The Health Screenings Every Woman Should Get At Every Age

While some people go to the doctor for annual check-ups or when they’re experiencing specific symptoms, there are other crucial exams and screenings to have on your radar. In fact, there are various health check-ups every woman needs at different stages of life. But it can get confusing to keep track of them all. Aren’t mammograms not necessary until your mid-40s? (According to the Mayo Clinic, you should start having them at age 40 and then continue to go once a year or every other year, depending on what you and your doctor decide.) And did you know that you should start getting screened for cervical cancer at the age of 21?

And of course, there’s the fact that some women need to be tested more frequently than others if there is a history of cancer or other medical ailments in their genetic lineage. “Good health habits and lifestyle choices should start at a young age, but it’s never too late to commit to your health,” Dr. Sherry Ross, women’s sexual health expert and author of she-ology and she-ology the she-quel, tells TZR in an email. “Embrace and value the importance of your preventative screening tools, including Pap smears and mammogram screening tests. Get educated, know what’s at stake, and take control over your feminine health.”

Ahead, doctors lay out a comprehensive health screening plan for every stage of and decade of your life. (Also, keep in mind that the age parameters below are for those with average to little risk of specific conditions. If you have a history of certain cancers in your family, check with your doctor about when you should begin testing.)

HPV & Cervical Cancer: Starting At Age 21

You may know that HPV can lead to cervical cancer, which is why it’s important to be tested for both. “HPV is an epidemic and highly contagious sexually transmitted infection (STI) known to cause precancerous and cancer changes in the cervix, anus, penis, head, neck, and throat,” says Ross. To that end, over 90% of cervical cancer is caused by high-risk HPV, adds Catherine Dezynski, medical science liaison at BD, a global medical technology company. “There are 14 high-risk HPV genotypes, and each high-risk genotype is associated with a different level of risk of progression to cervical precancer and cancer,” she tells TZR in an email. “Most HPV infections will clear on their own, but for those infections that do not clear spontaneously, these are the people at high risk for developing a cervical pre-cancer and need to be monitored more closely.” And, because of the link between HPV and cervical cancer, the importance of the HPV vaccines can't be stressed enough, Erica Montes, board-certified OB/GYN, and pH-D Feminine Health Advisor, tells TZR.

But when you get tested varies depending on the source, Dezynski says. “The U.S. Preventive Services Task Force (USPSTF) advises cervical cancer screening with a Pap test alone, also called cytology, in ages 21 to 29 years,” she says. “Once in the age range of 30 to 65 years, you may screen with a Pap test every three years, a HPV test alone, or a cotest, which is the HPV test and the Pap test.” However, the American Cancer Society recommends you start getting screened for HPV and cervical cancer at the age of 25, then every five years until age 65. “If primary HPV testing is not available, then you can be screened with both HPV/Pap cotest every five years, or a Pap test alone every three years,” says Dezynski.

In addition, you may need to be tested more often if you’ve had a prior positive HPV test, she explains, are immunocompromised, or if you have a history of abnormal cervical cells on a biopsy (also called cervical dysplasia). “Cervical dysplasia is not cancer, but it is pre-cancer — if not detected early, it can progress into cervical cancer,” Dezynski says. Ross also says discussing your personal risks for cervical cancer with your health care provider will help you determine how frequently you should have Pap smear and HPV testing.

Montes says the Pap test is one of the only tests that we can use to prevent and detect cervical cancer. “Prevention is key,” she adds. Dezynski agrees. “When we screen patients, we are actually looking for those with cervical pre-cancer so we can more closely monitor those specific patients — and stop the pre-cancer cells from turning into cancer cells,” she says. “Even if you received the HPV vaccine, you still are at risk for the HPV types that are not included in the vaccine and need to have routine cervical cancer screening. And if you were exposed to HPV prior to receiving vaccination, you are still at risk for carrying the virus.”

Mammograms: Starting At Age 40

In the United States, one in eight women will develop breast cancer in their lifetime. Mammography — which uses X-ray technology to view the breasts — is the primary tool used to screen for breast cancer and other problems. “For women at average risk of breast cancer, screening mammography is recommended every one to two years beginning at age 40,” Monte Swarup, board-certified in OB/GYN and founder of HPD Rx, tells TZR in an email. “And screening should continue until at least age 75.”

Ross agrees, but says certain women should get screened more often — those who have a family history of breast cancer or dense breasts, people who eat a diet high in red meat or consume two or more alcoholic beverages per day, and those who have a high body mass index (BMI) — over 30.

“Regular breast screening can help find cancer at an early, and more curable, stage,” says Swarup. “Screening can also find problems in the breasts that are not cancer.” Between mammograms, it’s important for women to do self-exams at home. “You and your breasts have a long relationship together, so it’s important to identify any changes in breast shape, size, skin changes, or nipple discharge,” says Ross. She adds that breast tissue can be intimidating in the beginning, but once you become familiar with yours — and all its normal lumps and bumps — you will be able to find abnormal changes if they occur. “The best time to do a self-exam at home is once a month, during the first week of your period, when the hormonal effects on breast tissue have subsided,” she explains. “There are five steps to it, and with each step, you need to look at your breasts closely to identify any new changes,” she says.

