What preventive health screenings and measures are recommended for an 82-year-old woman?

Preventive Health Screening for an 82-Year-Old Woman

For an 82-year-old woman, continue breast cancer screening with biennial mammography if she has good health and life expectancy exceeding 10 years, discontinue cervical cancer screening if prior results were normal, screen for osteoporosis if not previously done, and focus on cardiovascular risk factor management and immunizations. 1

Cancer Screening

Breast Cancer

• Continue mammography screening if the patient is in good health with life expectancy ≥10 years. 2
• The American Cancer Society recommends that screening decisions should be individualized based on overall health status and longevity, with screening continuing as long as a woman would be a candidate for treatment. 2
• At age 82, average life expectancy for women in the United States is approximately 9 years, but this varies significantly based on individual health status and comorbidities. 1
• If she has significant comorbidities limiting life expectancy below 5-10 years, discontinue mammography as the survival benefit from cancer screening requires at least 5 years of life expectancy. 3

Cervical Cancer

• Discontinue cervical cancer screening if she had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap co-tests within the last 10 years, with the most recent test within the last 5 years. 2, 4, 1
• Women over age 65 who meet these criteria should stop screening regardless of current age. 2
• Continue screening only if she has a history of high-grade cervical intraepithelial neoplasia (CIN2 or worse), which requires surveillance for at least 20 years even beyond age 65. 2
• Women who have had a total hysterectomy with cervix removal for benign reasons should not be screened. 4

Colorectal Cancer

• At age 82, colorectal cancer screening should generally be discontinued as individuals over age 85 should be discouraged from continuing screening due to minimal incremental benefit that is unlikely to outweigh harms. 1
• The decision depends heavily on prior screening history—those with consistently normal prior screening derive minimal benefit from continued screening. 1
• If she has never been screened and is in excellent health with life expectancy >10 years, consider one-time screening, but this is not standard practice at this age. 1

Bone Health

Osteoporosis Screening

• Screen with bone density testing (dual-energy x-ray absorptiometry of the femoral neck) if not previously done. 2
• The National Osteoporosis Foundation recommends bone density testing for all women 65 years and older. 2
• Femoral neck measurement by dual-energy x-ray absorptiometry is the best predictor of hip fracture. 2
• If previously screened with normal results, repeat screening intervals should be at least 2 years, though longer intervals may be adequate. 2

Cardiovascular Risk Management

Blood Pressure

• Measure blood pressure at every visit. 1
• Hypertension prevalence in women over 65 is 76.6%, making this a critical screening measure. 5

Lipid Screening

• Continue lipid profile screening with intervals based on prior results and cardiovascular risk. 1
• Women at advanced age have considerably higher total cholesterol levels than men, and approximately 10 million elderly (two-thirds women) may require lipid management. 6
• The Framingham Risk Score can guide treatment decisions, though its application in very elderly populations has limitations. 2

Diabetes Screening

• Screen with hemoglobin A1C, especially if BMI ≥25 kg/m² or other risk factors present. 1
• Diabetes affects 21.2% of older adults, making screening important even at advanced age. 5

Cognitive Screening

• Perform annual screening for cognitive impairment using Mini-Cog, Mini-Mental State Examination, or Montreal Cognitive Assessment. 1
• This is recommended for all adults 65 years and older. 1

Immunizations

• Administer annual influenza vaccine. 3
• Ensure pneumococcal vaccination is up to date (both PCV13 and PPSV23 as appropriate). 3
• Verify tetanus-diphtheria booster status (every 10 years). 3
• Consider herpes zoster vaccination if not previously administered. 3

Lifestyle Counseling

• Counsel on smoking cessation if applicable, diet rich in healthy fats, aerobic exercise, and strength training. 3
• These interventions remain beneficial even at advanced age, as many aspects of mortality are modifiable through behavior change. 3
• Physical inactivity is one of the actual causes of death that can be addressed at any age. 3

Key Clinical Pitfalls

• Avoid continuing cancer screening in patients with limited life expectancy (<5-10 years) as harms outweigh benefits. 3
• Do not screen for cervical cancer in women over 65 with adequate prior negative screening—this represents unnecessary testing. 2, 4
• Recognize that goal attainment for hypertension, dyslipidemia, and diabetes is problematic in older adults (48.8%, 64.9%, and 50.4% respectively among those treated), requiring close monitoring. 5
• Remember that women have higher rates of hypertension but lower control rates when treated (42.9% vs 57.9% in men), necessitating more aggressive management. 5