Scheduling routine health screenings — which can detect potential problems early — is an important part of keeping yourself healthy. From mammograms and cholesterol screenings to pap smears and bone density scans, women can take charge of their health by getting checked at the right times.
“Screening is done for prevention,” explains Louito Edje, MD, associate dean of Graduate Medical Education at the University of Cincinnati College of Medicine. When a patient has no evidence of disease, doctors use primary prevention to prevent disease from occurring. “Secondary prevention is used to decrease the effect of a disease that has already been diagnosed, and tertiary prevention can lessen the effects of an ongoing illness.”
Do you know if you are at average or high risk for breast cancer? The American College of Radiology and the Society of Breast Imaging set guidelines depending on a woman’s risk level. Women with an average risk should start receiving annual screening mammography starting at age 40. “For those at high risk, either due to genetics, previous personal history of breast cancer, dense breasts, or who are diagnosed prior to age 50, supplemental screening with a contrast-enhanced MRI is recommended,” Dr. Edje says. The American Cancer Society pushes the timeline back a bit, asking to get their first mammogram by age 45. By contrast, the U.S. Preventive Services Task Force (USPTF) recommends no mammograms for women in their forties, but every other year between ages 50 and 74.
Confused yet? To sort out your risk level, always discuss your family history with a primary care physician. A breast exam can further determine if breasts may be dense. “We advise against wearing deodorant or powder for the mammogram visit itself,” Dr. Edje says. “If a patient has symptoms of a nipple discharge or mass, patients should make an appointment with their physicians regardless of age. An ultrasound or biopsy may be used to evaluate the breast.”
The National Heart, Lung and Blood Institute recommends getting an initial cholesterol screening between ages 9 and 11, then every five years after that. Women ages 55 to 65 (and men 45 to 65) should get checked every one to two years. “If the tests are abnormal or if a patient has risk factors for cardiovascular disease such as diabetes or obesity, those tests may be needed more frequently,” Dr. Edje says.
Your PCP can order the blood test, called a lipid panel, to check for several kinds of cholesterol. Here’s a breakdown:
- Total cholesterol is the sum of the cholesterol in your blood.
- LDL is the low density lipoprotein which can cause fatty deposits in arteries.
- HDL is the high density lipoprotein which carries the LDL out of the blood. (The more HDL, the better!)
- Triglycerides are the leftover, unused calories the body stores in fat cells.
The USPSTF recommends that women between ages 21 and 29 have cervical cancer screening every 3 years by PAP smear. Women ages 30 to 65 have a choice to have cervical screening which only examines the cervical cells every 3 years; a check for high-risk papillomavirus testing alone every 5 years; or check both every 5 years. Both methods can be done during a pelvic exam. No screening is recommended after age 65 if the patient is not high risk for cervical cancer or for women with prior history of a total hysterectomy.
Bone Density Testing
Bone density testing uses X-rays to help determine if a woman has a risk of breaking a bone — specifically at the wrist, hip or vertebrae. It determines if the structure of the bone is more fragile than it should be. “There are a variety of testing procedures, but the gold standard is to check the density at the hip and the lumbar spine,” Dr. Edje says. “Testing at the wrist is less accurate.”
The bone density test, also called a dual-energy X-ray absorptiometry (DEXA) scan, rates bone using a T-score. A low T-score is a sign of osteopenia or weakening of the bone, and a very low score can indicate osteoporosis and a higher risk of fracture. The American College of Obstetrics and Gynecology, the USPSTF and the National Osteoporosis Foundation all agree that DEXA scans should be started at age 65 in women with no risk factors.
Colorectal Cancer, Hypertension and Mental Health Screenings
There are many other screenings important to women, from colorectal cancer screenings to blood pressure checks and mental health surveys. “One of the most important foundations for excellent preventive care is a strong relationship with a primary care physician or allied health professional who can help navigate what is needed,” Dr. Edje says. “Additionally, there are some useful well-vetted screening apps which can help individuals determine what may be considered for their age.” The USPSTF’s app asks patients to enter their age, height, weight, and smoking status and then recommends a range of screenings, though this tool is not meant to replace a physician’s advice for specific patient needs.