What physical examination and screening tests are recommended for a 73-year-old woman?

Screening and Physical Examination for a 73-Year-Old Woman

For a 73-year-old woman in good health, continue annual mammography, discontinue cervical cancer screening if adequately screened previously, perform colorectal cancer screening if not up-to-date, and screen for osteoporosis if not done at age 65.

Cervical Cancer Screening

Stop cervical cancer screening if she has had adequate prior screening 1. Adequate prior screening means:

• Three consecutive negative Pap tests OR two consecutive negative HPV tests within the past 10 years
• Most recent test within the last 5 years
• No history of high-grade precancerous lesions (CIN 2/3) or cervical cancer 1, 2

Continue screening only if:

• Never adequately screened previously
• History of CIN 2/3 or cervical cancer (continue for 20 years after treatment, even beyond age 65) 2
• Immunocompromised (HIV+, organ transplant, chronic immunosuppression) 2
• In utero DES exposure 2

Do not screen if she had a hysterectomy with cervix removal for benign disease 1.

Breast Cancer Screening

Continue annual mammography as long as she remains in good health and would be a candidate for breast cancer treatment 3. The 2024 USPSTF recommends biennial screening through age 74, but the decision should be individualized based on:

• Overall health status
• Life expectancy (screening requires years to show mortality benefit)
• Willingness to undergo treatment if cancer detected 3, 4

There is no definite upper age at which to discontinue mammography—base the decision on functional status and comorbidities, not chronologic age alone 3, 4.

Colorectal Cancer Screening

Screen if not up-to-date (screening recommended through age 75) 3. Acceptable options include:

• Colonoscopy every 10 years (preferred—detects cancer AND adenomas)
• Annual high-sensitivity fecal immunochemical testing (FIT) or guaiac FOBT
• Flexible sigmoidoscopy every 5 years
• CT colonography every 5 years 3

Stop screening after age 75 if previously up-to-date, unless she has exceptional health and life expectancy.

Osteoporosis Screening

Perform DXA bone density testing if not done at age 65 5. At 73, she should have already been screened. If initial screening was normal:

• Repeat DXA every 4-8 years based on baseline T-score
• Shorter intervals (≈5 years) if baseline T-score -1.5 to -1.99
• Longer intervals (≈17 years) if baseline T-score normal 5

Consider FRAX calculation (with BMD) to assess 10-year fracture risk and guide treatment decisions 5.

Cardiovascular Risk Assessment

Screen for:

• Blood pressure at every visit (sustained >135/80 mm Hg warrants diabetes screening) 6
• Dyslipidemia if not recently checked—all women 20+ with coronary heart disease risk factors 6
• Diabetes if blood pressure >135/80 mm Hg 6
• Obesity (BMI calculation) 6

Consider aspirin 75 mg daily if she's 55-79 years old and stroke reduction benefit outweighs GI bleeding risk (individualize based on cardiovascular risk profile) 6.

Infectious Disease Screening

• HIV: One-time screening if never tested 6
• Hepatitis C: One-time screening (birth cohort 1945-1965 or risk factors) 7

Behavioral Health and Safety

Screen for:

• Depression (PHQ-2 or PHQ-9) 6
• Tobacco use and offer cessation counseling 6
• Alcohol misuse (AUDIT-C or single question screening) 6
• Intimate partner violence 6

Immunizations

Ensure up-to-date:

• Influenza annually 6
• Tdap/Td (Tdap once if not received, then Td every 10 years) 6
• Pneumococcal (PCV20 once OR PCV15 followed by PPSV23) 6
• Zoster (Shingrix 2-dose series if ≥50 years) 6
• COVID-19 per current CDC recommendations

Physical Examination Components

Focus on functional assessment:

• Gait and balance (fall risk assessment)
• Vision and hearing screening
• Skin examination (melanoma risk increases with age)
• Cardiovascular examination (murmurs, peripheral pulses, edema)
• Breast examination: Not routinely recommended for screening but may be performed based on symptoms 8
• Pelvic examination: Not recommended for screening in asymptomatic women; perform only if symptoms present or indicated by history 8

Common Pitfalls to Avoid

• Do not continue cervical cancer screening if adequately screened—this leads to unnecessary procedures and anxiety 1
• Do not perform annual Pap smears at any age 9
• Do not stop mammography based solely on age 73—consider health status and life expectancy 3
• Do not use single-panel FOBT from digital rectal exam for colorectal screening—inadequate sensitivity 3
• Do not screen for breast or ovarian cancer with pelvic examination alone—insufficient evidence 8