recommends that women ages 50 and older be screened for colorectal cancer if they are at average risk. If a woman has a family history of familial polyposis or hereditary nonpolyposis colorectal cancer, or a personal history of ulcerative colitis, screening at an earlier age may be advised. Several screening methods are available: fecal occult blood test (FOBT), which looks for blood in stool samples; sigmoidoscopy, which uses a thin, flexible tube to examine part of the colon and rectum for precancerous polyps; a colonoscopy, which uses a longer flexible tube to examine the entire colon and rectum for precancerous polyps; and a barium enema, which allows a doctor to take an X-ray of the colon to look for precancerous polyps. Talk to your doctor about which screening method might be right for you.