An annual checkup with your doctor is no longer enough. Here are 12 screening tests every woman should consider.

By Bev Lucas

If you’re feeling fine and haven’t seen the doctor lately, you might think that—unless you get sick—there’s no need for a visit. But you might want to rethink this assumption.

“Even if you’re healthy, doctors recommend several screening tests to prevent potential health problems or detect them in their earliest stages before there are any signs or symptoms,” says Wanda Nicholson, MD, vice chair of the United States Preventive Services Task Force (USPSTF) in Rockville, Maryland.

Be aware that many preventive health experts say that if you’re healthy, you don’t need to have a yearly physical to get your screenings done. As an alternative, they suggest scheduling multiple shorter visits that take place over time. The tests a woman needs, and when she needs them, depend largely on her age and risk for developing particular conditions. Most of the following recommendations, from the USPSTF and the Women’s Preventive Services Initiative (WPSI) are for nonpregnant women at average risk.

The USPSTF is an independent volunteer group of national experts in disease prevention, and many primary care providers follow their advice. The WPSI is a national coalition of health-professional and patient organizations with expertise in women’s health. “While both groups issue recommendations on many of the same health topics, the charge of the WPSI is to fill gaps in preventive service recommendations for women,” says Amy Cantor, MD, WPSI advisory panel member. That means some WPSI recommendations are more expansive than those from the USPSTF. For example, WPSI suggests screening all women for anxiety, but the USPSTF sets an age limit. Others are unique to WPSI (for example, screening for urinary incontinence). Advocacy of screening tests and other preventive services from both groups are backed up by strong scientific evidence showing that they promote good health and are likely to improve how long or how well a person lives.

Other health-professional organizations, such as the American Cancer Society, also issue evidence-based recommendations. While there is not always absolute agreement on which age to do these tests, screenings are one of the most important things to do for your health. “It’s incredibly important for Black women, in particular, to be aware of the need for screening and other preventive services because of the high rates of diabetes and high blood pressure and of death from breast cancer in the Black community,” says Dr. Nicholson.

Keep in mind that some screening tests can have risks as well as benefits. So it’s important to have a conversation with your health-care provider about which preventive screenings you need and the pros and cons of getting them.

And it’s good to know that most private insurers cover a range of women’s preventive services, such as mammograms and screening for cervical cancer, at no cost to you—even if you have not met your yearly deductible.

Recommended screenings

1. Anxiety and depression. Last year, for the first time in its history, the USPSTF issued a recommendation for doctors to screen adults under age 65 for anxiety during routine medical visits. The WPSI suggests screening women for anxiety regardless of age if they have not recently been screened. Both groups advise screening all adults for depression.

2. Breast cancer. The USPSTF recommends beginning mammograms at age 40, a change this year (from its earlier suggestion to begin at 50) based on new evidence; the task force advises continuing the tests every other year to age 74. The WPSI recommends that screening start at age 40 at the earliest and 50 at the latest, and take place every one or two years, continuing through at least age 74, with age alone not being a reason to stop. The American Cancer Society, in contrast, calls for most women to start screening at 45. If you have concerns or questions, such as when to stop screening, Dr. Cantor suggests you and your health-care provider approach decision-making as a shared process. “That includes a discussion about the benefits and harms of screening, an assessment of your values and preferences, and consideration of factors such as life expectancy, comorbidities, and health status,” she explains.

3. Cervical cancer. The USPSTF and WPSI recommend a Pap test for cervical cancer every three years in women ages 21 to 65. Every five years, women ages 30 to 65 should have a high-risk human papillomavirus (hrHPV) test alone or in combination with a Pap test.

4. Colorectal cancer. Both groups recommend colorectal cancer screening for women, starting at age 45 and continuing to age 75. Several tests are available, including colonoscopy and two types of stool tests that can be performed at home and sent to a lab for analysis. You and your doctor should consider a variety of factors (risk, convenience, insurance, etc.) in deciding which test may be best for you. How often to undergo screening depends on your risk of developing colon cancer and the test chosen.

