What is the recommended age‑based schedule of evidence‑based preventive screenings for average‑risk women from adolescence through older age?

Preventative Health Screenings for Women: Age-Based Schedule

Breast Cancer Screening

For average-risk women, annual mammography should begin at age 40 and continue as long as overall health is good and life expectancy exceeds 10 years. 1

Ages 25-39 Years

• Clinical breast examination every 1-3 years with ongoing risk assessment and counseling 2
• Encourage breast awareness and prompt reporting of any changes 2
• Do not perform routine screening mammography in this age group unless high-risk factors are present 1

Ages 40-44 Years

• Offer annual mammography as a qualified recommendation based on shared decision-making 1, 3
• Women who value potential mortality benefit over higher false-positive rates may choose to begin screening 2
• Approximately 10% of screening mammograms result in recall, with higher rates in this age group 1

Ages 45-54 Years

• Annual mammography is strongly recommended as this age group demonstrates clear mortality benefit with the highest consensus across guidelines 1, 3
• Continue annual clinical breast examination 2
• This represents the optimal age range where screening provides maximum benefit relative to harms 1

Ages 55-74 Years

• Transition to biennial mammography (every 2 years), though continuing annual screening remains acceptable based on patient preference 1, 3
• USPSTF provides a B-level recommendation for biennial screening in ages 50-74 2
• The decision between annual versus biennial should consider individual values regarding mortality reduction versus screening burden 1

Ages 75 and Older

• Continue screening as long as overall health is good and life expectancy exceeds 10 years 1, 3
• Base decisions on health status and comorbidities rather than age alone 2
• Evidence is insufficient for routine screening beyond age 75, making this a conditional recommendation 2

What NOT to Do for Breast Screening

• Do not perform clinical breast examination as a standalone screening tool for average-risk women 2
• Do not recommend breast self-examination as a screening strategy 2
• Do not use MRI, ultrasound, or tomosynthesis for average-risk women 2

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Cervical Cancer Screening

Women aged 21-29 years should undergo cervical cytology (Pap test) every 3 years, while women aged 30-65 years should be screened every 3 years with cytology alone or every 5 years with hrHPV testing alone or cotesting. 4

Ages <21 Years

• Do not screen regardless of sexual activity initiation 4
• Screening in this age group provides no benefit and causes unnecessary harm 4

Ages 21-29 Years

• Cervical cytology (Pap test) every 3 years 4
• Do not use hrHPV testing in this age group 4
• Annual screening is explicitly not recommended at any age 5

Ages 30-65 Years

• Preferred: Cotesting (Pap + hrHPV) every 5 years 5, 4
• Acceptable alternatives:
  • Cervical cytology alone every 3 years 4
  • hrHPV testing alone every 5 years 4
• All three strategies provide equivalent mortality reduction 4

Ages >65 Years

• Do not screen if adequate prior screening has been documented and the woman is not otherwise at high risk 4
• Adequate prior screening means three consecutive negative cytology results or two consecutive negative cotesting results within the past 10 years, with the most recent test within 5 years 4

Special Circumstances

• Do not screen women who have had hysterectomy with cervix removal for benign indications 4
• Women with history of high-grade precancerous lesions or cervical cancer require continued surveillance regardless of hysterectomy status 4

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Colorectal Cancer Screening

All average-risk women should begin colorectal cancer screening at age 45 and continue through age 75. 5

Ages 45-75 Years

• First-tier options (choose one):
  • Annual fecal immunochemical test (FIT) 5
  • Colonoscopy every 10 years 5
  • CT colonography every 5 years 5
• Delaying screening beyond age 45 increases mortality risk and should be avoided 5

Ages 76-85 Years

• Screening decisions should be individualized based on overall health, prior screening history, and life expectancy 5

Ages >85 Years

• Do not screen as harms outweigh benefits in this age group 5

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Cardiovascular Risk Assessment

Blood pressure should be measured at every clinical encounter starting in adolescence, while lipid screening should begin at age 40. 5

All Ages

• Measure blood pressure at every clinical visit 5
• Hypertension screening is critical for preventing cardiovascular morbidity and mortality 5

Ages 40 and Older

• Annual lipid profile screening to assess cardiovascular risk 5
• This becomes particularly important in women aged 40-49 as cardiovascular risk increases 5

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Diabetes Screening

Screen with hemoglobin A1C if BMI ≥25 kg/m² with additional risk factors. 5

Risk Factors Warranting Screening

• Family history of diabetes 5
• Hypertension 5
• Sedentary lifestyle 5
• History of gestational diabetes 5

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Endometrial Cancer Counseling

At menopause (typically ages 45-55), inform average-risk women about endometrial cancer symptoms and strongly encourage reporting of any unexpected bleeding or spotting. 5

• Routine screening is not indicated for average-risk women 5
• Counseling focuses on symptom awareness rather than screening tests 5

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Common Pitfalls to Avoid

• Do not order routine CBC or CMP without specific clinical indications 5
• Do not delay colorectal cancer screening beyond age 45, as this is now the recommended starting age 5
• Do not perform annual cervical cancer screening at any age—this represents overscreening 5, 4
• Do not continue cervical cancer screening beyond age 65 in women with adequate prior negative screening 4
• Do not screen women under age 21 for cervical cancer regardless of sexual history 4