The 411 on Women’s Health Screenings

Mammograms, bone density tests, pelvic exams and Pap smears. With so many health screenings available, which ones are right for you?

Written by Wayne Friedman, M.D. on behalf of Tennova Healthcare. 

Some health screenings are for women or men only, while others like blood glucose tests and cholesterol checks are important for both genders. In many cases, health exams become more important as you age. With recent changes in health screening guidelines, how do you decide if it’s time for you to schedule a test?

The U.S. Preventive Services Task Force, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and various other health organizations have released new guidelines for preventive health screenings, including mammograms and Pap smears. These recommendations have caused some confusion and concern within the medical community as well as among women of all ages.

Screening intervals may depend on your age, health status, risk factors, and insurance coverage. In some cases, testing may be done as part of your routine checkup. So, what screenings should you be getting? Here are some tips:

Breast Cancer Screening

Starting around age 20, women should have a clinical breast exam at least every three years until age 40, when this should be done annually, according to most experts. During this manual exam, your doctor will check the breasts for any lumps or abnormalities.

At Tennova Healthcare, we encourage women to get a screening mammogram beginning at age 40 and continuing annually. Not all organizations agree on breast cancer screening guidelines. For instance, the American Cancer Society now recommends women begin screening mammograms at age 45. But most experts acknowledge that beginning screening at 40 makes sense for the majority of women.

The fact of the matter is doctors can’t distinguish dangerous breast cancers from those that are non-life-threatening. Therefore, annual mammograms remain the best option for detecting cancer early and reducing the risk of death from breast cancer.

Also, women of all ages should do breast self-exams on a regular basis. While mammograms can help you to detect cancer before you can feel a lump, breast self-exams help you to be familiar with how your breasts look and feel so you can alert your doctor regarding any changes.

Cervical Cancer Screening

Since the advent of the annual Pap test in the 1950s, cases of what was once the #1 cancer in women have plummeted. The human papillomavirus (HPV) vaccination, introduced in 2006, has further reduced those numbers. Despite such positive storylines, women should be vigilant and continue with regular examinations. In the United States, one of the most common risk factors for cervical cancer is a prolonged interval (over 5–10 years) between cancer screenings.

Recently, guidelines about screening frequency have changed—creating some confusion. The American Cancer Society’s longstanding advice to get a yearly Pap smear has become less clear. Recommended screening intervals are now longer, and two separate tests are now available.

While not everybody agrees on the revised guidelines, the following are good rules from the American Congress of Obstetricians and Gynecologists to guard against cervical cancer:

  • All women should begin cervical cancer screening via a Pap smear at age 21.
  • Between the ages of 21 and 29, women should have a Pap test at least every three years. HPV testing should be done only if needed, following an abnormal Pap test.
  • Women between the ages of 30 and 65 should have both a Pap test and an HPV test at least every five years.
  • After age 65, women who have had screenings with normal results do not need to be regularly screened for cervical cancer.
  • Women at increased risk for cervical cancer, such as a history of dysplasia or abnormal Pap smears, may need to increase the frequency of these screenings.
  • If a hysterectomy has been performed for non-cancerous reasons, Pap smears are not regularly needed.

If you do have HPV and/or have had an abnormal Pap smear, these guidelines won’t apply to you. Your OB/GYN will request that you have more frequent Pap smears—usually about every six months. Talk to your doctor if you’re unsure about how often you should be screened for cervical cancer.

A word about the HPV vaccine.

This vaccine protects against the main types of HPV that cause certain types of cancer, especially cervical cancer. The Centers for Disease Control and Prevention recommend young women and men receive the HPV vaccination at age 11 or 12 to provide the best protection long before the start of any sexual activity. Catch-up vaccines are recommended for males through age 21 and for females through age 26.

Bone Density Testing

Although osteoporosis can occur in men, it’s most common in women older than 65. Research indicates that as many as one in every two women over age 50 may be living with significant bone loss, which can lead to osteoporosis, a loss of mobility and a reduction in overall quality of life.

Women should start getting screened for osteoporosis with a bone density test at age 65. Those with risk factors for osteoporosis, such as having a slender frame or a previous bone fracture, should be screened earlier.

If you’re age 50 or older, and your OB/GYN has recommended adding a bone density screening to your yearly physical, I encourage you to follow through. This type of quick, painless x-ray screening, which measures the density of minerals in your bones, can help your doctor determine if you have—or are at risk for—osteoporosis.

See Your OB/GYN Every Year!

The American College of Obstetricians and Gynecologists recommends women have an annual well-woman exam starting at age 21. In addition to Pap smears and mammograms at appropriate intervals, every woman should see her doctor for other routine health screenings—such as cholesterol checks, blood pressure screenings, blood glucose tests, and colon cancer screenings—to spot any potential problems early. 

Because all of these tests are considered preventive, many insurance plans will cover them. However, there may be certain criteria you need to meet, such as age, the reason for the test, and the time since your last screening.

Need an OB/GYN? For a referral to a women’s care specialist, call 1-855-TENNOVA (836-6682) or visit 

Wayne Friedman M.D.About the Author:

Dr. Wayne Friedman is a board-certified obstetrician and gynecologist with Tennova Women’s Care in Knoxville, LaFollette and Lenoir City. He specializes in a full range of women’s health services. Dr. Friedman delivers babies at Physicians Regional Medical Center in Knoxville. He also performs gynecologic surgery at both Physicians Regional Medical Center and Turkey Creek Medical Center in West Knoxville.




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