What should be included in an annual exam for a 20-year-old female?

Annual Examination Components for a 20-Year-Old Female

The annual examination for a 20-year-old female should include a clinical breast examination (CBE) every 3 years, cervical cancer screening beginning approximately 3 years after first vaginal intercourse (but no later than age 21), and a comprehensive cancer-related checkup with appropriate counseling about risk factors and preventive health measures. 1, 2

Core Components

• A complete medical history focusing on family history of cancer, particularly breast cancer, should be taken to identify patients who may benefit from genetic counseling 1
• Clinical breast examination (CBE) should be performed every 3 years for women in their 20s as part of periodic health examination 3
• A comprehensive physical examination with particular attention to blood pressure measurement, heart, lungs, abdomen, and reflexes should be performed 2

Cancer Screening

• Cervical cancer screening with Pap test should begin approximately 3 years after a woman begins having vaginal intercourse, but no later than age 21 3
• Screening should be done every year with conventional Pap tests or every 2 years using liquid-based Pap tests 3
• Discussion about breast self-examination (BSE) benefits and limitations should be conducted, emphasizing prompt reporting of any new breast symptoms 3, 1
• No mammography is recommended at this age (begins at age 40) 3

Counseling and Education

• Health counseling about tobacco use, sun exposure, diet and nutrition, risk factors, sexual practices, and environmental/occupational exposures should be provided 3, 1
• Education about risk factors for various cancers and preventive measures should be provided 1
• The importance of recognizing breast cancer symptoms and developing awareness about breast changes should be discussed 2

Cancer-Related Checkup

• Examination for cancers of the thyroid, ovaries, lymph nodes, oral cavity, and skin should be performed as part of the cancer-related checkup 3, 1
• This comprehensive cancer-related checkup should be performed every 3 years from ages 20 to 39 3

Breast Health

• If the patient chooses to perform BSE, instruction and technique review should be provided 3
• The American Cancer Society no longer recommends monthly BSE beginning at age 20, but emphasizes the importance of prompt reporting of any new breast symptoms 3
• Women who choose to do BSE should receive instruction and have their technique reviewed during the periodic health examination 3

Common Pitfalls to Avoid

• Ordering unnecessary screening tests not recommended for this age group (e.g., mammography, colorectal cancer screening) should be avoided 1, 2
• Performing annual Pap tests when guidelines recommend less frequent screening based on risk factors should be avoided 1, 2
• Failing to provide adequate education about the importance of recognizing and reporting new symptoms should be avoided 1, 2
• Overlooking family history that might indicate need for earlier or more intensive screening should be avoided 2

Patient Expectations

• Be aware that many patients expect comprehensive annual physical examinations and extensive laboratory testing despite lack of evidence supporting these practices for healthy adults 4, 5
• Patients may desire tests that are not recommended for their age group, such as mammography, cholesterol measurement, and urinalysis 4
• Use the examination as an opportunity to reinforce behaviors that have kept the patient healthy rather than focusing solely on disease detection 6