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Prevention Guidelines for Women 40–49

A screening test is done to find possible health problems or diseases in people who don't have any symptoms. The goal is to find a disease early so lifestyle changes can be made and you can be watched more closely to lower the risk of disease, or to find it early enough to treat it most effectively. Screening tests are not diagnostic. But they are used to find out if more testing is needed. Health counseling is vital, too. This plan does not include recommendations for pregnancy. You and your healthcare provider may decide that a different schedule is best for you. But this plan can guide your discussion.

Screening

Who needs it

How often

Type 2 diabetes or prediabetes

All adults starting at age 45 and adults with no symptoms at any age who are overweight or obese and have 1 or more additional risk factors for diabetes

At least every 3 years

Alcohol misuse

All adults

At routine exams

Blood pressure

All adults

Yearly checkup if your blood pressure is normal.

 

Normal blood pressure is less than 120/80 mmHg.1

 

If your blood pressure reading is higher than normal, follow the advice of your healthcare provider.

 

Breast cancer

All women2

Screening with a mammogram every year is an option starting at age 40. Talk to your healthcare provider regarding your recommended frequency depending on your risk factors.

Cervical cancer

All women, except those who had a hysterectomy (with removal of the cervix) for reasons not related to cervical cancer and no history of cervical cancer or serious precancer

Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called "co-testing") every 5 years. This is the preferred approach. But it is also acceptable to continue to have Pap tests alone every 3 years.

Colorectal cancer

Women of average risk ages 45 years and older

Several tests are available and used at different times.

Tests include:

  • Flexible sigmoidoscopy every 5 years, or

  • CT colonography (virtual colonoscopy) every 5 years, or

  • Colonoscopy every 10 years, or

  • Yearly fecal occult blood test, or

  • Yearly fecal immunochemical test every year, or

  • Stool DNA test, every 3 years

You will need a follow-up colonoscopy if you choose any test other than a colonoscopy and you have an abnormal result. Screening recommendations vary among expert groups. Talk with your doctor about which test is best for you.

Some people should be screened using a different schedule because of their personal or family history. Talk with your doctor about your health history and what colorectal cancer screening schedule is best for you.

Chlamydia

Women at a higher risk for infection

At routine exams if at risk

Depression

All adults in clinical practices that have staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up

At routine exams

Gonorrhea

Sexually active women at a higher risk for infection

At routine exams if at risk

Hepatitis C

Adults at a higher risk; 1 time for those born between 1945 and 1965

At routine exams if at risk

HIV

All women

At routine exams

Lipid disorders

All women age 45 and older at a higher risk for coronary artery disease

For women ages 19 to 44, screening should be based on risk factors; talk with your healthcare provider

At least every 5 years

Obesity

All adults

At routine checkups

Syphilis

Women at a higher risk for infection

At routine exams if at risk

Tuberculosis

Adults at a higher risk for infection

Check with your healthcare provider.

Vision

All adults3

Baseline comprehensive exam at age 40; if you have a chronic disease, check with your healthcare provider for exam frequency.

Counseling

Who needs it

How often

Breast cancer, chemoprevention

Women at high risk

When risk is identified

BRCA mutation testing for breast and ovarian cancer susceptibility

Women with a higher risk

When risk is identified

Diet and exercise

Adults who are overweight or obese

When diagnosed and at routine exams

Domestic violence

Women of child-bearing age and older women with a higher risk

At routine exams

Sexually transmitted disease prevention

Adults at a higher risk for infection

At routine exams

Tobacco use and tobacco-related disease

All adults

Every exam

Immunization

Who needs it

How often

Tetanus/diphtheria/pertussis (Td/Tdap) booster

All adults

Td: every 10 years

Tdap: substitute a one-time dose of Tdap for a Td booster after age 18, then boost with Td every 10 years

Chickenpox (varicella)

All adults in this age group who have no record of previous infection or vaccinations

2 doses; the second dose should be given at least 4 weeks after the first dose

Measles, mumps, rubella (MMR)

All adults in this age group who have no record of previous infection or vaccinations

1 or 2 doses

Flu vaccine (seasonal)

All adults

Yearly, when the vaccine becomes available in the community

Hepatitis A vaccine

People at risk4

2 doses given 6 months apart

Hepatitis B vaccine

People at risk5

3 doses; the second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose).

Haemophilus influenzae type B (HIB)

People at risk

1 to 3 doses

Meningococcal

People at risk**

1 or 2 doses

Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)

People at risk6

1 or 2 doses

1. American College of Cardiology and the American Heart Association Task Force on Clinical Practice Guidelines

2. American Cancer Society

3. Recommendation from the American Academy of Ophthalmology

4. For complete list, see the CDC website

5. Exceptions may exist. Please talk with your healthcare provider.

Other guidelines from the USPSTF

Immunization schedule from the CDC

Online Medical Reviewer: Adler, Liora C, MD
Online Medical Reviewer: Cunningham, Louise, RN
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Date Last Reviewed: 6/1/2018
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