What exam should be ordered for Medicare wellness in females?

From the Guidelines

For Medicare wellness in females, it is recommended to order a routine annual wellness exam that includes a Pap smear for cervical cancer screening every 3 years for women between 21 and 65 years old, a mammogram for breast cancer screening every year for women between 40 and 54 years old and every 2 years for women 55 years and older 1, and a clinical breast exam.

Key Exams and Tests

• Cervical Cancer Screening:
  • Women aged 21-29 years: Pap test every 3 years 1
  • Women aged 30-65 years: Pap test and HPV DNA test every 5 years or Pap test alone every 3 years 1
• Breast Cancer Screening:
  • Women aged 40-54 years: Mammography every year 1
  • Women aged 55 years and older: Mammography every 2 years or annually if preferred 1
• Clinical Breast Exam: Annually for women aged 40 years and older 1 Additionally, a lipid profile and blood pressure check should be performed. For women between 50 and 64 years old with no history of osteoporosis, a bone density test should be ordered. A human papillomavirus (HPV) test should also be considered for women between 30 and 65 years old. Furthermore, a screening for sexually transmitted infections, such as chlamydia and gonorrhea, should be performed for women under 25 years old or those at high risk. It is essential to note that the pelvic examination is not recommended as a routine screening test for asymptomatic, nonpregnant, adult women 1.

From the Research

Medicare Wellness Exams for Females

To determine the appropriate exam for Medicare wellness in females, several studies provide relevant information:

• The US Preventive Services Task Force recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years, and every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years 2.
• A study on mammography, clinical breast exam, and Pap testing found that age, level of education, smoking status, and access to healthcare were associated with screening for breast and cervical cancer 3.
• An ultrasound screening exam during Medicare Wellness visits may be beneficial, identifying frequent abnormalities and important new chronic conditions with low follow-up costs 4.
• Patterns of mammography, Pap smear, and colorectal cancer screening services among women aged 45 and over show that higher percentages of screening are associated with higher socioeconomic status, being married or living with a partner, and healthy behaviors 5.
• The Medicare Annual Wellness Visit has been shown to increase breast cancer screening, with a 22.4-percentage point increase in the probability of receiving a screening mammogram within 6 months 6.

Recommended Exams

Based on the studies, the following exams are recommended for Medicare wellness in females:

• Cervical cytology alone every 3 years for women aged 21 to 29 years
• Cervical cytology alone every 3 years, hrHPV testing alone every 5 years, or cotesting every 5 years for women aged 30 to 65 years
• Mammography every 2 years for women aged 45 and over
• Ultrasound screening exam during Medicare Wellness visits for women aged 65 and over
• Colorectal cancer screening for women aged 45 and over, with options including home fecal occult blood test, sigmoidoscopy, or colonoscopy.