The 'well-woman' screening guidelines

July 23, 2019
Charles J. Lockwood, MD, MHCM

Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South Florida, Tampa. He can be reached at DrLockwood@ubm.com.

,
Emily Haly, MD

,
Cathy Lynch, MD

As more patients turn to ob/gyns for wellness exams, physicians need to stay up-to-date on current recommendations.

Pap smears & annual pelvic exam

  • USPSTF and ASCCP recommend cytology screening every 3 years from ages 21 to 29

  • From ages 30 to 64, screening can be cytologic every 3 years or cytology with high-risk HPV testing every 5 years (co-testing) 

  • Pap testing can be discontinued at age 65 for those who have had previous negative smears

  • The same Pap smear screening guidelines should be followed in women who had the HPV vaccine

  • Women under 21 may need testing for STIs but that does not include a Pap smear or HPV testing

For more on well-woman exams: Key points for today’s ‘well-woman’ exam: A guide for ob/gyns

NEXT: Testing for HIV

Testing for HIV

  • CDC recommends HIV testing all patients aged 13 to 64 

  • Testing should be performed annually on high-risk patients

  • High-risk populations include injection-drug users and their sex partners, individuals who exchange sex for money or drugs, sex partners of HIV-infected individuals, and heterosexuals if they or their sex partners have had ≥ 1 sex partner since their most recent HIV test

NEXT: Testing for STIs

Testing for STIs

  • Annual testing for chlamydia and gonorrhea is recommended in sexually active women < 25, and those older who have a new partner, multiple partners or a partner with a STD

  • Type-specific HSV testing should be considered in patients who present for STI evaluation 

  • Hepatitis C testing should be done on women born between 1945 and 1965 and patients who are at high risk, including individuals on immunosuppressive therapy or hemodialysis or who are HIV-positive

NEXT: Colorectal cancer screening

Colorectal cancer screening

  • ACS recommends screening average-risk patients at age 45 

  • Options include colonoscopy every 10 years, computed tomographic colonography or sigmoidoscopy every 5 years, take-home high-sensitivity guaiac-based FOBT or FIT annually, and multitargeted stool-DNA testing every 3 years 

  • A positive result on a non-colonoscopy test should trigger colonoscopy 

NEXT: Breast cancer screening

Breast cancer screening

  • USPSTF recommends mammography every 2 years for women > 50

  • USPSTF does not recommend biannual screening for women aged 40 to 49 but ACP does

  • For high-risk women, ACS recommends annual screening with mammography and MRI beginning at age 30 

  • ACP recommends mammography every 2 years in patients with life expectancy ≥ 10 years

  • After age 75, according to ACP, the decision to continue screening should be based on a patient’s health status

  • ACP recommends limiting use of MRI to patients at high risk or to determine disease extent after diagnosis

NEXT: Hypertension, CVD, diabetes

Hypertension, CVD, diabetes

  • The AHA-approved cut-off for diagnosis of hypertension is now 130/80 mg/Hg

  • The risk calculator (cvriskcalculator.com) should be used instead of LDL levels to determine whether use of statins is warranted

  • To determine need for statins in patients with a 10-year risk of 5% to 20%, coronary artery calcium scoring is recommended by the Society for Cardiovascular Computed Tomography

  • Screening for diabetes should be done after pregnancy and in patients who have hypertension, hyperlipidemia or obesity (aged 40-70)

  • For patients aged ≥ 45, a baseline fasting blood sugar and repeat screening at least every 3 years thereafter are recommended

  • Annual screening is recommended for patients who are overweight or have risk factors for diabetes

NEXT: Osteoporosis screening

Osteoporosis screening

  • BMD should be performed in women > 65 with no risk factors for osteoporosis

  • Follow-up testing should be done every 2 to 5 years, depending on risk