What are the guidelines for a 35-year-old female new patient presenting to a primary care clinic?

From the Guidelines

For a 35-year-old female new patient presenting to a primary care clinic, the guidelines recommend a clinical encounter, which includes ongoing breast cancer risk assessment, risk reduction counseling, as well as a clinical breast examination (CBE) every 1 to 3 years.

Key Recommendations

• Breast Cancer Screening: The NCCN panel recommends a CBE every 1 to 3 years for average-risk women aged 25 to 39 years, as well as encouraging women to be aware of their breasts and promptly report any changes to their healthcare provider 1.
• Cervical Cancer Screening: The American Cancer Society recommends cervical cancer screening to begin at age 21 years, with screening every 3 years with conventional or liquid-based Pap tests for women ages 21-29 years, and every 5 years with both the HPV test and the Pap test (preferred) or every 3 years with the Pap test alone (acceptable) for women ages 30-65 years 1.
• Colorectal Cancer Screening: The American Cancer Society recommends annual screening for colorectal cancer starting at age 50 years, with options including FOBT, FIT, stool DNA test, FSIG, DCBE, colonoscopy, or CT colonography 1.
• Other Cancer Screenings: There is no recommendation for routine screening for other cancers, such as endometrial, lung, or ovarian cancer, in average-risk women at this age 1.

Clinical Considerations

• Risk Assessment: A clinical encounter should include ongoing breast cancer risk assessment and risk reduction counseling 1.
• Patient Education: Women should be encouraged to be aware of their breasts and promptly report any changes to their healthcare provider 1.
• Shared Decision-Making: The decision to start screening mammography before age 50 years should be an individual one, taking into account patient values regarding specific benefits and harms 1.

From the Research

Guidelines for a 35-year-old Female New Patient

The guidelines for a 35-year-old female new patient presenting to a primary care clinic include:

• Screening for obesity and other cardiovascular risk factors, depression, intimate partner violence, cervical cancer, HIV, hepatitis C virus, tobacco use, and unhealthy alcohol and drug use as part of routine primary care 2
• Breast cancer screening with mammography is not recommended until age 50, but may be individualized for women 40 to 49 years of age 2
• Screening for sexually transmitted infections is based on age and risk factors, but women younger than 25 years who are sexually active should be screened routinely for gonorrhea and chlamydia 2
• Immunizations should be recommended according to guidelines from the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices 2

Components of the Well-Woman Visit

The components of the well-woman visit for a 35-year-old female include:

• Taking a comprehensive history, including obtaining detailed information on symptoms and past medical and gynecologic history 3
• Family history should be used as a risk assessment tool and should be completed and updated regularly 3
• Development and discussion of her reproductive life plan to ensure that medical testing and treatments provided are aligned with her current and future plans 3
• Counseling and screening tests that have been demonstrated to prevent disease and improve health, as recommended by the Women's Preventive Services Initiative and the U.S. Preventive Services Task Force 4, 2, 5

Preventive Services Recommendations

The preventive services recommendations for a 35-year-old female include:

• Screening for cervical cancer, HIV, and other sexually transmitted infections 2
• Immunizations against influenza, tetanus, measles, mumps, and rubella, varicella, meningococcus, and human papillomavirus 2
• Counseling on healthy lifestyle and minimizing health risks, including obesity, tobacco use, and unhealthy alcohol and drug use 2, 3