Screening Tests for a 71-Year-Old Female
A 71-year-old woman should undergo annual mammography screening and can discontinue cervical cancer screening if she has had adequate prior negative testing. 1
Breast Cancer Screening
Annual mammography is recommended and should continue as long as she remains in good health with a life expectancy of 10 years or longer. 2
- At age 71, this patient falls into the category where observational studies demonstrate continued benefit from screening mammography, even though randomized trials did not enroll women over 74 years 2
- Annual screening reduces mortality by 40% compared to 32% for biennial screening in women aged 40-84 years 2
- There is no specific upper age limit for mammography screening—decisions should be based on life expectancy and competing comorbidities rather than age alone 2, 1
- For a 70-year-old woman without significant comorbidities, average life expectancy is approximately 19 years, which strongly justifies continued screening 3
- Women should continue screening as long as they remain in overall good health and are willing to undergo subsequent testing or biopsy if an abnormality is identified 2
Important Considerations for Breast Screening
- Clinical breast examination can be performed as part of periodic health evaluation, though mammography remains the primary screening modality 2
- The mortality reduction from screening mammography requires years to be fully attained, making continued screening appropriate for women with reasonable life expectancy 2
Cervical Cancer Screening
This patient can discontinue Pap smear screening if she meets specific criteria. 1
- Women over age 65 can stop cervical cancer screening if they have had at least 3 consecutive negative Pap tests OR at least 2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test within the last 5 years 2, 1
- She must have no history of high-grade precancerous lesions or cervical cancer 1
- If she has had a total hysterectomy with removal of the cervix for non-cancerous reasons, she can stop screening 2, 1
- Exception: Women with a history of cervical cancer or high-grade precancerous lesions should continue screening for at least 20 years after treatment, even beyond age 65 1
Colorectal Cancer Screening
Annual fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT), or colonoscopy every 10 years, or flexible sigmoidoscopy every 5 years is recommended. 2
- Screening should have been initiated at age 50 and should continue 2
- Colonoscopy every 10 years remains the gold standard option 2
- If using FOBT/FIT, testing must be done at home with adherence to manufacturer's recommendations—single stool samples collected during digital rectal examination are not adequate 2
- Flexible sigmoidoscopy every 5 years is an alternative, potentially combined with annual FOBT/FIT 2
Endometrial Cancer Awareness
She should be counseled about endometrial cancer symptoms and instructed to report any unexpected vaginal bleeding or spotting immediately. 2, 1
- At menopause, women should be informed about risks and symptoms of endometrial cancer 2, 1
- Routine screening for endometrial cancer is not recommended for average-risk women 2
- Prompt reporting of any abnormal bleeding is critical 1
Additional Screening Considerations
Bone Density Screening
- While not explicitly covered in the provided evidence, bone density screening (DEXA scan) is typically recommended for women at age 65 or postmenopausal women with risk factors
Common Pitfalls to Avoid
- Do not stop mammography screening based solely on age 71—base the decision on overall health status and life expectancy 2, 3
- Do not perform single-sample FOBT during digital rectal examination—this is inadequate for colorectal cancer screening 2
- Do not continue cervical cancer screening unnecessarily if adequate prior negative testing has been documented and she has no high-risk history 1
- Do not delay investigation of any unexpected vaginal bleeding in this age group, as it may indicate endometrial cancer 1