Screenings 101 Let’s face it: Your to-do list is packed—and little things like your annual gyno checkup easily fall to the bottom. But the truth is you do need a handful of basic tests every
Let’s face it: Your to-do list is packed—and little things like your annual gyno checkup easily fall to the bottom. But the truth is you do need a handful of basic tests every year, and they reap rich rewards. “So many diseases, such as hypertension and diabetes, are symptomless in the early stages, when they can be easily caught and controlled,” says Nieca Goldberg, MD, director of the NYU Women’s Heart Center. Even better: Your health insurance may cover a lot of this essential preventive care with no out-of-pocket costs for you. In addition to seeing your gynecologist once a year for a well-woman visit and your primary care doctor every two or three years for a physical, pencil in these key screenings.
A board-certified dermatologist examines the skin over your entire body (including your scalp, genitals and between your toes), looking for suspicious growths, moles or lesions. And for good reason: Skin cancer is on the rise, especially in women.
When to get it: At least once a year. “If you have risk factors such as being fair, having a lot of moles or having a family history of skin cancer, then you may need to be seen as often as every three to six months,” says David Leffell, MD, chief of dermatologic surgery at Yale School of Medicine. You could go to your primary care doc, but dermatologists are better at diagnosing potentially cancerous lesions, studies show.
During a Pap smear, your gynecologist uses a small brush and a spatula to collect cells from your cervix to screen for precancerous changes. Thanks to this test, the cervical cancer death rate declined by almost 70% between 1955 and 1992, according to the American Cancer Society (ACS).
When to get it: Every three years, provided your last one was normal. Cervical cancer is so slow to develop that three years is plenty of time to catch it. “If you get a test more often, it can pick up small suspicious changes that won’t turn into cancer but result in your getting more frequent screenings or biopsies,” says David Chelmow, MD, chair of the department of obstetrics and gynecology at Virginia Commonwealth University. In your 20s, get a Pap alone; starting at 30, you can continue having a Pap every three years, or stretch it to every five years if paired with an HPV test. Most women can stop cervical cancer screenings at age 65.
HPV (human papillomavirus) test
Typically done at the same time as a Pap, this checks for strains of HPV that are most likely to cause cervical cancer. It’s not recommended before age 30, as nearly all sexually active people contract HPV at some point, according to the Centers for Disease Control and Prevention (CDC). “Most of the time, HPV is harmless and clears up on its own,” Dr. Chelmow explains. But since HPV infection is less common in women over 30, a positive test result is more apt to signal a potential problem.
When to get it: Women age 30 to 65 should get an HPV test paired with a Pap test every five years. While the U.S. Food and Drug Administration recently approved one type of HPV test for use as a stand-alone screening, some experts say it’s not ready for prime time: “Among women whose tests have revealed precancerous cells, a small group—around 6%—have abnormal Pap smears but normal HPV tests,” Dr. Chelmow cautions.
This involves your ob-gyn visually checking your genital area and manually feeling organs such as your ovaries and uterus to note any unusual changes. While the American College of Physicians (ACP) recently issued a position statement saying pelvic screening exams are unnecessary because they don’t reduce death rates from diseases like cancer, other groups, such as the American College of Obstetricians and Gynecologists (ACOG), disagree. “It’s an important way a doctor can pick up a condition such as fibroids or infection,” says Rebecca Starck, MD, director of regional obstetrics and gynecology at the Cleveland Clinic.
When to get it: Annually starting at age 21.
These blood, urine and/or genital swab tests check for sexually transmitted diseases including gonorrhea, chlamydia and HIV. If left untreated, certain STDs can spread to your fallopian tubes, causing fertility-threatening pelvic inflammatory disease.
When to get it: The CDC and U.S. Preventive Services Task Force (USPSTF) recommend annual chlamydia and gonorrhea screening for all sexually active women under 25, as well as older women with risk factors such as a new partner or more than one partner. “I also recommend all people in their 20s have an HIV and syphilis test at some point, even if they’re low-risk,” says internist David Fleming, MD, president of the ACP.
