A Woman's Guide to Cancer Screenings

You run two miles every other day and lift weights twice a week. You've been trying to eat more fruits and vegetables and less meat. You don't smoke. When it comes to your health, you figure you've got everything covered. But when was the last time you saw your health care provider for a health screening?

Preventive care screenings are vital to everyone's health. For women, Pap tests with or without human papillomavirus (HPV) tests, clinical breast exams, and mammograms are important tools for early detection of disease. Yet many women don't have these tests. There are many reasons for this: no time, fear of finding something, or forgetfulness. If you are afraid of getting bad news, remember this: The vast majority of screening tests come back normal, and even those that don't often do not mean cancer is present. These screenings can help you and your health care provider catch cancer at an early stage when it can be treated successfully.

Health screenings are an investment in your future. Here is a guide to screenings that the American Cancer Society (ACS) and the American Congress of Obstetricians and Gynecologists say every woman at average cancer risk needs for continued good health. These recommendations are for the average woman. Some women with higher risk may need to be screened with a different schedule because of a personal or family history of cancer. Talk with your provider to determine what schedule is best for you.  

Pap test and HPV test 

Pap tests can detect precancerous changes in the cells of your cervix before they become cancer. They can also detect cervical cancer in its early stages, when it can be treated most easily. HPV infection causes most of the cervical cell changes that lead to cervical cancer. So getting regular Pap tests with or without HPV testing gives you a better chance of preventing cancer. Occasionally, Pap tests can also help detect some cancers of the uterus and other parts of the female reproductive system.

How are these tests performed?

During a Pap test, your health care provider will gently scrape cells from the outside of the cervix, which connects the uterus to the vagina. These cells are sent to a lab for analysis. The cells can also be used for a separate HPV test that is done at the same time. If your health care provider tells you your Pap test results are abnormal, it does not necessarily mean you have cancer. Abnormal cells may indicate an infection or another cause, or they may signal precancerous changes in your cells. If you have an abnormal Pap test, your health care provider will do follow-up tests to determine the cause. If your test shows that you have HPV, your health care provider will talk to you about whether you need any other tests. 

Many women feel uncomfortable about having these tests. If you are nervous about them, talk with your health care provider. There may be things he or she can do to make you feel more comfortable.

How often?

According to the ACS, all women should have Pap tests starting at age 21. Women between ages 21 and 29 should have a Pap test every three years. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called co-testing) every five years. This is the preferred approach, but it is also acceptable to continue to have Pap tests alone every three years. Women over age 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again. A woman who has had a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer and who has no history of cervical cancer or serious precancer should not be screened. A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.

Clinical breast exams

A clinical breast exam is an exam of the breast by a health care provider or other health professional.

It is important to know how your breasts usually look and feel. You may want to talk with your health care provider about breast self exams. If you feel any lumps or notice any other changes, talk with your health care provider as soon as possible.

How is it performed?

The health care provider will carefully feel the breasts and under the arms for lumps or anything else that seems unusual. If any abnormalities are found, you may need a mammogram or an ultrasound, depending on how old you are. Mammograms are not good screening tools for young women.

How often?

For women 20 to 39, the ACS recommends that clinical breast examination (CBE) be part of a periodic health examination, preferably at least every three years. Asymptomatic women ages 40 and older should continue to receive a CBE as part of a periodic health examination, preferably every year.

Mammogram

A mammogram is an X-ray of the breast. It is a safe, effective way to detect cancerous tumors and other abnormal breast conditions. Mammograms can locate a tumor before it can be easily felt and while it is easier to treat.

How is it performed?

During a mammogram, a technician will X-ray each breast twice, once from above and once from the side. To do this, each breast must be compressed between two flat plates so that an accurate image can be taken. This can be uncomfortable, but it only lasts a few seconds. It may help to schedule this test for the week after your menstrual period when your breasts are less tender and lumpy. On the day of the mammogram, do not use deodorants, lotions, or powders. These products can show up on the image.

Digital mammography, which is approved by the FDA, records X-ray images in computer code and stores them electronically instead of on X-ray film, as with conventional mammography. There is no difference in your preparation or the procedure for a mammogram with a digital system.

If any abnormalities show up on the mammogram, your health care provider may recommend more tests and maybe a biopsy (removal of a small amount of tissue) to check for cancer.

Get your mammogram at a site approved by the FDA for conventional or digital mammography. The FDA ensures that facilities across the country meet quality standards for safety and reliability.

How often?

The U.S. Preventive Services Task Force recommends a mammogram every two years for women aged to 50 to 74. The ACS and other organizations have different age recommendations. Talk with your health care provider about when you should start having mammograms, and how often you should have them. He or she will make a recommendation based on your risk and your medical and family history.

Colorectal cancer screening

Regular screening tests for colorectal cancer should start at age 50 for women at average risk. There are different kinds of tests that can be done and each has its own recommended schedule.

*FOBT as it is sometimes done in doctors' offices, with the single stool sample collected on a fingertip during a digital rectal examination, is not an adequate substitute for the recommended at-home procedure of collecting two samples from three consecutive specimens. Toilet bowl FOBT tests also are not recommended. In comparison with guaiac-based tests for the detection of occult blood, immunochemical tests are more patient-friendly, and are likely to be equal or better in sensitivity and specificity.

There is no justification for repeating FOBT in response to an initial positive finding.