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Women's Health Education Program (WHEP) Blog Cancer Screening for Women

Closeup of a mammogram.

December 6, 2021
By Anna Owen, MS4, Drexel University College of Medicine

Cervical Cancer screening

Cervical cancer screening is done with a pap smear (infographic description in link below). Recently, guidelines from the American College of Obstetrics and Gynecology (ACOG) regarding the frequency of pap smears changed. Now, it is recommended that women <21 years old are not screened. Women 21-29 years old will be screened every three years with cytology alone. Starting at age 30, recommended testing includes cytology and high-risk HPV testing every five years until the age of 65. At the age of 65, it is a decision between the physician and patient based on preferences and history of abnormal pap smears. The patient may opt out of further pap smears at 65 if they have not had an abnormal pap smear or meet precise criteria. If the patient has a hysterectomy with removal of the cervix and has no history of cervical precancerous or cancerous lesions, they may stop cervical cancer screening.

Breast Cancer screening

Breast cancer is the second leading cause of cancer-related death in U.S. women. The American Academy of Family Physicians (AAFP) guidelines suggest beginning to screen average-risk women with mammography by age 50 (image in link below). Data shows reduced mortality in average-risk women when screening begins at age 40, but this is an opportunity for a provider-patient discussion. It is recommended that mammography screening is repeated every one to two years based on harms/benefits and patient preference/values. After age 55, biennial screening is reasonable to reduce possible harm associated with false-positive test results and overdiagnosis. Screening should be continued until age 75 for average-risk women. The clinical breast exam may be offered to asymptomatic women, but the benefits are uncertain. It could be performed every one to three years for women aged 25-39 and then annually for women aged 40 years until about 75 years based on longevity. Asymptomatic women are encouraged to practice “awareness” of their breasts and report changes to clinicians. The clinical breast exam is recommended for high-risk and symptomatic women. In-depth breast cancer screening recommendations are available at the link below.

Endometrial Cancer screening

It is not standard practice to screen for endometrial cancer in asymptomatic average-risk patients. Symptomatic or high-risk women should be screened. A postmenopausal woman who experiences bleeding or spotting should have endometrial cancer ruled out.

Ovarian Cancer screening

It is not helpful to screen for ovarian cancer in asymptomatic women and is class D, recommended against, by the USPSTF. Screening may be done for women who have high-risk hereditary cancer syndromes. Symptoms such as fatigue, upset stomach, back pain, pain with sex, constipation, changes in period regularity or bleeding, and abdominal swelling with weight loss can be indications of ovarian cancer.

Other screenings

Women are also still at risk for other common cancers such as colorectal cancer and lung cancer. Screening for these should be pursued based on personal and familial risk factors.



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