• Stand in front of the mirror with your hands on your hips.
• Raise your arms over your head while looking for changes in the mirror.
• Look for any discharge or fluid coming from the nipples.
• Lie on your back and feel each breast, looking for lumps and unfamiliar tissue changes. Extend the hand over your head of the breast you are examining. Use the opposite hand and run your fingertips firmly over the breast tissue in a circular motion, about the size of a quarter. Think of the breast as a “+” sign, feeling each quarter in a purposeful way each month. Once you have finished examining each breast, check each underarm to feel for similar changes.
• Stand up or sit and recheck your breasts in a similar fashion as above.

“Sometimes checking the breasts in the shower, when the skin is wet and slippery, helps identify abnormal findings more easily,” Ross adds. “And your gynecologist can also walk you through the steps.”

As for symptoms of breast cancer, you may or may not have any. But Swarup recommends making an appointment with your doctor if you notice a hard lump or knot near your underarm; changes in the way your breasts look or feel, including thickening or prominent fullness that is different from the surrounding tissue; dimples, puckers, bulges, or ridges on the skin of your breast; a recent change in a nipple to become pushed in (inverted) instead of sticking out; redness, warmth, swelling, or pain; itching, scales, sores, or rashes; or bloody nipple discharge.

Montes adds that if you notice any of these abnormalities, you should be evaluated ASAP. “Unfortunately, we are seeing more breast cancer in younger women — and especially in women of color — so any change is important to get evaluated,” she says. To that end, the Centers for Disease Control and Prevention (CDC) CDC states that 9% of all new cases occur in women under 45. And, according to the American Cancer Society, as of 2019, breast cancer became the primary cause of cancer death for Black women. “Going to the OB/GYN or general physician can be uncomfortable, particularly when dealing with such intimate issues,” says Montes. “But remember that we are here to help, and want you to feel heard and comfortable. Showing up for your health is the best thing you can do!”

Skin Cancer: Starting In Your 20s

Although there are no specific guidelines for getting screened for skin cancer, early detection is important, according to the Skin Cancer Foundation. “You should start getting screened for skin cancer in your 20s or 30s,” Denise Gallo, APRN, board-certified nurse practitioner with SkinCare Physicians of Fairfield County, a division of Advanced Dermatology, PC, tells TZR in an email. “This is important because it is a safe, easy way to detect skin cancer. Early detection, especially in melanoma, can save your life.”

Although a dermatologist can do a full-body skin exam annually, self-exams can help you catch skin cancer early. “Keep track of the spots on your skin and make note of any changes from year-to-year,” says Gallo. “Examine your body from front to back with a mirror. Look at your left and right sides with your arms raised — and check your forearms, underarms, and palms. Use a hand mirror to examine your back, neck, and scalp, and also check your back and buttocks.” She says not to forget about looking at the backs of your legs and feet, as well as in between your toes and on the soles of your feet. “Legs are a common site in women,” says Gallo. “Non-melanoma skin cancer disproportionately affects women younger than 45. If you notice a mole that is different from others, or that changes or bleeds, make an appointment with your dermatologist.”

Colon Cancer: Starting At Age 45

Colorectal cancer — also known as colon cancer — is the third most common cancer for men and women in the U.S. “In many cases, it is entirely preventable,” Max Pitman, medical director at Salvo Health, a startup for chronic gut illnesses, tells TZR. “Routine screening colonoscopy can detect precancerous polyps at an early stage and remove them before they can turn into cancer. It also can detect cancers at an early stage so they can be effectively treated.”

He says that over the last 10 years, doctors are seeing more colon cancers in younger patients less than 50 years old, which is why it is now important to start screening at age 45. And 45 is the age The American Cancer Society and US Preventive Services Task Force now recommend for women and men at average risk of colon cancer. “Colonoscopy is usually considered the best screening test for colon cancer, but other types of screening — such as stool testing and CT scans — are available, as well,” says Pitman.

However, if you are at higher risk of colon cancer because of a strong family history of it — or if you have another condition that puts you at higher risk (such as ulcerative colitis) — then your doctor may recommend that you start screening earlier. “Exactly when to start screening depends on your risk factor, like who in your family had colon cancer,” says Pitman. “Was it multiple family members? At what age were they diagnosed? These are all important questions to discuss with your doctor.”

If you are at average colon cancer risk and you have a completely normal colonoscopy at age 45 with a good colon cleanse (the medication you have to take the night before) and no polyps, you would get a colonoscopy every 10 years. “But if you have polyps removed during your first colonoscopy, or if you’re at higher risk of getting colon cancer, you might have colonoscopies more frequently,” says Pitman. “This may mean every five years, or even more often for some conditions.”

As for symptoms to watch for, you may not have any. But Pitman says to take note of blood in your stool, a sudden change in bowel habits, new and persistent abdominal pain, or unexplained anemia. “Many times, colon cancer has no symptoms until later stages, though, which is why it’s so important to do routine screening even when you have no symptoms,” he says. “And other lifestyle factors can decrease your risk of colon cancer, too. These include not smoking, maintaining an active lifestyle, limiting excess alcohol consumption, and eating a diet low in processed foods and high in fiber, fresh fruits and vegetables, whole grains, and healthy fats and proteins.”

As Benjamin Franklin famously said, “An ounce of prevention is worth a pound of cure” — which is why it’s essential to keep up with the aforementioned health screenings. They just may save your life.