The USPSTF recommends mammograms every two years for women at average risk of breast cancer from age 50 to 74. The ACOG recommends getting your first mammogram no later than 50, and the ACS recommends annual screening starting at 45—and earlier if you have risk factors like a family history. “Beginning this early saves thousands of lives,” says Elisa Port, MD, chief of breast surgery and director of the Dubin Breast Center at Mount Sinai Hospital in New York City.
When to get it: More and more, guidelines suggest making a shared decision with your doctor about when to start breast cancer screening. If you’re at high risk for breast cancer (for example, you have a BRCA gene mutation), you should be screened annually with both a mammogram and an MRI.
Clinical breast exam
As part of your well-woman visit, your ob-gyn examines and feels your breasts for abnormalities in size or shape or in your skin or nipples, as well as any suspicious lumps, that may indicate cancer.
When to get it: Every one to three years in your 20s and 30s and every year starting at age 40, according to ACOG.
A blood cholesterol test, aka a lipid panel or profile, reports your total cholesterol, your LDL (“bad”) cholesterol, your HDL (“good”) cholesterol and a type of fat in the blood called triglycerides. High levels of total cholesterol, LDL and triglycerides raise your risk of heart disease and stroke.
When to get it: Once every four to six years. If your results aren’t normal and/or you have risk factors such as a family history of heart disease, you may need more frequent screening. Some experts also say that women 50 and older (after menopause, when estrogen levels drop) should get checked more often—even annually, Dr. Goldberg says, depending on previous results and other risk factors like being overweight, smoking or having high blood pressure.
Blood pressure check
This test, in which an inflatable cuff attached to a dial or digital monitor is wrapped around your arm, measures the pressure in your arteries as your heart pumps. High blood pressure raises your risk of heart disease, stroke, kidney failure and other serious conditions.
When to get it: Every two years as part of a routine physical; once a year or more if your pressure is above 120/80.
In a complete exam, your doctor does things like test your eye pressure and examine the interior of your eyes by dilating them. Even if you think your vision is 20/20, you still need to have your eyes looked at regularly—especially after age 40. As you get older, you’re at risk for conditions such as glaucoma, which is symptomless but can rob you of your vision. “An exam can also find signs of another disease that may be affecting your eyes, such as diabetes or high blood pressure,” explains Rebecca Taylor, MD, an ophthalmologist in Nashville and spokesperson for the American Academy of Ophthalmology.
When to get it: In your 20s and 30s, Dr. Taylor suggests getting a full exam with an optometrist or ophthalmologist every 5 to 10 years (yearly if you wear contacts). Starting at age 40, bump it up to every two years. You may need more frequent exams if you have a family history of eye disease, have had previous eye injuries or eye surgery, have diabetes or high blood pressure or are over 65.
This blood test has become the screening test of choice for diabetes, as it measures your average blood glucose over the course of roughly three months; others, such as the fasting blood glucose test, just tell doctors what your level is that moment.
When to get it: The standard recommendation is every three years starting at 45. But the American Diabetes Association advises beginning earlier if you’re overweight and have one or more of these risk factors: You have a family member with diabetes, delivered a baby over 9 pounds, had gestational diabetes, have high blood pressure or belong to an ethnic group with higher rates of diabetes, such as African Americans, Hispanics or Native Americans.
Your doctor examines your colon using a thin, flexible tube called a colonoscope to look for ulcers, polyps, tumors and areas of inflammation or bleeding. The test is your best defense against colon cancer, the third most common cancer in both men and women. While there are other screening tools, including sigmoidoscopy and fecal blood tests, colonoscopy is considered the gold standard: “It doesn’t just diagnose; if the doctor sees adenomas (potentially precancerous polyps), he can remove them then and there,” says Seth Gross, MD, director of endoscopy at Tisch Hospital at NYU Langone Medical Center.
