Women’s health screenings: An essential (and cost-effective) guide for all stages of life

Pssst … looking for a bargain in health care?  

That’s not a contradiction in terms, believe it or not. 

Health screenings that catch problems early are a little-known part of Obamacare — a reform designed to save both money and lives. Under the Affordable Care Act, more than a dozen screenings are free to the patient under most insurance plans. 

While some of these tests aren’t exactly pleasant — nobody likes to be poked, prodded, swabbed or smushed — they can spare you a world of hurt down the road. 

One unfortunate impact of the COVID-19 pandemic was a drop-off in routine screenings as people avoided any trip to health care providers that wasn’t seen as essential. Doctors now worry they’ll soon see diseases being diagnosed at a later, and more dangerous, stage. 

That means it’s catch-up time for many women. Here’s what you need to know from puberty, through their childbearing years, then into menopause. 

Medical experts favor mammograms every year until 50, then every one to two years. Photo courtesy of Getty Images

MAMMOGRAMS 

The guidelines are somewhat muddied, unfortunately. In 2009, the federal panel that decides which screenings insurers must cover announced mammograms need not begin until age 50, and could then be done every two years. That triggered a firestorm of criticism that starting that late might miss too many cases of earlier, more aggressive cancers. The net result is a mish-mash of exceptions, forcing women and their doctors to weigh their individual risk against their insurance coverage. 

When to start: Despite the federal panel’s selection of age 50, “the standard of practice has remained to start at 40,” said Dr. Lance R. Bruck, vice president and chairman of Jersey City Medical Center’s Department of Obstetrics, Gynecology and Women’s Health. 

How often: Here, too, practitioners may order a mammogram more often than the guidelines recommend. Bruck favors mammograms every year until 50, then every one to two years. “A lot of this is dictated by insurance companies, which dictate how often we can order one,” he said. “That is the unfortunate part of the world we live in.” 

When to stop: While some experts suggest pulling back on frequent mammograms after the age of 65 or 75, Bruck said he believes they should be continued indefinitely. “I don’t envision a point at which you stop doing mammography,” he said. “I still want to do them. Why would I not do them?” 

The exception to this approach, he said, is if an elderly woman is bedridden in a nursing home, or has dementia. “At that point, does it really make sense to do a mammogram?” he asked. Such women probably wouldn’t opt for burdensome treatment if cancer were found, making screening somewhat pointless. 

Testing for genetic mutations that heighten the risk of breast cancer is highly recommended by doctors. Photo courtesy of Getty Images

BREAST CANCER GENETIC TESTING 

It used to be difficult to get insurance coverage to test for genetic mutations that heighten the risk of breast cancer, Bruck said. But as the price of the test has dropped, insurers have loosened the purse strings substantially.  

“Once the human genome was unraveled, every year the advances that come out are astounding,” Bruck said. “So much has come out about the genetic links to cancer that it’s very hard for insurers to say they’re not going to cover genetic testing.” 

Genetic counseling should proceed testing; that, too, is considered a preventive service insurers must cover. 

A Pap smear test and HPV test are recommended for women ages 30 to 65 to prevent cervical cancer. Photo courtesy of Getty Images

CERVICAL CANCER SCREENING 

Guidelines for Pap smears, which look for abnormal cells, have also undergone recent changes, Bruck said. 

When to start: The new recommendation says screening is unnecessary before 21. 

How often: For women ages 21 to 29, a Pap smear every three years suffices, unless an abnormality is detected. For women ages 30 to 65, there are three choices: a Pap smear; a different test for variants of the human papillomavirus, or HPV, that can cause cancer every five years; or both tests every five years. 

Since these tests rely on a health care provider taking a sample of cells from the outside of the cervix, using both tests minimizes the chance the collection was done improperly, or missed a section with abnormalities, Bruck said. (But be aware insurance might balk at covering both.) 

When to stop: At 65, if a woman hasn’t had any abnormal results, she can be done with them. 

