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Health screening - women - ages 40 to 64

Definition

You should visit your health care provider from time to time, even if you are healthy. The purpose of these visits is to:

  • Screen for medical issues
  • Assess your risk of future medical problems
  • Encourage a healthy lifestyle
  • Update vaccinations
  • Help you get to know your provider in case of an illness

Alternative Names

Health maintenance visit - women - ages 40 to 64; Physical exam - women - ages 40 to 64; Yearly exam - women - ages 40 to 64; Checkup - women - ages 40 to 64; Women's health - ages 40 to 64; Preventive care - women - ages 40 to 64

Information

Even if you feel fine, you should still see your health care provider for regular checkups. These visits can help you avoid problems in the future. For example, the only way to find out if you have high blood pressure is to have it checked regularly. High blood sugar and high cholesterol levels also may not have any symptoms in the early stages. A simple blood test can check for these conditions.

There are specific times when you should see your provider. Below are screening guidelines for women ages 40 to 64.

BLOOD PRESSURE SCREENING

  • Have your blood pressure checked every 2 years. If the top number (systolic number) is between 120 and 139 or the bottom number (diastolic number) is between 80 and 89 mm Hg or higher, have it checked every year.
  • Watch for blood pressure screenings in your area. Ask your provider if you can stop in to have your blood pressure checked. Or check your blood pressure using the automated machines at local grocery stores and pharmacies.
  • If the top number is greater than 140, or the bottom number is greater than 90, schedule an appointment with your provider.
  • If you have diabetes, heart disease, kidney problems, or certain other conditions, you may need to have your blood pressure checked more often.

CHOLESTEROL SCREENING

  • If you are age 20 or older and have risk factors for coronary heart disease, your cholesterol should be checked every five years.
  • If you have high cholesterol levels, diabetes, heart disease, kidney problems, or certain other conditions, you may need to be checked more often.

DIABETES SCREENING

  • If you are over age 44, you should be screened every 3 years.
  • If you are overweight, ask your provider if you should be screened at a younger age. Asian Americans should be screened if their BMI is greater than 23.
  • If your blood pressure is above 135/80 mm Hg, or you have other risk factors for diabetes, your provider may test your blood sugar level for diabetes.

COLON CANCER SCREENING

If you are under age 50, you should be screened if you have a strong family history of colon cancer or polyps. Screening may also be considered if you have risk factors such as a history of inflammatory bowel disease or polyps.

If you are between ages 50 to 75, you should be screened for colorectal cancer. There are several screening tests available. Some common screening tests include:

  • A fecal occult blood test done every year
  • Flexible sigmoidoscopy every 5 years along with a fecal occult blood test every 3 years
  • Colonoscopy every 10 years

You may need a colonoscopy more often if you have risk factors for colon cancer, such as:

  • Ulcerative colitis
  • A personal or family history of colorectal cancer
  • A history of colorectal adenomas

DENTAL EXAM

  • Go to the dentist once or twice every year for an exam and cleaning. Your dentist will evaluate if you have a need for more frequent visits.

EYE EXAM

  • Have an eye exam every 2 to 4 years ages 40 to 54 and every 1 to 3 years ages 55 to 64. Your provider may recommend more frequent eye exams if you have vision problems or glaucoma risk.

IMMUNIZATIONS

  • You should get a flu shot every year.
  • Ask your provider if you should get a vaccine to reduce your risk of pneumonia.
  • You should have a tetanus-diphtheria and acellular pertussis (Tap) vaccine once as part of your tetanus-diphtheria vaccines. You should have a tetanus-diphtheria booster every 10 years.
  • You may get a shingles or herpes zoster vaccine once after age 60.
  • Your provider may recommend other immunizations if you are at high risk for certain conditions.

PHYSICAL EXAM

  • Your blood pressure should be checked at least every two years.
  • Your provider may recommended checking your cholesterol every 5 years if you have risk factors for coronary heart disease
  • Your height, weight, and body mass index (BMI) should be checked at each exam.

During your exam, your provider may ask you about:

  • Depression
  • Diet and exercise
  • Alcohol and tobacco use
  • Safety issues, such as using seat belts and smoke detectors

BREAST EXAM

  • Women may do a monthly breast self-exam. However, experts do not agree about the benefits of breast self-exams in finding breast cancer or saving lives. Talk to your provider about what is best for you.
  • You should contact your provider immediately if you notice a change in your breasts, whether or not you do self-exams.
  • Your provider may do a clinical breast exam as part of your preventive exam.

MAMMOGRAM

  • Women ages 40 to 49 may have a mammogram every 1 to 2 years. However, not all experts agree about the benefits of having a mammogram when women are in their forties. Talk to your provider about what is best for you.
  • Women ages 50 to 75 should have a mammogram every 1 to 2 years depending on their risk factors, to check for breast cancer.

OSTEOPOROSIS SCREENING

  • All women over age 50 with fractures should have a bone density test (DEXA scan).
  • If you are under age 65 and have risk factors for osteoporosis, you should be screened.

