What are the United States Preventative health services recommendations for a female over 70?

Preventive Health Services for Women Over 70 in the United States

Women over 70 should receive biennial mammography screening (if under age 75), colorectal cancer screening (if not already adequately screened), annual influenza vaccination, pneumococcal vaccination (if not previously received), and should discontinue cervical cancer screening if they have had adequate prior screening. 1, 2

Cancer Screening

Breast Cancer Screening

• Women aged 70-74 years should receive biennial (every 2 years) mammography screening. 1
• For women aged 75 years and older, the evidence is insufficient to make a firm recommendation - the USPSTF concludes there is inadequate evidence to assess benefits versus harms in this age group. 1
• The rationale for uncertainty after age 75 includes: benefits of screening occur several years after testing while survival probability decreases with age, higher rates of easily-treated estrogen receptor-positive cancers in this age group, and dramatically increased risk of overdiagnosis and overtreatment after age 70-75. 1
• Do not teach or recommend breast self-examination - this provides no mortality benefit. 1
• Clinical breast examination beyond mammography has insufficient evidence to recommend for or against. 1

Cervical Cancer Screening

• Women over 70 should NOT receive routine Pap smear screening if they have had adequate prior screening (consistently normal results). 1, 2
• The American Geriatrics Society recommends Pap tests every 3 years until age 70, after which screening can be discontinued with two negative tests one year apart. 1
• USPSTF recommends against screening after age 65 in women with consistently normal prior results. 1, 2
• Continued screening after age 65 reduces cervical cancer mortality by only 0.06% at age 74 based on modeling data. 1
• Exception: Women who have never been screened should receive screening with two negative tests one year apart regardless of age. 1
• Women who had hysterectomy with cervix removal (and no history of high-grade lesions or cervical cancer) should not be screened. 1, 2

Colorectal Cancer Screening

• Women over 70 should continue colorectal cancer screening if not already adequately screened, using one of these options: 1
  • Annual fecal occult blood testing (FOBT) 1
  • Flexible sigmoidoscopy every 3-5 years 1
  • Colonoscopy every 10 years 1
  • Double-contrast barium enema every 5-10 years 1
• Digital rectal examination should be performed simultaneously with screening procedures. 1
• Medicare covers annual FOBT for individuals over 50, flexible sigmoidoscopy every 4 years (or every 2 years if high risk), and colonoscopy every 2 years if high risk. 1

Bone Health Screening

Osteoporosis Screening

• All women aged 65 years and older should undergo routine DEXA screening regardless of risk factors. 1, 3
• For women over 70 with normal bone density at age 65, repeat DEXA screening intervals should be 4-8 years unless new risk factors develop. 3
• For women with osteopenia (T-score -1.0 to -2.5), repeat DEXA in 2-3 years. 3
• For women with osteoporosis or on treatment, repeat DEXA in 1-2 years to monitor treatment effectiveness. 3
• Assess for new risk factors at each clinical encounter: height loss >4 cm, new medications affecting bone metabolism (especially glucocorticoids), development of conditions associated with bone loss. 3
• Consider vertebral fracture assessment (VFA) for women aged 70+ years with T-score ≤-1.0 at lumbar spine, total hip, or femoral neck. 3

Immunizations

Influenza Vaccination

• Annual influenza vaccination is recommended for all women aged 65 and older. 4
• Despite recommendations, only 60% of older women report receiving flu vaccination. 4

Pneumococcal Vaccination

• Pneumococcal vaccination is recommended for all women aged 65 and older if not previously received. 4
• Approximately 43% of older women have not received pneumococcal vaccination despite recommendations. 4

Counseling Services

Exercise Counseling

• Exercise counseling should be provided to all women aged 65 and older. 5
• Only 34% of older women report receiving exercise counseling, representing a significant missed opportunity. 5

Common Pitfalls to Avoid

• Do not continue Pap smear screening in women over 70 with adequate prior screening - this represents poor targeting of preventive services and provides minimal benefit (0.06% mortality reduction at age 74). 1, 5
• Do not repeat DEXA scans more frequently than every 2 years in women with normal bone density, as this exposes patients to unnecessary radiation and costs without clinical benefit. 3
• Do not assume all preventive services should continue indefinitely - mammography screening after age 75 has uncertain benefit-to-harm ratio due to increased overdiagnosis risk. 1
• Do not neglect immunizations - 40-43% of older women are not current with recommended vaccinations despite clear benefits. 4
• Recognize that preventive service utilization decreases with age - fewer than 1% of women over 65 receive all recommended screening services, requiring proactive outreach. 6