Annual Physical Guidelines for Women in Their 50s
For women in their 50s, the annual visit should focus on evidence-based cancer screening (annual mammography, cervical cancer screening every 2-3 years if prior tests normal, and colorectal cancer screening), cardiovascular risk assessment with blood pressure and lipid screening, and targeted counseling rather than a comprehensive head-to-toe physical examination. 1
Cancer Screening
Breast Cancer
- Annual mammography is recommended starting at age 40 and continuing through the 50s 1, 2
- Clinical breast examination (CBE) should be performed annually, preferably before mammography 1
- Educate patients about breast awareness and emphasize prompt reporting of any new breast symptoms rather than routine monthly self-examination 1
Cervical Cancer
- Women in their 50s who have had 3 consecutive normal Pap tests can be screened every 2-3 years with cervical cytology alone, or every 3 years with HPV DNA test plus cervical cytology 1
- Women aged 70+ with 3 normal tests and no abnormal results in the last 10 years may discontinue screening, but this does not apply to women in their 50s 1
- Women who have had total hysterectomy with cervix removal (unless for cervical cancer) do not require continued screening 1
Colorectal Cancer
- Begin screening at age 50 with one of the following options: 1
- Annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT), OR
- Flexible sigmoidoscopy every 5 years, OR
- Colonoscopy every 10 years, OR
- CT colonography every 5 years 1
- Digital rectal examination should be performed at the time of screening 1
Endometrial Cancer
- At menopause, inform women about risks and symptoms of endometrial cancer and strongly encourage reporting any unexpected bleeding or spotting 1
- Routine screening with biopsy or ultrasound is not recommended for average-risk women 1
Cardiovascular Risk Assessment
- Measure blood pressure annually 1, 3
- Obtain fasting lipid profile every 6-12 months, or at minimum according to cardiovascular risk 1, 3
- Baseline ECG is appropriate for midlife patients 3
- Screen for diabetes with fasting glucose, particularly if risk factors present 1
Additional Screening and Counseling
Thyroid
- Consider thyroid examination as part of the cancer-related checkup 1
- Screen women for thyroid disease, as they are at higher risk 3
Bone Health
- For postmenopausal women in their 50s with risk factors for premature bone loss, consider baseline bone densitometry 1
- Counsel about adequate calcium and vitamin D intake 3
Immunizations
- Verify tetanus-diphtheria status and update as needed 3
Lifestyle Counseling
- Address tobacco use, diet and nutrition, exercise, alcohol use, sun exposure, sexual practices, and environmental/occupational exposures 1
- Counsel on seatbelt use 1
Functional Assessment
- Ask about hearing problems and test as needed 3
- Screen for urinary incontinence symptoms 3
- Inquire about sexual health concerns 3
Physical Examination Components
The comprehensive head-to-toe physical examination lacks evidence of benefit for healthy adults 4, but the following targeted examinations are appropriate:
- Blood pressure measurement 1
- Heart and lung examination 1
- Abdominal examination 1
- Thyroid examination 1
- Lymph node examination 1
- Skin examination 1
- Oral cavity examination 1
Common Pitfalls to Avoid
- Avoid ordering extensive laboratory panels not supported by guidelines (such as routine urinalysis, chest radiography, or blood glucose in low-risk patients) 1, 5
- Do not perform annual Pap tests when less frequent screening is appropriate based on prior normal results 1
- Recognize that patient expectations for comprehensive testing often exceed evidence-based recommendations, and use this visit as an opportunity for education about appropriate screening 5, 4
- Do not skip colorectal cancer screening discussion - many patients are unaware this should begin at age 50 1