4 Critical Tests for Women Over 40

Dr. Mimi Secor DNP, FNP-BC, FAANP, FAAN, is a board-certified Nurse Practitioner specializing in Women’s Health for over 40 years. She is a sought-after national speaker and consultant has been featured in numerous local and national media outlets. Dr. Mimi is also a fitness and health advocate, and is passionate about helping women to lose weight and feel great, and is the #1 international bestselling author of Debut a New You: Transforming Your Life At Any Age.

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Critical Test for Women Over 40:

There are certain routine screening tests that all women over the age 40 should be sure to schedule according to medical experts. These tests are critical because when it comes to deadly diseases, early detection saves lives. Here are 4 routine screening tests:

Mammograms

For average-risk women, the American Cancer Society (ACS) recommends mammography screening begin at age 45 and be repeated every year until age 55, then every 2 years. Mammography is the recommended screening test for breast cancer so it is very important that women follow the ACS guidelines. Women who are at high risk should be referred to a breast expert or breast center for management. 1 in 8 women will develop breast cancer in their lives, and by age 50 the risk is approximately 1 in 50 women. This is a real threat to women and why life-saving mammography is so important.

Pelvic Exam and Pap Tests

Cervical cancer screening is recommended by multiple organizations (ACS, American College of Obstetricians and Gynecologists (ACOG), and the American Society of Colposcopists and Pathologists (ASCCP). In 2020 the ACS issued new guidelines recommending screening begin at age 25 and be repeated every 5 years (if tests are negative) through the age of 65. They also recommend the previous recommendations be phased out, including screening from ages 21-24. The yearly pelvic exam is no longer recommended by all organizations. ACOG still recommends a yearly pelvic exam, but other organizations, notably the United States Preventative Task Force (USPTF) recommends only if the woman is symptomatic or there is an indication to perform a pelvic exam; such as the suspicion of uterine cancer (abnormal vaginal bleeding), fibroids, polyps, STIs, vaginitis, or other conditions/problems. This is a significant departure from previous guidelines over many decades recommending yearly pelvic exams and Pap smear/cervical cancer screening tests.

The pelvic exam evaluates the vulva, vagina, cervix, uterus, ovaries, and sometimes the rectum (optional based on need determined by the clinician). The Pap test is a cervical cancer screening test. The newer screening test, hrHPV, checks for high-risk (hr) subtypes of the human papillomavirus (HPV) (most notably 16, 18), which are both linked to cervical cancer.

Colorectal Cancer

Approximately 18,000 people are diagnosed with colorectal cancer each year. The NEW 2020 guidelines (for low-risk individuals) recommend the first colonoscopy at 45 years of age. The previous recommendation was for 50 years old. After screening at 45, (if the test is negative) colonoscopy should be repeated every 10 years or a stool-based test should be performed every one to three years, depending on the test. If the first test is positive then the follow-up guidelines are individualized based on the diagnosis/management and clinician’s follow-up recommendations.

 Hormonal Tests

According to the North American Menopause Society (NAMS) (menopause.org), hormonal tests are not recommended to diagnose menopause except for very specific situations. This is the same for women over 40 years old. Hormone tests are expensive and often not helpful in determining the medical problem a woman in her 40s is experiencing. Pregnancy tests should be done if a woman has missed her period and/or has a history of unprotected sex or noncompliance with their contraceptive method or not using a contraceptive. Of note, hormone tests may be recommended in a woman under 50 if early menopause is suspected. Symptoms may include stopping periods for 6 months or longer and/or vasomotor symptoms of hot flashes and/or night sweats. Women should consult with their clinician (primary care or OB-GYN) if they are concerned about this possibility.