Here are the screening tests and immunizations that most women ages 40 to 49 need. Although you and your health care provider may decide that a different schedule is best for you, this plan can guide your discussion.
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Screening
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Who needs it
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How often
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Alcohol misuse
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All adults and pregnant women
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At routine exams
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Anemia - Iron Deficiency
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All pregnant women
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At prenatal visits, especially the first
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Asymptomatic Bacteriuria (with urine culture)
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All pregnant women
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At 12-16 weeks' gestation or the first prenatal visit, if later
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Blood pressure
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All adults
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Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends the following screening schedules:
Every two years if blood pressure reading < 120/80 mm Hg, and
Yearly if systolic blood pressure reading of 120 to 139 mm Hg or diastolic blood pressure
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Breast cancer
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All women*
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Yearly mammogram and clinical breast exam*
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Cervical cancer
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An update to this recommendation is currently in progress and being reviewed by the U.S. Preventive Services Task Force (USPSTF). The recommendation below may contain information that is out of date. Please consult your health care provider.
Women who have been sexually active and have a cervix
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Please discuss with your health care provider.
The American Cancer Society (ACS) recommends a pap test every two years.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that women age 30 and older get a pap test once every three years, and women with certain risk factors (or at increased risk) may need more frequent screening.**
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Chlamydia
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Women at increased risk for infection, and pregnant women
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At routine exams
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Depression
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All adults in clinical practices that have staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up
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At routine exams
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Diabetes Mellitus, type 2
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Adults who are asymptomatic with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg
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At routine exams
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Gonorrhea
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Sexually active women at increased risk for infection, and pregnant women
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At routine exams
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Hepatitis B virus
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All pregnant women
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At first prenatal visit
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HIV
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Anyone at increased risk for infection, and pregnant women
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At routine checkups
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Lipid Disorders
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All women age 45 and older at increased risk for coronary artery disease
For women ages 19 to 44, ACOG recommends screening based on risk factors. Please discuss with your health care provider.
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At least every five years
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Obesity
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All adults
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At routine checkups
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Preeclampsia
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Given the availability of new evidence, USPSTF has decided to update this recommendation. The recommendation below may contain information that is out of date. Please consult your health care provider.
All pregnant women
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The recommendation below may contain information that is out of date. Please consult your health care provider.
At routine checkups
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Rh (D) Incompatibility
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All pregnant women
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First prenatal visit
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Rubella
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Given the availability of new evidence, USPSTF has decided to update this recommendation. The recommendation below may contain information that is out of date. Please consult your health care provider.
All pregnant women
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The recommendation below may contain information that is out of date. Please consult your health care provider.
At routine checkups
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Syphilis
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Women at increased risk for infection, and all pregnant women
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At routine exams
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Tuberculosis
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Anyone at increased risk for infection
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Check with your health care provider
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Counseling
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Who needs it
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How often
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Breast cancer, chemoprevention
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An update to this recommendation is currently in progress and being reviewed by the USPSTF.
The recommendation below may contain information that is out of date. Please discuss with your health care provider.
Women with high risk
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The recommendation below may contain information that is out of date. Please consult your health care provider.
When risk is identified
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BRCA mutation testing for breast and ovarian cancer susceptibility
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Women with increased risk
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When risk is identified
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Breastfeeding
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All pregnant women
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During pregnancy and after delivery
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Diet, behavioral counseling
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Adults with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease
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When diagnosed
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Tobacco use and tobacco-caused disease
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All adults
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Every visit
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Immunization
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Who needs it
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How often
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Tetanus/diphtheria/pertussis (Td/Tdap) booster
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All adults
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Td: Every 10 years
Tdap: Substitute a one-time dose of Tdap for a Td booster - once after age 18
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Chickenpox (varicella)
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All adults ages 19 to 49 and who lack evidence of immunity (no documentation of prior infection or vaccinations)
Pregnant women should be assessed for evidence of immunity.
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Two doses. The second dose should be administered four to eight weeks after the first dose.
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Measles, mumps, rubella (MMR)
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All adults ages 19 to 49 and who lack evidence of immunity (no documentation of prior infection or vaccinations)
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One or two doses
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Flu vaccine (seasonal)
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People at risk***
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Yearly
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Hepatitis A vaccine
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People at risk***
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Two doses
Schedule:
Zero and 6 to 12 months (Havrix), OR
Zero and 6 to 18 months schedule (Vaqta)
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Hepatitis B vaccine
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People at risk***
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Three doses. The second dose should be administered one month after the first dose; the third dose should be administered at least two months after the second dose (and at least four months after the first dose).
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Meningococcal
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People at risk***
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One or more doses
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Pneumococcal (polysaccharide)
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People at risk***
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One or two doses
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* Recommendation from the American Cancer Society (ACS). Currently, the U.S. Preventive Services Task Force (USPSTF) recommends screening every two years for women ages 50 to 74. The ACS recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them. The ACS also recommends annual clinical breast exams (CBEs) for women ages 40 and older. The USPSTF, however, believes there is not enough evidence to assess the value of CBEs for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.
** Women 30 and older who have had three consecutive negative Pap tests may be screened every three years, according to recommendations from the American Congress of Obstetricians and Gynecologists.
