Screening Guidelines for Women: Comprehensive Age-Based Recommendations
Cervical Cancer Screening
Begin cervical cancer screening at age 21 years regardless of sexual activity history, screen every 3 years with cytology alone until age 29, then transition to co-testing (cytology plus HPV) every 5 years from ages 30-65, and stop screening after age 65 with adequate negative prior results. 1
Ages 21-29 Years
- Screen every 3 years with conventional or liquid-based Pap test (cytology alone) 1, 2
- Do NOT use HPV testing or co-testing in this age group because HPV infections are extremely common and usually transient in younger women 1, 3
- Do not screen women younger than 21 years, even if sexually active 1, 2
Ages 30-65 Years
- Preferred strategy: Co-testing (cytology plus HPV DNA test) every 5 years 1, 2
- Acceptable alternative: Cytology alone every 3 years 1, 2
- HPV testing should never be used as a stand-alone screening test 1, 3
When to Stop Screening (Age >65 Years)
- Stop screening if ≥3 consecutive negative Pap tests OR ≥2 consecutive negative co-tests within the last 10 years, with the most recent test in the last 5 years 1, 3, 2
- Women who have had total hysterectomy with cervix removal for benign reasons should stop screening 1, 3, 2
Critical Pitfall to Avoid
- Annual screening is NOT recommended for any age group 1
- Women vaccinated against HPV must follow the same screening recommendations as unvaccinated women 1, 3
Breast Cancer Screening
Women should begin annual mammography screening at age 45 years, transition to biennial screening at age 55, and continue as long as life expectancy exceeds 10 years. 1
Ages 40-44 Years
- Women should have the opportunity to begin annual screening, but this is a qualified recommendation 1
Ages 45-54 Years
- Annual mammography screening (strong recommendation) 1
Ages ≥55 Years
- Transition to biennial (every 2 years) screening 1
- Women may choose to continue annual screening 1
- Continue screening as long as overall health is good and life expectancy is ≥10 years 1
Colorectal Cancer Screening
Begin colorectal cancer screening at age 45 years with either stool-based testing or structural examination, continue through age 75 years in good health, and individualize decisions for ages 76-85 based on health status and prior screening. 1
Ages 45-75 Years
- Multiple acceptable options 1:
- Annual fecal immunochemical test (FIT) or high-sensitivity guaiac-based fecal occult blood test (gFOBT)
- Multitarget stool DNA test every 3 years
- Colonoscopy every 10 years (preferred structural exam)
- CT colonography every 5 years
- Flexible sigmoidoscopy every 5 years
- All positive non-colonoscopy tests must be followed with timely colonoscopy 1
- Continue screening through age 75 in adults with good health and life expectancy >10 years 1
Ages 76-85 Years
- Base screening decisions on patient preferences, life expectancy, health status, and prior screening history 1
Ages >85 Years
- Discourage continued screening 1
Chlamydia Screening
Screen all sexually active women aged ≤24 years annually for chlamydia, and screen women aged ≥25 years only if they have increased risk factors.
Who to Screen
- All sexually active women age 24 years and younger: annual screening
- Women age 25 years and older with risk factors: new sexual partner, multiple partners, partner with STI, inconsistent condom use, sex work, or history of STI
Blood Pressure Screening
Screen all adults aged ≥18 years for hypertension with office blood pressure measurement, and confirm diagnosis with out-of-office measurements before initiating treatment.
Screening Frequency
- Adults aged 18-39 years with normal BP (<120/80 mmHg) and no risk factors: every 3-5 years
- Adults aged ≥40 years or those with increased risk (BP 120-139/80-89 mmHg, overweight/obesity, Black race): annually
- Confirm all elevated readings with ambulatory or home blood pressure monitoring before diagnosing hypertension
Diabetes Screening
Screen all adults aged 35-70 years who are overweight or obese (BMI ≥25 kg/m²) for type 2 diabetes every 3 years, and screen earlier or more frequently in those with additional risk factors.
Who to Screen
- All adults aged 35-70 years with BMI ≥25 kg/m² (or ≥23 kg/m² in Asian Americans): every 3 years
- Earlier screening for those with additional risk factors: family history of diabetes, history of gestational diabetes, polycystic ovary syndrome, high-risk race/ethnicity (African American, Latino, Native American, Asian American, Pacific Islander)
- Screen all pregnant women at 24-28 weeks gestation for gestational diabetes
Screening Methods
- Fasting plasma glucose, hemoglobin A1c, or oral glucose tolerance test are all acceptable
Diabetic Eye Exam (Retinopathy Screening)
All patients with diabetes should have a comprehensive dilated eye examination by an ophthalmologist or optometrist at diagnosis (Type 2) or within 5 years of diagnosis (Type 1), then annually thereafter if no retinopathy is present.
Type 1 Diabetes
- Initial comprehensive dilated eye exam within 5 years of diagnosis
- Annual exams thereafter
Type 2 Diabetes
- Initial comprehensive dilated eye exam at time of diagnosis
- Annual exams thereafter
Frequency Modifications
- If no retinopathy present on one or more annual exams and glycemic control is good: may extend to every 2 years
- If any retinopathy present: continue annual or more frequent exams as recommended by eye care specialist
- Pregnant women with diabetes: exam in first trimester, then monitor throughout pregnancy and for 1 year postpartum
Special Population: HIV-Positive Women
HIV-positive women require more intensive cervical cancer screening starting at age 21 or within 1 year of sexual debut, with annual screening for the first year after HIV diagnosis, then annually thereafter for life—standard age-based stopping criteria do NOT apply. 4, 3
- Screen twice in the first year after HIV diagnosis, then annually indefinitely 4
- Use cytology as primary screening method; primary HPV testing alone is not recommended 4
- After 3 consecutive normal annual results, may extend to every 3 years 4
- Never stop screening based on age—lifelong screening is required 4