At a typical yearly visit in primary care, your health care provider is likely to run through a checklist of screening questions with you. As you near middle age, you may dread that “it’s-time-for-your-first-colonoscopy” talk — and wonder what exactly will happen and why. Not to mention that you need to plan for mammograms and Pap tests as well.
While having all these tests may be less than appealing, it might help to look at these important screening exams as an opportunity to invest in your health.
Rather than focusing on treating illnesses as they pop up, prevention means taking steps in your daily life and with your routine health care to prevent illnesses from happening in the first place. In addition, screening and health maintenance efforts are meant to catch and treat important diseases and conditions at early, more manageable stages.
Here’s a look at routine screening tests that are recommended for women as they enter into midlife and beyond. Keep in mind that the recommended screening schedules are for women at average risk. If you’re at increased risk of a particular condition or cannot comply with the recommended testing schedule, your health care provider will work with you to come up with a screening schedule that’s appropriate for you.
Breast cancer screening
All women are at risk of breast cancer. Likely surprising to most, the biggest risk factor for developing breast cancer is age. To increase the chance of detecting breast cancer at an earlier stage — when the probability of successful treatment is highest — it’s important to be screened with a mammogram.
Many professional organizations no longer recommend that health care providers perform a yearly clinical breast exam. If you have a strong family history of breast cancer or other factors that place you at high risk, talk with your provider to decide whether you should have a yearly clinical breast exam. Whether women benefit from home self-breast exams is not clear, though many providers will still encourage women to be familiar with their own bodies.
What’s the mammogram for?
During a mammogram, images are taken of your breast tissue while your breasts are compressed between X-ray plates. The test can detect invasive cancer, noninvasive cancer, and precancerous or high-risk changes in breast tissue. A mammogram can identify small breast masses and calcifications — often the first indication of early breast cancer — which are too small to be felt.
When and how often should you have it?
There’s been debate in recent years over the best screening schedule for mammograms. Presently, the best advice is to consider screening mammograms starting at age 40. If you’re at high risk of breast cancer, you may have screenings sooner. Between ages 40 and 49, discuss with your health care provider how often to have a mammogram. If you’re age 50 or older, have a mammogram every 1 to 2 years. If you’re age 75 or older, talk with your provider about how long to continue having mammograms. In some cases, other breast-imaging methods may be used in addition to a mammogram.
Cervical cancer screening
With a Pap test, a health care provider inserts a plastic or metal speculum into the vagina to view the cervix. Then, using a spatula and a soft brush, he or she gently obtains scrapings from the cervix, places the sample in a bottle, and sends it to a laboratory for analysis. This test may be accompanied by human papillomavirus (HPV) screening, which involves the same process and can be done at the same time as the Pap test.
What’s the test for?
The Pap test detects cancer and precancerous changes in the cervix. HPV screening is done to check for the presence of a high-risk strain of HPV. Almost all cervical cancers are linked to exposure to and presence of a high-risk strain of this sexually transmitted virus.
When and how often should you have it?
Women should start having Pap tests at age 21. For women ages 21 to 29, Pap tests are recommended every three years. Women over age 30 can have a Pap test every three years, or co-testing — HPV testing in addition to the Pap test — every five years. In some cases, the HPV testing may be done on its own.
For women who’ve had a total hysterectomy — which includes removal of the cervix — for a noncancerous condition, routine Pap tests aren’t necessary. They’re also not necessary if you’re age 65 or older, you’ve had typical test results over the past 10 years (including the last three Pap tests or the last two co-tests), and you aren’t at high risk of developing cervical cancer. When in doubt, ask your health care provider what’s appropriate for you.
Regular Pap tests are especially important if you smoke, if you’ve had a sexually transmitted infection or multiple sex partners, and if you have a history of cervical, vaginal or vulvar cancer. You’re also at increased risk of cervical cancer and should be screened regularly if your immune system is suppressed or you were exposed to the synthetic hormone diethylstilbestrol (DES) in utero.
Although there’s no known cure for HPV infection, the cervical changes that result from it can be treated. Fortunately, for most women, HPV infection clears on its own within 1 to 2 years.
Colorectal cancer screening
For this screening exam, a variety of tests may be used. You may have just one or a combination.
- Colonoscopy. With this exam, a long, flexible tube (colonoscope) is inserted into the rectum, which allows the health care provider to examine the entire length of your colon. This is considered the gold standard for colon cancer screening.
- Virtual colonoscopy. For this exam, computerized tomography (CT) is used to produce cross-sectional images of your abdominal organs.
- Flexible sigmoidoscopy. Similar to a colonoscopy, a thin tube is inserted into your rectum. However, this test only evaluates the lower part of the colon (sigmoid colon).
- Fecal occult blood test or fecal immunochemical test. With these tests, a stool sample is tested in a lab for hidden (occult) blood.
- Stool DNA test. This test uses a stool sample to look for DNA changes in cells that might indicate the presence of colon cancer or precancerous conditions. It also looks for signs of blood in your stool.
What’s the test for?
To detect cancer and precancerous growths (polyps) on the inside wall of the colon that could become cancerous. Many people are afraid to have colorectal cancer screening because of fear of embarrassment or worry or discomfort. However, this screening could save your life by detecting and removing precancerous polyps, thereby preventing this common cancer from occurring. Early detection of cancer also can be lifesaving.
When and how often should you have it?
If you’re at average risk of developing colorectal cancer, you may begin screening tests as early as 45. The frequency of screening will depend on the type of test you have.
Talk with your health care provider about which screening approach and frequency are best for you, given your health issues. If you’re at increased risk of developing colorectal cancer, your provider may recommend beginning screenings at an earlier age and scheduling them more frequently.
Partner with your provider
Keep in mind that the screening recommendations are general guidelines. Work with your health care provider to develop a schedule that fits your individual risks and preferences. Developing a healthy partnership with your provider — one where you can candidly discuss your risks, concerns and symptoms — is a key step in maintaining good health.
Relevant reading
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