PELVIC EXAM AND PAP SMEAR

  • You should have a Pap smear every 3 years. If you have both a Pap smear and human papilloma virus (HPV) test, you may be tested every 5 years. HPV is the virus that causes genital warts and cervical cancer.
  • Your provider may do pelvic exams more often if you develop problems.
  • If you have had your uterus and cervix removed (total hysterectomy), and you have not been diagnosed with cervical cancer, you do not need to have Pap smears.
  • Women who are sexually active and at high risk should be screened for chlamydia and gonorrhea. Your provider may talk with you about testing for other infections..
  • Your provider will ask you questions about alcohol and tobacco, and may ask you about depression.

SKIN EXAM

  • The American Cancer Society recommends a skin exam as part of a periodic exam by your provider, if it is indicated.
  • The U.S. Preventive Services Task Force (USPSTF) does not recommend for or against performing a skin self-exam.

LUNG CANCER SCREENING

The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who:

  • Have a 30 pack-year smoking history AND
  • Currently smoke or have quit within the past 15 years

References

Advisory committee on immunization practices recommended immunization schedule for adults aged 19 years or older--United States, 2015. Kim DK, Bridges CB, Harriman KH; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP); ACIP Adult Immunization Work Group. MMWR Morb Mortal Wkly Rep. 2015 Feb 6;64(4):91-2. PMID: 25654609 www.ncbi.nlm.nih.gov/pubmed/25654609.

American College of Obstetricians and Gynecologists. Committee opinion no. 463: Cervical cancer in adolescents: screening, evaluation, and management. Obstet Gynecol. 2010;116:469-72. PMID: 20664421 www.ncbi.nlm.nih.gov/pubmed/20664421.

American College of Obstetricians and Gynecologists. Practice bulletin no.122: Breast cancer screening. Obstet Gynecol. 2011;118:372-82. PMID: 21775869 www.ncbi.nlm.nih.gov/pubmed/21775869.

American College of Obstetricians and Gynecologists. Practice bulletin no. 131: Screening for cervical cancer. Obstet Gynecol. 2012;120:1222-38. PMID: 23090560 www.ncbi.nlm.nih.gov/pubmed/23090560.

American Dental Association. Questions about going to the dentist. Available at: www.mouthhealthy.org/en/dental-care-concerns/questions-about-going-to-the-dentist. Accessed Jul 24, 2015.

American Gastroenterology Association. AGA institute guidelines for colonoscopy surveillance after cancer resection: clinical decision tool. Gastroenterology. 2014 May;146(5):1413-4. PMID: 24742563 www.ncbi.nlm.nih.gov/pubmed/24742563.

American Optometric Association. Comprehensive adult eye and vision examination. February 6, 2015. Available at: www.aoa.org/Documents/EBO/Adult%20Eye%20and%20Vision%20Examination%20Guideline%20Peer-Public%20Review%20Document.pdf. Accessed July 24, 2015.

Atkins D, Barton M. The periodic health examination. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.

Breast Cancer Screening Draft Recommendations. U.S. Preventive Services Task Force. Available at: www.screeningforbreastcancer.org/?ds=1&s=breast%2520cancer. Accessed July 24, 2015.

Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. PMID: 24352797 www.ncbi.nlm.nih.gov/pubmed/24352797.

Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jun. PMID: 20722146 www.ncbi.nlm.nih.gov/pubmed/20722146.

Meschia JF, Bushnell C, Boden-Albala B et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014 Dec;45(12):3754-832. PMID: 25355838 www.ncbi.nlm.nih.gov/pubmed/25355838.

Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update: A guideline from the American Heart Association. Circulation. 2011;123(11):1243-62. PMID: 21325087 www.ncbi.nlm.nih.gov/pubmed/21325087.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Breast Cancer Screening and Diagnosis Version 3.2015. Available at: www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed July 24, 2015.

Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension: what are the right goals and purposes? JAMA. 2014 Feb 5;311(5):474-6. PMID: 24352710 www.ncbi.nlm.nih.gov/pubmed/24352710.

Ridker PM, Libby P, Burning JE. Risk Markers and the Primary Prevention of Cardiovascular Disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 42.

Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-72. PMID: 22422631 www.ncbi.nlm.nih.gov/pubmed/22422631.

Screening for Cervical Cancer. U.S. Preventive Services Task Force. Available at: www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening?ds=1&s=cervical%20cancer. Accessed July 24, 2015.

Screening for Lung Cancer: U.S. Preventive Services Task Force recommendation statement.Moyer VA; U.S. Preventive Services Task Force. Ann Intern Med. 2014 Mar 4;160(5):330-8. PMID: 24378917 www.ncbi.nlm.nih.gov/pubmed/24378917.

Smith RA, Brooks D, Cokkinides V, Saslow D, Brawley OW. Cancer screening in the United States, 2013. A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2013 Mar-Apr;63(2):88-105. PMID: 23378235 www.ncbi.nlm.nih.gov/pubmed/23378235.

Standards of medical care in diabetes--2015: summary of revisions. Diabetes Care. 2015 Jan;38 Suppl:S4. PMID: 25537706 www.ncbi.nlm.nih.gov/pubmed/25537706.

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Review Date:5/22/2015
Reviewed By:Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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