With so many different health screenings and vaccinations available, it may seem difficult to keep track of it all. While many women are aware of the options available to them, there is still room for improvement when it comes to knowledge about screenings and vaccinations that can help maintain health.

Financial factor

There are many reasons why some patients choose not to get the recommended health screenings and vaccinations-one current one being the down economy.

“A lot of patients aren’t getting screened this year because of financial stress, even though these screenings are important,” said Jennifer Goldfarb, M.D., an internal medicine specialist based near Chicago in Des Plaines, IL. “They’re not willing to get a colonoscopy if they have to pay $2,000 out of pocket. For those who lost their jobs, many aren’t getting their mammogram this year. Some people have even stopped taking their medications because they can’t afford them.”

However, cost does not have to be a barrier. There are clinics that provide reduced price mammograms during the months of October and May, and people with low or no income may be able to receive discounted or free medical services from public health institutions such as community clinics or government-run medical centers.

Busyness factor

Another reason for not keeping up with recommended health screenings is that many women feel too busy to go to the doctor for a routine visit.

“Most people lead very busy lives, and don’t feel they have time to see their doctors unless there is something wrong,” said Irene O’Neill, M.D., a physician based in Northwest Indiana. “But if you only see your doctor when you’re sick with a cold or influenza, there may not be enough time at that visit to discuss the routine health screenings.”

In addition, some people avoid screenings because they are afraid of the results or even of the procedures. However, Dr. O’Neill stresses to her patients that the discomfort of a screening test is far less than the discomfort of going through cancer or other treatments.

“I remind my patients that a mammogram can sometimes pick up a cancer four-to-five years before they feel a lump,” she said. “If you catch a cancer when it is a speck on a mammogram, you are probably catching it before it spreads, and then the treatment is relatively easy and painless.”

Steven Goldstein, M.D., professor of obstetrics and gynecology at New York University’s Langone Medical Center, said he doesn’t ever want to feel breast cancer again for that same reason.

“When you see it on the mammogram, something can be done about it,” he said, noting that later, when the doctor or patient can feel the lump, treatment is much more difficult. “No one enjoys coming to me, even those who say I’m their favorite doctor. I don’t love having my prostate checkup every year, but I still do it.”

Screenings not only pick up potential health problems early, before they get serious, but can also provide peace of mind if the test results show good health. The U.S. Preventive Services Task Force has issued guidelines for women 50 and over to help them know when they should have various screenings and vaccinations. These guidelines apply to healthy women, but each person should partner with her doctor on her individual timing for screenings, as they can vary based on her medical history, family history, and lifestyle.

Screening Guidelines for Women 50 and Above

General health

• Full general checkup. Talk with your doctor about how often you should get a full checkup, which includes measuring height and weight and checking your body mass index (BMI), which screens for obesity.
• Thyroid (TSH levels). Have thyroid levels tested every five years.

Heart health

• Hypertension. Your blood pressure should be measured at least every two years.
• Cholesterol. Your lipid panel should be measured every five years, or more frequently based on results and risk profile.

Reproductive health

• Pelvic exam. Get a pelvic exam annually.
• Pap test. If you’re between the ages of 50 and 64, you should have a Pap smear every one to three years if you ever have been sexually active. However, this screening is not required after a hysterectomy unless the surgery was performed for cancer or a precancerous disease. Also, if you’re older than 65 and had at least 3 normal Pap smears over the preceding 10 years, you do not need to continue getting this test.
• Sexually transmitted infection (STI) tests. Both partners should get tested for STIs, including HIV, before initiating sexual intercourse.

Breast health

• Mammogram. This x-ray of your breast should be done every one to two years if no risk factors are present (no family history or genetic predisposition). Also, the breast self exam is best done just after the menstrual period for optimal results.
• Clinical breast exam. This should be done annually.
• Breast self-exam. Women should perform self-exams monthly.

Bone health

• Bone density screen. Routine screening for otherwise healthy women should begin at age 65, or earlier if they have risk factors like a family history of osteoporosis or for women who are smokers, heavy drinkers (more than two drinks/day), or heavy caffeine consumers (more than four cups of coffee per day). Also, women with rheumatoid arthritis, thin women, and those with eating disorders should be tested earlier. Your doctor will determine the frequency of follow-up intervals based on test results.

Diabetes

•  Blood glucose. Have a fasting plasma glucose test every three years.

Colorectal health

• Fecal occult blood test. Should be performed annually.
• Flexible sigmoidoscopy (with fecal occult blood test). Should be performed every five years.
• Colonoscopy. Colonoscopy should start at age 50 and be done every 10 years, unless other risk factors (genetic syndrome associated with colon ca or family history or prior polyps). Also, the fecal occult blood test and the flex sig are alternatives to a colonoscopy (but not as accurate). Having all three tests done is not necessary.

Eye and ear health

• Eye exam. If you are between the ages of 50 and 64, you should have a complete eye exam every two-to-four years, or more frequently as advised by your physician. If you are 65 or older, have an eye exam every one-to-two years.
• Hearing test. Have your hearing checked every three years.

Skin health

• Clinical mole exam. Should be annually, as part of the routine full checkup.
• Mole self-exam. Women should perform these monthly.

Oral health

• Dental exam. The guideline is “routinely,” so discuss how often you need to come in with your dentist, whether it is once a year or multiple times each year.

Mental health

• Mental health screening. If you have felt sad, down, or hopeless for more than two weeks, you may be depressed. Talk to your doctor or nurse about being screened for depression.

Immunization guidelines for women 50 and above

• Influenza (flu) vaccine. Annually. In addition this year, with cases of the H1N1 “swine flu” virus reported in more than 30 countries, those 50 and over may want to consider being immunized for H1N1. However, since the virus has turned out to be less prevalent and less virulent than expected, immunization may not be recommended because of possible side effects such as neurologic complications. Women should consult with their doctor to see if H1N1 vaccination is recommended in their individual cases.
• Pneumococcal vaccine (for pneumonia). One-time vaccine for adults ages 65 and older who are at average risk. High-risk adults of any age with diabetes, cancer, or heart, lung, or immune disease should have the initial vaccination, with a single revaccination five years later.
• Diphtheria/tetanus/pertussis vaccine. There has been an increase of pertussis (whooping cough) in the United States since the 1980s, so it’s recommended that women have this vaccine one time between the ages of 19 and 64 in place of the diphtheria/tetanus booster. Once you have received one dose, your next routine tetanus vaccination will be the diphtheria/tetanus booster, listed below.
• Diphtheria/tetanus booster vaccine. This should be received every ten years.
• Herpes Zoster vaccine (to prevent shingles). This is a one-time vaccine, which should be given at 60. The vaccine is made from a live virus and should be given only to people with a healthy immune system. Otherwise, it can result in that person getting the virus throughout the body, which can be deadly. People with AIDS, lymphoma, leukemia, or people being treated for other cancers should not be vaccinated and should avoid those who recently received the vaccine.

–Sarah Severson

Resources:

• Agency for Healthcare Research and Quality: http://www.ahrq.gov/ppip/women50.htm
• Cleveland Clinic’s Health Maintenance Guidelines for Adults: http://my.clevelandclinic.org/Documents/Health/health_maintenance_guidelines.pdf
• Dr. Steven Goldstein: www.goldsteinmd.com
• Health, United States 2008 (Center for Disease Control and Prevention): http://www.cdc.gov/nchs/data/hus/hus08.pdf
• Older American 2008 report (Federal Interagency Forum on Aging-Related Statistics): http://www.aoa.gov/agingstatsdotnet/Main_Site/Data/2008_Documents/OA_2008.pdf