When to get it: Your first should happen at age 50, earlier if you’ve got other risk factors, such as a family history, or if you have suspicious symptoms like blood in your stool. If the test is negative, continue getting one every 10 years.
An X-ray test to measure bone density, this is recommended for all women at age 65. But you may want to get one around menopause, when declining estrogen levels increase your risk of osteoporosis. In 2011 the USPSTF recommended that women under 65 be screened if they have risk factors (which include smoking, not consuming enough calcium, having a family history of osteoporosis or being at a low weight). “Most women fit into one or more of the risk categories,” says Chad Deal, MD, head of the Center for Osteoporosis and Metabolic Bone Disease at the Cleveland Clinic.
When to get it: Once at menopause if you have risk factors; if your results are normal, you don’t need another scan until age 65.
Vitamin D test
Since so many of us (up to 75 percent, a 2009 study suggested) have low levels, it’s a good idea to get tested in your 20s when you go in for your physical, advises Marianne Legato, MD, professor emeritus of clinical medicine at Columbia University Medical Center.
Complete blood count
If you have heavy periods, ask your doctor about this test in your 20s, which measures the types of cells that make up your blood. Though it’s not recommended as a routine screen, it’s useful to check to see if you’re anemic.
TSH (thyroid-stimulating hormone) test
Although experts disagree about whether routine thyroid screening is necessary, make sure to get your blood level of TSH checked if you have symptoms such as fatigue, unexplained weight gain and period changes. “Thyroid disorders are more likely to be initially diagnosed in women in their 20s and 30s, so when in doubt, your doctor should check it out,” says Bill Law Jr., MD, professor of medicine and chief of endocrinology at the University of Tennessee Graduate School of Medicine.
Cholesterol particle tests
These tests look closely at LDL cholesterol particles to gauge heart disease risk. People in their 40s whose particles of LDL cholesterol are mostly small and dense have a three times greater risk of coronary heart disease. Ask about this test if your cholesterol is borderline, especially if you’re debating whether to go on cholesterol-lowering meds, Dr. Goldberg says.
Coronary calcium scan
A CT scan of your heart is used to look for specks of calcium in your arteries that may indicate hidden early signs of coronary artery disease. While it’s not recommended for everyone, it can be useful if you’re in your 40s and got a family history or other risk factors. “A score greater than 300 tells us that you’re at increased risk of cardiovascular events in the next 5 to 10 years,” Dr. Goldberg says. “In that case, your doctor would be more aggressive with medication, even if otherwise you don’t seem to need it.”
CRP (C-reactive protein) test
If you’re 50 or older, this test measures blood levels of CRP, an inflammatory protein associated with heart disease. It’s most predictive in men over age 50 and women over 60, Dr. Goldberg says. One 2010 study found that people in these age ranges at intermediate risk of heart disease who had normal cholesterol levels but high CRP levels benefited from going on cholesterol-lowering statin medications.
Skip: Complete blood count and urinalysis for general health checks
These routine tests cost the U.S. health care system as much as $80 million each year, yet they rarely pick up serious problems when used as a general screening tool, according to the American Academy of Family Physicians.
Skip: Exercise stress test for heart disease
If you’re low-risk, this isn’t a useful screening tool, as it has a high rate of false positives, Dr. Goldberg explains. As a rule, it’s best reserved for people who have heart disease risk factors or symptoms such as chest pain, shortness of breath or an irregular heartbeat.
Skip: CA-125 test for ovarian cancer
This blood test measures the protein CA-125, associated with ovarian cancer. But many other conditions, like fibroids, can also increase levels. Research shows the test doesn’t reduce rates of death from ovarian cancer and can result in unnecessary and sometimes dangerous procedures, including surgery.
Skip: Low-dose CT scan for lung cancer
Most of us aren’t even eligible for this scan, and any benefits are outweighed by the possible harms, including the risks of invasive follow-up procedures. However, people with a history of heavy smoking—30 pack-years, meaning a pack a day for 30 years, for example—should get it annually starting at age 55.