5. Osteoporosis. The USPSTF and WPSI recommend bone density screening for all women age 65 or older. The test most commonly used to measure bone strength is a type of X-ray called DEXA scan. How often you need follow-up testing depends on the results of your first test.

6. Diabetes. Both groups advise screening to check for prediabetes and type 2 diabetes in adults ages 35 to 70 who are overweight or obese, even those who have no symptoms. The suggested interval is every three years. Additionally, the WPSI recommends screening for women who had gestational diabetes during a pregnancy. If you weren’t screened in the first year after giving birth, or your first screening test was negative, screening at least every three years for at least 10 years after pregnancy is recommended.

7. Hypertension. The USPSTF and WPSI recommend an in-office blood pressure check yearly for all adults ages 40 and older who do not have hypertension. Every three to five years is reasonable for 18- to 39-year-olds with normal blood pressure who are not at increased risk for hypertension. Anyone at an increased risk for high blood pressure should also be screened annually (those at greater risk include Black adults and overweight or obese adults).

8. Hepatitis C. The USPSTF and the WPSI recommend a blood test to check for hepatitis C virus (HCV) infection at least once between ages 18 and 79. Earlier or additional screening should be based on whether risk factors of HCV infection are present.

9. HIV. Both groups recommend a blood test for human immuno-deficiency virus (HIV) at least once between ages 15 and 65. Earlier or additional screening may be called for if there is an increased risk of HIV
infection.

10. Urinary incontinence. Loss of bladder control, or urinary incontinence, is a problem for many women. The WPSI recommends screening for it annually.

11. Vision. The American Academy of Ophthalmology (AAO) advises people with no vision problems to have a complete exam once in their 20s and twice in their 30s. An eye exam is also recommended for anyone age 40 or older with no vision problems if they haven’t recently been screened. Your eye doctor will tell you when to return for a follow-up exam. People with vision problems and those with medical conditions, including diabetes or high blood pressure, or a family history of eye disease, are strongly urged to get a complete eye exam before age 40.

12. Dental. The latest advice from the American Dental Association (ADA) is to see your dentist regularly to spot dental health issues early on. How often is regularly? According to the ADA, “there is no one-size-fits-all recommendation. Some people need to visit the dentist once or twice a year; others may need more visits.” DW

Bev Lucas is a freelance writer in New Jersey. She frequently covers health-care issues affecting communities of color.

EXTRA!

Did You Know. . .?

• Anxiety disorders affect about 40 million adults in the United States each year, but women are more than twice as likely as men to experience it. Women are also twice as likely as men to experience depression.
• Breast cancer is the leading cause of cancer death for Black and Latina women in the United States and is the second leading cause of cancer death among women overall.
• Approximately 11,500 new cases of cervical cancer are diagnosed every year in the United States, and about 4,000 women die of it. Latinas have the highest rates of developing cervical cancer, but Black women are more likely than women of other races to die from this disease.
• In the United States, about 10 million people have osteo-porosis and 80 percent of those are women. White and Asian women are at greatest risk, but Latina and African American women are at risk too.
• Diabetes is the leading cause of kidney failure, lower limb amputations, and new cases of blindness among adults in the United States. More than 37 million Americans have diabetes, but 20 percent don’t know it. American Indian, Black, and Latino populations are at greatest risk of developing diabetes.
• High blood pressure is a major contributing risk factor for heart failure, heart attack, stroke, and chronic kidney disease. In the United States, nearly 58 percent of Black women, including 50 percent of those over age 20, have hypertension, as do an estimated 41 percent of white and Latina women.
• Unchecked and untreated, the hepatitis C virus can lead to serious liver damage, liver cancer, and even death.
• Urinary incontinence is a relatively common problem that affects women of all ages, but many are reluctant to bring it up to their health-care provider.
• The hormones estrogen and progesterone are an important reason women should see the dentist regularly. Hormone surges from puberty to menopause may make women more vulnerable to gum disease.