Here’s my holiday to-do list: Schedule a Pap smear. Schedule a bone scan. Schedule a colonoscopy. These are just some of the medical screening tests and checkups that I put off because of the pandemic. As my doctor told me, “You need to get back on track. Pronto.”
I’m not the only one. More than 40 percent of Americans skipped medical care from March through mid-July 2020, according to a study published in 2021 in JAMA Network Open. Many of us (including me) put it off even longer. The National Cancer Institute reported 9.4. million cancer screening tests skipped in 2020, with fewer patients coming in for tests through June 2021, according to a recent study reported in the journal Cancer.
For women ages 50 to 75, resuming preventive screening is especially important to catch problems early, said Caroline Goldzweig, M.D., an internist and the chief medical officer of the Cedars-Sinai Medical Network in California. “Screening tests that check for problems before symptoms develop can make a big difference in treatment and long-term survival. Once symptoms develop, our ability to reverse things becomes harder.”
Older adults, in particular, had their health care disrupted. A 2022 national survey by the University of Michigan and AARP found that 1 in 3 adults age 50-plus had put off seeing their doctor or dentist or had postponed or cancelled a medical procedure or operation, due to the pandemic.
I asked Goldzweig to list the most important screening tests older women need to get done. She recommended four that should get top priority, plus two more you might not expect, including a new screening recently announced.
- Breast cancer screening
The risk of breast cancer increases with age — most breast cancers are found in women 50 or older, so regular screening is important for catching it early when it’s easier to treat.
How often do I need it?
It depends on whom you ask — either once a year or every two years. The American Cancer Society says women age 55-plus at average risk can have them once a year or every two years, while the U.S. Preventive Services Task Force (USPSTF), an influential advisory panel of health experts appointed by the federal government, recommends every two years for women ages 50 to 74, but offers no suggestions for those over 75. If you’re at a higher risk for breast cancer, talk to your health care provider, who may recommend more frequent screening or other breast-imaging methods, such as ultrasound or MRI.
When can I safely stop?
If you’re 75 or older and at average risk, discuss with your doctor about how long to continue to have mammograms.
- Bone scan for osteoporosis
Keeping bones healthy is crucial as women age. Osteoporosis causes bones to weaken and become brittle and more likely to break, and these kinds of fractures occur most often in older women. Hip fractures, in particular, can result in loss of independence, pain and even death. One in 3 adults 50 and older die within a year of a hip fracture, according to a study of nearly 123,000 older adults published in 2017 in the Journal of Internal Medicine.
How often do I need it?
The preventive services panel recommends regular screening for osteoporosis — typically, every two years — for women under age 65 who are at high risk for fracture, as well as for all women 65 and older
- Cervical cancer screening
A Pap test is the traditional test for cervical cancer. It detects cancer and precancerous changes in the cervix, the narrow canal that connects the uterus and the vagina. A Pap test is often done along with screening for the human papillomavirus (HPV), a sexually transmitted virus that can cause cervical cancer.
How often do I need it?
Women ages 30 to 65 at average risk for cancer should have a Pap test done every three years with HPV screening every five years, according to the most recent medical guidelines from the American College of Obstetricians and Gynecologists.
When can I safely stop?
If you had a total hysterectomy, including removal of the cervix, and have no history of cervical cancer or precancerous lesions, testing can stop. If you are older than 65 with no history of cervical cancer and have had three Pap tests in a row that didn’t find cancer in the past 10 years, you may be able to stop screening. Talk to your doctor.
- Colon cancer screening
There are basically two kinds of colon cancer screening tests: Visual tests, like a colonoscopy and others, that use a long, flexible tube with a tiny camera to check the inside wall of the colon for cancer or precancerous growths (polyps), and stool-based tests that check a feces sample for signs of blood or abnormal cell changes. “If you’re worried about having a colonoscopy and keep putting it off, talk to your doctor about doing a stool-based test instead. Doing something is better than doing nothing,” advised Goldzweig.
How often do I need it?
The American Cancer Society now recommends regular colon screening from ages 45 to 75. If your colonoscopy doesn’t find any signs of cancer, your doctor may recommend screening every 10 years. More frequent screening may be necessary if you have a family history of colon cancer or your colonoscopy detects polyps. If you choose a stool-based test, some types may need to be done annually.
When can I stop?
For those ages 76 to 85, talk to your doctor about how often to be screened. It will depend on prior screening history and overall health. People over 85 no longer need to get colon cancer screening.
- Screening for anxiety
For the first time, the USPSTF is proposing that adults 64 and younger get screened for anxiety. The announcement, which came in September, acknowledges the stress and anxiety of the past few years, including the toll on mental health from the pandemic. Those 65 and older weren’t included in the recommendation — the panel said there was insufficient research about anxiety screening in adults age 65-plus — but the panel did repeat an earlier recommendation that adults of all ages undergo routine screening for depression. “Our emotional well-being affects our physical well-being,” said Goldzweig. “It’s important for doctors to know how well we’re coping or whether we’ve developed unhealthy habits to deal with the recent stress.”
- Screening for metabolic health: blood pressure, cholesterol, blood glucose and weight
Since our bodies change overall after menopause, having regular medical checkups becomes increasingly important. Screenings monitor blood pressure, sugar levels, cholesterol and other lifestyle factors that contribute to stroke and heart disease.
Here’s to giving yourself the gift of good health as we turn the corner on a new year!
