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Health screening - women - ages 40 to 64

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

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

Information

Even if you feel fine, you should still see your 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 once a year. 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. You can also 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

  • Begin cholesterol screening between the ages of 40 to 45.
  • Once cholesterol screening has started, your cholesterol should be checked every 5 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.
  • Have an eye exam at least every year if you have diabetes.

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 year.
  • Your provider may recommend 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.
  • Women with a mother or sister who had breast cancer at a younger age should consider yearly mammograms. They should begin earlier than the age at which their youngest family member was diagnosed.

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 US 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

American College of Obstetricians and Gynecologists. Committee opinion no. 641: human papillomavirus vaccination. Obstet Gynecol. 2015;126(3): e38-43. PMID: 26287792. www.ncbi.nlm.nih.gov/pubmed/26287792.

American College of Obstetricians and Gynecologists. Practice bulletin no. 131: screening for cervical cancer. Obstet Gynecol. 2012;120(5):1222-1238. PMID: 23090560. www.ncbi.nlm.nih.gov/pubmed/23090560.

American College of Obstetricians and Gynecologists. Practice bulletin no. 157: cervical cancer screening and prevention. Obstet Gynecol. 2016;127(1):e1-e20. PMID: 26695583. www.ncbi.nlm.nih.gov/pubmed/26695583.

American Dental Association. Questions about going to the dentist. 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;146(5):1413-1414. PMID: 24742563. www.ncbi.nlm.nih.gov/pubmed/24742563.

American Optometric Association. Comprehensive adult eye and vision examination. Updated February 6, 2015. 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's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 15.

Chamberlain JJ, Rhinehart AS, Shaefer CF Jr, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association Standards of medical care in diabetes. Ann Intern Med. 2016;164(8):542-552. PMID: 26928912. www.ncbi.nlm.nih.gov/pubmed/26928912.

De Paula FJA, Black DM, Rosen CJ. Osteoporosis and bone biology. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 29.

James PA, Oparil S, Carter BL, 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;311(5):507-520. PMID: 24352797. www.ncbi.nlm.nih.gov/pubmed/24352797.

Kim DK, Bridges CB, Harriman KH; Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices (ACIP); ACIP Adult Immunization Work Group. Advisory Committee on immunization practices recommended immunization schedule for adults aged 19 years or older--United States, 2016. MMWR Morb Mortal Wkly Rep. 2016;65(4):88-90. PMID: 26845417. www.ncbi.nlm.nih.gov/pubmed/26845417.

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;45(12):3754-3832. PMID: 25355838. www.ncbi.nlm.nih.gov/pubmed/25355838.

Mosca L, Benjamin EJ, Berra K, 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):1243-1262. PMID: 21325087. www.ncbi.nlm.nih.gov/pubmed/21325087.

Moyer VA; US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. PMID: 24378917. www.ncbi.nlm.nih.gov/pubmed/24378917.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): breast cancer screening and diagnosis. Version 3.2015. www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed July 24, 2015.

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):147-172. PMID: 22422631. www.ncbi.nlm.nih.gov/pubmed/22422631.

Siu AL; US Preventive Services Task Force. Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786. PMID: 26458123. www.ncbi.nlm.nih.gov/pubmed/26458123.

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;63(2):88-105. PMID: 23378235. www.ncbi.nlm.nih.gov/pubmed/23378235.

Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation. 2014;129(25 Suppl 2):S1-S45. PMID: 24222016. www.ncbi.nlm.nih.gov/pubmed/24222016.

US Preventive Services Task Force. Final recommendation statement: cervical cancer: screening. Updated October 2014. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/cervical-cancer-screening. Accessed April 19, 2016.

US Preventive Services Task Force. Draft recommendation statement: statin use for the primary prevention of cardiovascular disease in adults: preventive medication. www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement175/statin-use-in-adults-preventive-medication1.

US Preventive Services Task Force. Final update summary: breast cancer: screening. Updated February 2016. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1. Accessed March 9, 2016.

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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. Internal review and update on 8/5/2016 by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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