Screening Tests for Women Archive

Some tests that are widely offered for screening aren't advised for generally healthy people and may lead to unnecessary procedures.

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You've probably had more than a few screening tests—blood pressure and cholesterol checks, mammograms, Pap smears, and colonoscopies. However, health fairs and clinics often promote screening tests you might not have had. If you've wondered whether they're a worthwhile investment in your health, the United States Preventive Services Task Force (USPSTF) can help you. The USPSTF is a panel of primary care physicians and epidemiologists appointed and funded by the U.S. Department of Health and Human Services. Its role is to develop clinical practice guidelines—recommendations for clinicians about the care of patients with specific conditions. Other health organizations also develop guidelines.

"We've known for some time that there is a wide variation in the way medicine is practiced across parts of the country," says Dr. Mark Aronson, professor of medicine at Harvard Medical School. "Guidelines are based upon the best available research evidence and practice experience and are meant to give guidance to doctors for best practices."

New research has linked heart tissue damage to blood pressure treatments that drive diastolic pressure (the bottom number in a reading) too low. 

Talk to your doctor to nail down your cancer risk, and check this list to see which tests may help save your life.

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Recommendations for cancer screenings sometimes change, and it can be confusing about which tests you need and when. "It's best to talk to your doctor about your cancer risk factors and family history, learn which screenings are right for you, and then develop and stick to a screening schedule," says Dr. JoAnn Manson, chief of preventive medicine at Harvard-affiliated Brigham and Women's Hospital.

Routine screenings

Don't be intimidated about screening tests. The latest guidelines suggest you can choose from multiple strategies.

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Colon cancer continues to be the country's second leading cause of cancer-related deaths and the third most common cancer in men, according to the CDC.

It almost always develops from precancerous polyps (abnormal growths). Screening tests, which are recommended for men ages 50 to 75, help find and sometimes aid removal of polyps before they become cancer. (Men older than 75 may still benefit, depending on their health.)

Letters notifying women that they have dense breasts are difficult to understand. Women receiving them should contact their doctors.

Research We’re Watching

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When specks of calcium appear in ductal tissue on mammograms, they can indicate a small cancer. But when calcifications are found in the breast arteries, they haven't been a cause for concern. However, in recent years, physicians have begun to suspect that arterial calcifications in the breast, like calcifications in the coronary arteries of the heart, can be an early sign of cardiovascular disease.

A team of researchers at Mount Sinai St. Luke's Medical Center in New York City studied the test results of 292 women who'd had digital mammography and non-contrast CT chest scans within a year. None of the women were known to have heart disease. They found that 42.5% of the women had evidence of breast artery calcifications on mammography, and of these, 70% also had evidence of coronary artery calcification on their CT scans. Moreover, 63% of those whose CT images revealed coronary artery calcifications had breast artery calcifications as well. Over all, the results indicated that women with breast artery calcifications are three times as likely as those who don't to have coronary artery calcifications. The study was published online March 24, 2016, by JACC Clinical Imaging.

Research we're watching

Mammograms, which are widely used to detect early breast cancer, may also be an effective tool for spotting early signs of heart disease, a small study suggests.

The study, in the April JACC: Cardiology Imaging, involved nearly 300 women free of heart disease. All underwent both a mammogram and a computed tomography (CT) scan of the chest. The mammograms showed calcifications (which look like a chalked line) in the arteries within the breast in just over 40% of the women. These artery calcifications are different from the irregular spots of calcifications that may indicate early cancer.

News Briefs

Don't be surprised if your doctor screens you for depression at your next visit. An update to the U.S. Preventive Services Task Force recommendations for screenings, published Jan. 26, 2016, in The Journal of the American Medical Association, suggests that all adults 18 or older, including older adults, should be screened for depression when there are systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. The previous recommendations encouraged selective screening based on professional judgment and patient preferences. The new recommendation also includes pregnant and postpartum women for the first time. "Older adults often struggle with chronic disease, or the loss of a loved one, which may lead to depression," says Dr. Michael Craig Miller, an assistant professor of psychiatry at Harvard Medical School. "Screening is just a way to open the door for people who might otherwise not get the help they need." Dr. Miller says screening can simply be asking if, over a two-week period, you have either had little interest or pleasure in doing things or felt depressed and hopeless.

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A research letter published online Jan. 21, 2016, in JAMA Oncology suggests that many older adults are getting unnecessary cancer screenings. Researchers looked at questionnaire answers from about 150,000 seniors (ages 65 or older) across the country, and found that about half had received prostate-specific antigen (PSA) testing or mammography in the past year. But a third of those screened did not have a 10-year life expectancy, a major guideline for screening. Unnecessary screening rates varied by state—for example, 11% in Colorado and about 20% in Georgia. "Undergoing a screening test may actually cause more harm than good, especially with older patients or those with significant medical conditions," says Dr. Marc Garnick, an oncologist at Beth Israel Deaconess Medical Center and editor in chief of Harvard's Annual Report on Prostate Diseases. So talk to your doctor about the guidelines. Both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend routine mammograms every two years for women ages 55 to 74. The ACS does not recommend mammograms in this age group if a woman has a life expectancy of less than 10 years.

For all men, the USPSTF recommends against routine PSA testing. The ACS suggests that men 50 or older (at average risk for prostate cancer) make the decision about screening with their doctor, but only if they have a life expectancy of at least 10 years, and only if they have been advised about the uncertainties, risks, and potential benefits of prostate cancer screening.

The annual check-up is important for older men. Here is how to make the most out of your visit.

Men have a long reputation for avoiding check-ups, and that resistance tends not to soften when they are older.

"Many older men put off exams because they fear finding out something is wrong," says Dr. Suzanne Salamon, a geriatrician with Harvard-affiliated Beth Israel Deaconess Medical Center. "Also, many of today's baby boomers don't think they will have medical problems associated with age, so it can difficult for the 'younger older men,' like those in their 60s and early 70s, to see their doctor."