All women over age 65 should have a bone density screening, as well as younger, postmenopausal women with risk factors. Photo courtesy of Getty Images

BONE DENSITY SCREENING 

As women age, their natural drop-off in estrogen impacts bone density, which can eventually lead to spine or hip fractures. 

“The main goal of screening is to identify those of high risk and to intervene before they have fractures,” said Dr. Shruti Pandiri, an endocrinologist at Hackensack University Medical Center.  

The test is quick and painless; an imaging machine scans the body without making contact. 

When to start: All women over 65 should have a bone density screening, as well as younger, postmenopausal women with risk factors.  

However, anyone who has a history of fractures — particularly what is called a “nontraumatic” fracture — should have their bones checked no matter their age.  

If you fall off a ladder and fracture a shoulder, that’s understandable. If you break a bone tripping on a rug, however, that’s a concern, as healthy bones should be able to endure that without a fracture. (As an example, Pandiri told of an older man who fractured a rib simply by reaching out over his pool.) 

The other category of patients who might need screening before 65 are those who aren’t getting enough calcium because of underlying conditions. Digestive conditions such as Crohn’s disease, celiac disease, anorexia or even weight-loss surgery can impact the body’s ability to absorb sufficient minerals for bone health. 

Those who take certain ongoing medications for cancer treatment or rheumatological disorders may also need to be screened for bone loss.  

How often: The guidelines say postmenopausal women who have been diagnosed with mild osteopenia, which can be a precursor to osteoporosis, yet have no risk factors, should get a screening every 10 to 15 years. However, Pandiri said, advancing age is itself a risk factor, so most elderly women will be need to be reassessed more often than that.  

The screening produces a so-called T-score, and anyone whose score is -1.5 to -1.99 should get screened every three to five years. 

Women with a score of -2 to -2.49, or who have risk factors, should go every two years. Bones reknit themselves quite slowly, so more frequent screenings aren’t useful. 

When to stop: “One of the risk factors for osteoporosis is advancing age,” Pandiri said. “You’re never really out of the woods.”  

Think you can wait until you’re 50 for a colonoscopy? Listen up: The new guidelines say to start at age 45. Photo courtesy of Getty Images

COLONOSCOPIES 

While more men than women are diagnosed with colon cancer, it remains a threat to women as well, and one that can be easily nipped in the bud by a colonoscopy.  

Unfortunately, this cancer is striking at an earlier age, said Dr. Sophie Morse, a gastrointestinal oncologist at Atlantic Health System’s Overlook Medical Center. That means screening should begin earlier as well. “The median diagnosis age is now so much younger, so we don’t want to miss those early cases. If colon cancer is caught early, it’s very curable.” 

When to start: Think you can wait until you’re 50? Listen up: The new guidelines say to start at age 45. Anyone with a strong family history of colon cancer should consider starting as early as age 20 to be on the safe side. 

How often: It depends on what they find in your last colonoscopy. If the doctor finds no polyps and there is no family history to consider, you can go 10 years between screenings. If that’s not the case, repeat it every three to five years. 

When to stop: There is no hard and fast rule for when someone can safely forgo colonoscopies. A 75-year-old who is fairly healthy with a life expectancy of another 10 years might want to continue with them. But a 75-year-old with heart problems or kidney disease might decide the preparation and general anesthesia is too risky to warrant the procedure, Morse said. 

Can that at-home stool test advertised on television take the place of a colonoscopy?  

Not really, Morse said. While it can detect signs of cancer, “It’s not a perfect test,” she said. “I think it’s still important for a patient to get a colonoscopy. It still remains the gold standard.”

Kathleen O’Brien was a longtime columnist and health writer for The Star-Ledger. She continues to report on all facets of the health care industry for Jersey’s Best.

This article originally appeared in the Winter 2021 issue of Jersey’s Best. Subscribe here for in-depth access to everything that makes the Garden State great.